The value of the ophthalmological independent medical examination: analysis of 344 cases.
OBJECTIVE
The aim of the study was to assess the value of the ophthalmological independent medical examination (IME) for detecting malingering, exaggerated or feigned symptoms, and incorrect causal relationship.


METHODS
Retrospective observational cohort study.


METHODS
Consecutive examinees (n = 344) who underwent an IME by a single examiner between 1998 and 2005 in the setting of an ophthalmological group practice were included in the study. Diagnoses were made to at least a degree of medical certainty. Main outcome measures were frequency of exaggerated, feigned and non-causally related pathology and symptoms.


RESULTS
In 172 claimants (50%), the symptoms and pathology claimed were fully substantiated. The other 172 claimants were found to have either exaggerated or totally feigned symptoms and/or symptoms and pathology misattributed (non-causally related to the claimed accident or incident). The most frequent feigned/exaggerated symptoms were visual loss (74%), ocular pain/discomfort (28%), visual field loss (19%), headaches (17%) and photophobia (13%). Visual field loss and the symptoms of ocular discomfort, headaches, dizziness and epiphora were more frequent in the feigning group (p<0.01). In contrast, complaints of swelling and deformity were more frequent (p = 0.001) among the examinees with real pathology. Review of the medical records provided helpful information in 163/172 cases in the feigning group.


CONCLUSIONS
An ophthalmological IME is useful for detecting malingering, as well as symptoms and pathology not causally related to a claimed accident or injury or actually pre-existent to a claimed date. The advantages of an IME compared with relying on treating-doctor records, clues for diagnosing feigning and incorrect causal relationship, and guidelines for performing an ophthalmological IME are discussed.
Schutz
J S
JS
Ophthalmology Service, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland. js485squid@yahoo.com
Mavrakanas
N A
NA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D035881:Compensation and Redress; D003299:Cooperative Behavior; D003941:Diagnostic Techniques, Ophthalmological; D004185:Disability Evaluation; D005104:Expert Testimony; D005128:Eye Diseases / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008306:Malingering / Q000175:diagnosis*; D008499:Medical Records; D008875:Middle Aged; D012189:Retrospective Studies; D014786:Vision Disorders / Q000175:diagnosis / Q000209:etiology / Q000523:psychology; D014942:Workers' Compensation; D055815:Young Adult