Limitations and disadvantages of methods of proving simulation or aggravation of symptoms

Acute prechiasmatic optic nerve lesions without any pathology of the eye must be differentiated from visual disturbances of neurotic origin and malingering. The limitations and disadvantages of a number of methods for verifying central vision reduction are described, including registration of the visual evoked cortical potential (VECP), and of optokinetic nystagmus, and the swinging flashlight test. The significance of color sense examinations and the use of Thibaudet's charts are pointed out where visual disturbances of neurotic origin and malingering are suspected. Various possibilities should be considered if the results of the various simulation tests are contradictory.