Page 111 - The Indian Optician Digital Edition January-February 2022

and this case should be handled very tactfully,
THERE ARE MANY sensitively and with utmost patience. Also,
CHALLENGES TO BE while testing, the practitioner should be
FACED IN AN very careful to avoid any wrong step that will
disclose the hidden agenda behind conducting
OPHTHALMIC PRACTICE, the test to the patient. Any inadvertent mistake
BUT MALINGERING IS done during the eye examination can warn the
patient beforehand and thereby influence the
TRULY A BIG CHALLENGE test motto.
FOR EVERYONE Occasionally an eye care professional may

come across cases of patients who hope to gain
some advantage by pretending to be visually
 The FRIEND test consists of the letters defective. It is rare for complete blindness
FRIEND printed in alternate green and red to be assumed, and such cases can only be
letters and illuminated from behind. The detected by constant watching of the person’s
patient wearing red and green glasses is behaviour. When one eye is said to be blind, in
asked to read the letters. The red and green spite of absence of sufficient objective evidence
glasses and the red green letters must be to account for the condition, the demonstration
of complementary colour. If he reads all the of malingering resolves itself into a contest
letters he is obviously using both eyes. If he of wits between the practitioner and the
only reads the letters FIN he is using his left individual. Many tests have been devised, and
eye and if he reads only RED he is simply several should be employed in each case.
using his right eye.
It is rare for a patient to stimulate
blindness in both eyes, and such
a condition is more difficult to
select to detect. In some cases
malingering is suspected when
there is an absence of agreement
in the result of the functional and
objective examination of the eyes,
contradictory statements regarding
the different steps in the functional
examination, and brisk reaction of
the pupils to light in cases of absolute
blindness, the lesion in such cases being
situated in the visual cortex or in the visual
tract between the lateral geniculate
bodies and the visual cortex. SYNOPTOPHORE

Summary: Indeed, there are
many challenges to be faced in an
ophthalmic practice, but malingering is
truly a big challenge for everyone. It creates
apprehensions for both the practitioner
and the guardian accompanying the
patient. Sometimes it looks like an ocular
emergency in which the patient complains
of loss of eye vision in either one or sometimes
both eyes. It is a very problematic condition

107 | MALINGERING