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A method for identifying color vision deficiency malingering

  • Neurophthalmology
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To propose a new test to identify color vision deficiency malingering.

Methods

An online survey was distributed to 130 truly color vision deficient participants and 160 participants willing to simulate color vision deficiency. The survey contained three sets of six color-adjusted versions of the standard Ishihara color plates each, as well as one set of six control plates. The plates that best discriminated both participant groups were selected for a “balanced” test emphasizing both sensitivity and specificity. A “specific” test that prioritized high specificity was also created by selecting from these plates. Statistical measures of the test (sensitivity, specificity, and Youden index) were assessed at each possible cut-off threshold, and a receiver operating characteristic (ROC) function with its area under the curve (AUC) charted.

Results

The redshift plate set was identified as having the highest difference of means between groups (−58%, CI: −64 to −52%), as well as the widest gap between group modes. Statistical measures of the “balanced” test show an optimal cut-off of at least two incorrectly identified plates to suggest malingering (Youden index: 0.773, sensitivity: 83.3%, specificity: 94.0%, AUC of ROC 0.918). The “specific” test was able to identify color vision deficiency simulators with a specificity of 100% when using a cut-off of at least two incorrectly identified plates (Youden index 0.599, sensitivity 59.9%, specificity 100%, AUC of ROC 0.881).

Conclusions

Our proposed test for identifying color vision deficiency malingering demonstrates a high degree of reliability with AUCs of 0.918 and 0.881 for the “balanced” and “specific” tests, respectively. A cut-off threshold of at least two missed plates on the “specific” test was able to identify color vision deficiency simulators with 100% specificity.

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Authors and Affiliations

  1. Yale Department of Ophthalmology & Visual Science, Temple Medical Center, 3rd Floor 40 Temple St., New Haven, CT, 06510, USA

    Andrew Pouw

  2. Doheny Eye Institute, University of California Los Angeles, Los Angeles, CA, 90031, USA

    Rustum Karanjia & Alfredo Sadun

Authors
  1. Andrew Pouw
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  2. Rustum Karanjia
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  3. Alfredo Sadun
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Corresponding author

Correspondence to Andrew Pouw.

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Funding

No funding was received for this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Pouw, A., Karanjia, R. & Sadun, A. A method for identifying color vision deficiency malingering. Graefes Arch Clin Exp Ophthalmol 255, 613–618 (2017). https://doi.org/10.1007/s00417-016-3570-0

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  • DOI: https://doi.org/10.1007/s00417-016-3570-0

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