Skip to main content

Advertisement

SpringerLink
Log in

Evaluation of a visual acuity test using closed Landolt-Cs to determine malingering

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

Abstract

Purpose

To evaluate a visual acuity test (VAT) with unexpected optotypes to detect malingering.

Methods

We tested two groups. Group 1 consisted of 20 individuals with normal best corrected visual acuity (BCVA). Group 2 included participants with ocular diseases and reduced BCVA. All subjects underwent a VAT proposed by Gräf and Roesen to assess suspected malingering. This test used 36 charts with one Landolt-C per page. The first 20 optotypes were Landolt-Cs, while at positions 21, 26, 30, and 34 closed rings were presented. The testing distance was adapted to 50% of the test person’s visual acuity. The test person was requested to name the gap direction of the Landolt-C within 3 s. The complete testing conversation was recorded digitally to determine response latency for each optotype from the audio tracks.

Results

The average response time was 0.46 s in group 1 and 0.45 s in group 2 for the first 20 Landolt-Cs. In both groups the response time was significantly extended (p < 0.05) for the first closed ring compared to the mean of the first 20 Landolt-Cs, (group 1: 2.9 s; group 2: 2.3 s). The following three closed rings had also longer response times. However, these differences were not significant.

Conclusions

Our results suggest that the proposed test may be helpful to evaluate ocular malingering. The testing procedure appeared to be feasible and showed good repeatability. The fast training effect may be a limitation for malingering detection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Kathol RG, Cox TA, Corbett JJ, Thompson HS (1983) Functional visual-loss – follow-up of 42 cases. Arch Ophthalmol 101:729–735

    Article  CAS  PubMed  Google Scholar 

  2. Schutz JS, Mavrakanas NA (2009) The value of the ophthalmological independent medical examination: analysis of 344 cases. Br J Ophthalmol 93:1371–1375. https://doi.org/10.1136/bjo.2009.160614

    Article  CAS  PubMed  Google Scholar 

  3. Roland J, Hirsch U, Heinrich SP, Bach M, Graef M (2010) A stochastic test for validity control of visual acuity statements. Ophthalmologe 107:47–54. https://doi.org/10.1007/s00347-009-1928-y

    Article  CAS  PubMed  Google Scholar 

  4. Kotowski H (1966) New device for the objective determination of visual acuity. Klin Monatsbl Augenheilkd 149:397–401

    CAS  PubMed  Google Scholar 

  5. Teller DY, Morse R, Borton R, Regal D (1974) Visual-acuity for vertical and diagonal gratings in human infants. Vis Res 14:1433–1439. https://doi.org/10.1016/0042-6989(74)90018-2

    Article  CAS  PubMed  Google Scholar 

  6. Wilhelm H, Neitzel J, Wilhelm B, Beuel S, Ludtke H, Kretschmann U, Zrenner E (2000) Pupil perimetry using M-sequence stimulation technique. Invest Ophthalmol Vis Sci 41:1229–1238

    CAS  PubMed  Google Scholar 

  7. Xu S, Meyer D, Yoser S, Mathews D, Elfervig JL (2001) Pattern visual evoked potential in the diagnosis of functional visual loss. Ophthalmology 108:76–80

    Article  CAS  PubMed  Google Scholar 

  8. Graf MH, Roesen J (2001) The airtight Landolt-C - a handy test in the diagnosis of suspected ocular malingering. Klin Monatsbl Augenheilkd 218:435–437. https://doi.org/10.1055/s-2001-16258

    Article  CAS  PubMed  Google Scholar 

  9. Graf MH, Roesen J (2002) Ocular malingering: a surprising visual acuity test. Arch Ophthalmol 120:756–760

    Article  PubMed  Google Scholar 

  10. Wesemann W, Schiefer U, Bach M (2010) New DIN norms for determination of visual acuity. Ophthalmologe 107:821–826

    Article  CAS  PubMed  Google Scholar 

  11. Bach M, Kommerell G (1998) Determining visual acuity using European normal values: scientific principles and possibilities for automatic measurement. Klin Monatsbl Augenheilkd 212:190–195

    Article  CAS  PubMed  Google Scholar 

  12. Loumann Knudsen L (2003) Visual acuity testing in diabetic subjects: the decimal progression chart versus the Freiburg visual acuity test. Graefes Arch Clin Exp Ophthalmol 241(8):615–618

    Article  PubMed  Google Scholar 

Download references

Funding

No funding was received for this research.

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Ernst-Moritz-Arndt University, University Medicine, Greifswald, Germany

    Nils Kröger & Frank Tost

  2. Institute for Community Medicine, Ernst-Moritz-Arndt University, University Medicine, Walter Rathenau Straße 48, D-17475, Greifswald, Germany

    Clemens Jürgens & Thomas Kohlmann

Authors
  1. Nils Kröger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Clemens Jürgens
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas Kohlmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Frank Tost
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Clemens Jürgens.

Ethics declarations

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.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kröger, N., Jürgens, C., Kohlmann, T. et al. Evaluation of a visual acuity test using closed Landolt-Cs to determine malingering. Graefes Arch Clin Exp Ophthalmol 255, 2459–2465 (2017). https://doi.org/10.1007/s00417-017-3820-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-017-3820-9

Keywords

Search

Navigation