TY - JOUR T1 - The value of the ophthalmological independent medical examination: analysis of 344 cases JF - British Journal of Ophthalmology JO - Br J Ophthalmol SP - 1371 LP - 1375 DO - 10.1136/bjo.2009.160614 VL - 93 IS - 10 AU - J S Schutz AU - N A Mavrakanas Y1 - 2009/10/01 UR - http://bjo.bmj.com/content/93/10/1371.abstract N2 - Aim: 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.Design: Retrospective observational cohort study.Methods: Consecutive examinees (nā€Š=ā€Š344) 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 (pā€Š=ā€Š0.001) 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. ER -