Purpose: To assess the value of the ophthalmologic independent medical examination (IME) for detecting malingering, exaggerated or feigned symptoms, and incorrect causal relationship.
Design: Retrospective observational cohort study.
Methods: 344 consecutive examinees who underwent an IME by author JSS between 1998 – 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%). The symptoms of ocular discomfort, headaches, dizziness and epiphora were more frequent in the feigning group (p<0.01). In contrast, visual field loss and 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 of the feigning group.
Conclusions: An ophthalmologic IME is useful for detecting malingering as well as symptoms and pathology not causally related to a claimed accident or injury or actually preexistent to a claimed date. The advantages of an IME compared to relying on treating doctor records, clues for diagnosing feigning and incorrect causal relationship, and guidelines for performing an ophthalmologic IME are discussed.