Advertisement

Tests for Simulation of Monocular Blindness

  • Robert Enzenauer
  • William Morris
  • Thomas O’Donnell
  • Jill Montrey
Chapter

Abstract

An examiner can evaluate monocular blindness with many of the tests for binocular blindness performed with the good eye covered. There are also many tests for monocular blindness that depend upon both eyes remaining open. The examiner uses refractive dexterity, colored lenses and charts, and other maneuvers to create situations where the patient believes he is reporting on findings seen by his good eye when those findings can only be seen by a “seeing” bad eye. In addition, if a patient has high scores on Titmus Stereoacuity testing, the scores not only prove the presence of binocular vision but also correlate with definitive levels of Snellen visual acuity. Another method to demonstrate the presence of vision in the bad eye is to perform a bilateral visual field test using the Goldmann Perimeter. The functional patient’s guesses as to what a patient with true monocular blindness should see do not account for the normal overlap of the nasal visual fields and the resulting cover of the physiologic blind spot by that crossing portion of the visual field.

Keywords

Monocular blindness Induced diplopia Maddox rod tests Prism reading test Refractive dexterity Colored lenses and charts Stereopsis tests Binocular visual field exam Tunnel vision Constricted visual field Fogging test Crossed cylinder test Worth 4 dot test 

Supplementary material

Video 9.1

Objective fixation_1 (MOV 139809 kb)

Video 9.2

Objective fixation_2 (MOV 139809 kb)

Video 9.3

Objective fixation_3 (MOV 140648 kb)

Video 9.4

Induced diplopia (MOV 261614 kb)

Video 9.5

Prism reading test (MOV 351557 kb)

Video 9.6

Fogging tests (MOV 173527 kb)

Video 9.7

Polarized lenses (MOV 210362 kb)

Video 9.8

Worth 4-dot test (MOV 173527 kb)

Video 9.9

“FRIEND” card (MOV 204724 kb)

Video 9.10

Goldman visual fields_1 (MOV 372270 kb)

Video 9.11

Goldman visual fields_2 (MOV 372270 kb)

References

  1. Agatston H (1944) Ocular malingering. Archives of Ophthalmology 31:223–232CrossRefGoogle Scholar
  2. Bailey P (1918) Malingering in U.S. troops, Home Forces, 1917 (Concluded). Military Surgeon 42(4):427–449Google Scholar
  3. Baudry S (1900) Simulated blindness. In: Norris WF, Oliver CA (eds) System of diseases of the eye by American, British, Dutch, French, German, and Spanish authors, vol IV. J.B. Lippincott Company, Philadelphia and London, pp 861–905Google Scholar
  4. Beaumont WM (1918) Chapter XIX. Malingering in relation to sight. In: Jones AB, Llewellyn LJ (eds) Malingering or the simulation of disease. P. Blakiston Son & Co., Philadelphia, PA, pp 324–415Google Scholar
  5. Bruce BB, Newman NJ (2010) Functional visual loss. Neurologic Clinics 28(3):789–802. doi: 10.1016/j.ncl.2010.03.012 PubMedCentralPubMedCrossRefGoogle Scholar
  6. De Schweinitz GE (1916) Diseases of the eye: A handbook of ophthalmic practice for students and practitioners, 8th edn. W.B. Saunders Company, Philadelphia and LondonGoogle Scholar
  7. Donzis PB, Rappazzo JA, Burde RM, Gordon M (1983) Effect of binocular variations of Snellen’s visual acuity on Titmus stereoacuity. Archives of Ophthalmology 101:930–932PubMedCrossRefGoogle Scholar
  8. Duke-Elder S, Abrams D (1970) Malingering (Chapter XI). In: Duke-Elder S (ed) Ophthalmic optics and refraction, vol V. The C.V. Mosby Co., St. Louis, MO, pp 487–501Google Scholar
  9. Enzenauer, R., & CO (n.d.). University of. Personal experience.Google Scholar
  10. Fish RH (1988) Chapter 15. Hysteria and malingering. In: Bajandas FJ, Kline LB (eds) Neuro-ophthalmology review manual, 3rd edn. SLACK Inc., Thorofare, NJ, pp 163–174Google Scholar
  11. Fricke TR, Siderov J (1997) Stereopsis, stereotests, and their relation to vision screening and clinical practice. Clinical and Experimental Optometry 80(5):165–172. doi: 10.1111/j.1444-0938.1997.tb04876.x CrossRefGoogle Scholar
  12. Hamilton AM (1883) Chapter III. Hysteroid conditions and feigned diseases. In: Hamilton AM (ed) A manual of medical jurisprudence with special reference to diseases and injuries of the nervous system. Bermingham & Company, New York and London, pp 170–220Google Scholar
  13. Harlan GC (1885) Hysterical affections of the eye. Philadelphia Medical Times XV:642–644Google Scholar
  14. Janet, P. (1907). Thr troubles of vision. In The major symptoms of hysteria: Fifteen lectures given in the Medical school of Harvard university (pp. 182–207). New York: The Macmillan Company.Google Scholar
  15. Kleckner JF (1952) Malingering in relation to visual acuity: A review. American Journal of Ophthalmology 35(1):47–61PubMedCrossRefGoogle Scholar
  16. Kramer KK, La Piana FG, Appleton B (1979) Ocular malingering and hysteria: Diagnosis and management. Survey of Ophthalmology 24(2):89–96PubMedCrossRefGoogle Scholar
  17. Levy NS, Glick EB (1974) Stereoscopic perception and Snellen visual acuity. Archives of Ophthalmology 78:722–724Google Scholar
  18. Longmore T (1885) The optical manual, or handbook of instructions for the guidance of surgeons in testing the range and quality of vision of recruits and others seeking employment in the military service of Great Britain, and in distinguishing and dealing with Optical Defe, 3rd edn. Superintendence of Her Majesty’s Stationary Office, London, UKGoogle Scholar
  19. Lytton H (1942) Neutralizing cylinder glasses as a test for malingering. The British Journal of Ophthalmology 56:512–513CrossRefGoogle Scholar
  20. McAuley AG (1923) The ocular malingerer. Canadian Medical Association Journal 13(12):903–906PubMedCentralPubMedGoogle Scholar
  21. McLean AJ (1937) Practical perimetry: Construction and operation of the tangent screen. Canadian Medical Association Journal 36(6):578–583PubMedCentralPubMedGoogle Scholar
  22. Miller BW (1973) A review of practical tests for ocular malingering and hysteria. Survey of Ophthalmology 17(4):241–246PubMedGoogle Scholar
  23. Minor JL (1893) New colored letter tests for simulated monocular blindness. Archives of Ophthalmology 22(4):493–495Google Scholar
  24. Mukherjee PK (2006) Clinical examination in ophthalmology. Elsevier, India, p 400Google Scholar
  25. Nuzzi R, Piat LC (1994) Outpatient tests for visual acuity evaluation in malingerers: A review and personal experience. Annals of Ophthalmology 26:175–182Google Scholar
  26. Ophthalmology American Academy of. (n.d.). Dissimilar Image Tests. ONE Network. Retrieved March 27, 2014, from http://one.aao.org/bcscsnippetdetail.aspx?id=c964238e-4121-4346-90e2-043186bb1869
  27. Snell AC (1940) Treatise on medico-legal ophthalmology. St C.V. Mosby, Co., Louis, MOGoogle Scholar
  28. Spector RH (1990) Visual fields. In: Walker H, Hall W, Hurst J (eds) Clinical methods: The history, physical, and laboratory examinations, 3rd edn. Butterworths, A Division of Reed Publishing, Boston, MAGoogle Scholar
  29. Taylor D (1990) Non-organic ocular disorders. Chapter 33. In: Taylor D (ed) Pediatric ophthalmology. Blackwell Scientific Pub., Inc., Cambridge, MA, pp 517–524Google Scholar
  30. Theodor LH, Mandelcorn MS (1973) Hysterical blindness, a case report and study using a modern psychophysical technique. Canadian Journal of Ophthalmology 8(2):353–355PubMedGoogle Scholar
  31. Thompson HS (1985) Functional visual loss. American Journal of Ophthalmology 100(1):209–213PubMedCrossRefGoogle Scholar
  32. U.S. Army, O. of the S. G. (1918) Malingering in U.S. troops, home forces, 1917 (Introduction). The Military Surgeon: Journal of the Association of Military Surgeons of the United States 42(3):261–275Google Scholar
  33. Von Noorden, G. K., & Campos, E. C. (2001). Examination of the patient-V: Depth perception. In G. K. Von Noorden & E. C. Campos (Eds.), Binocular vision and ocular motility: Theory and management of strabismus (6th ed., pp. 298–307). St. Louis: Mosby.Google Scholar
  34. Walsh and Hoyt’s Clinical Neuro-Ophthalmology □:: EHSL—Walsh and Hoyt Textbook. (n.d.). Retrieved March 02, 2014, from http://content.lib.utah.edu/cdm/ref/collection/ehsl-wht/id/76
  35. Walsh, F. B., & Hoyt, W. F. (1969). In F. B. Walsh & W. F. Hoyt (Eds.), Clinical neuro-ophthalmology (3rd ed.). Baltimore: Williams & Wilkins.Google Scholar
  36. Wetzel JO (1943) Malingering tests. American Journal of Ophthalmology 26:577–586CrossRefGoogle Scholar
  37. Wright, K. (2003). Sensory aspects of strabismus. In K. Wright & J. P. Spiegel (Eds.), Pediatric ophthalmology and strabismus (2nd ed., pp. 172–188). New York: Springer Verlag.CrossRefGoogle Scholar
  38. Yasuna ER (1963) Hysterical amblyopia in children. American Journal of Diseases of Children 106:558–563PubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Robert Enzenauer
    • 1
  • William Morris
    • 2
  • Thomas O’Donnell
    • 2
  • Jill Montrey
    • 3
  1. 1.Department of OphthalmologyUniversity of ColoradoAuroraUSA
  2. 2.Department of OphthalmologyUniversity of TennesseeMemphisUSA
  3. 3.DenverUSA

Personalised recommendations