HEALTH : Faked Blindness Claims Raise Eyebrows of Ophthalmologists
They arrive at the doctor’s office complaining of severe vision loss, even blindness. But a physician’s examination finds either no problem at all or something far too minor to have resulted in the symptoms described.
Told of that favorable diagnosis, which most people would welcome, these patients grow indignant, even threatening. They get so angry they have even cursed their doctors and stormed out of the examining area.
Their symptoms and behavior are not as peculiar or puzzling as they might seem. These patients exhibit what Dr. John Keltner, an eye specialist at the UC Davis School of Medicine, calls the “California Syndrome.”
Those with this easy-to-identify syndrome often are “feigning for gain”--trying to parlay no symptoms or a few into a fat disability settlement, Keltner says.
Or the patients may be people--children or adults--whose psyches have taken over, producing the conviction their sight is limited, even when it isn’t, say Keltner and Dr. Jerry Donin, a Pomona-based ophthalmology consultant and clinical professor at the USC School of Medicine.
The problem may be far more common than most people--even most doctors--may think, Keltner argues in a newly published medical journal editorial that follows up on a 1985 article in which he coined the term “the California Syndrome.”
Keltner and Donin note that their perceptions may be skewed because they handle only difficult or problem cases referred by other physicians.
But the majority of 137 California Syndrome patients who consulted with him were faking some or all of their symptoms, Keltner reports in the “Archives of Ophthalmology.”
‘Ophthalmic Flakes’
Donin, who handles problem cases referred from states other than California, estimates that 15% of the 500 such patients he examines each year are what he once described in a medical textbook as “ophthalmic flakes”--people, who, for various reasons, complain of symptoms that don’t exist or markedly exaggerate symptoms that do.
Keltner notes that singling out California may be unfair because there is no evidence the behavior is unique to the state. “It’s just a catch phrase,” he says, referring to the name. “I think California maybe has a reputation to be a little more in that direction, but this exists everywhere.”
Keltner’s original study was published in March, 1985, in the journal “Ophthalmology.” He reported then that he had reviewed 84 patients, children and adults.
Disability Claims
He found that 51 of the 59 adults were motivated to claim vision loss by prospects of money settlements through disability or worker compensation programs.
In the 25 children, vision problems were at least partly explained by psychosocial problems related to divorce, poor academic performance or other critical needs for attention.
Of the 84 patients, 53% had what doctors call “functional overlay,” an emotional response to an underlying physical illness. This can lead to an exaggeration or hysterical overreaction to a comparatively minor disorder, and, in the absence of skilled diagnosis, can easily be mistaken for a primary illness.
Officials of California’s worker compensation program say that of 400,344 on-the-job injuries reported in 1987, there were 17,400 eye problems and 88,840 back complaints. State officials have not systematically studied the extent to which deliberate or hysterically motivated feigned conditions occur.
A Small Number
But Keltner argues that “feigning for gain” and use of psychogenic eye complaints to get attention--aspects of the California Syndrome--are more common than many doctors and patients believe. A small number of these patients are devoid of actual symptoms; some try to fake blindness.
To confirm suspicions raised in an initial exam, Keltner says he has been forced to resort to elaborate subterfuges with California Syndrome patients.
He has caught them by setting up office obstacle courses that a truly blind patient could never negotiate. He has gotten patients to react to provocative--even erotic--pictures he flashes to test their claim of severe loss of peripheral vision or blindness in one eye.
“We’re better off than orthopedic surgeons,” he says, noting that back pain is often difficult to confirm by diagnostic means. In contrast, modern ophthalmology has the technology to objectively confirm virtually all vision loss, though some people still try to establish that they can’t see.
“I think it’s going to get worse before it gets better as our society gets even more litigious,” he says of California Syndrome. “You first have to make sure the patient doesn’t have an illness. But when you finally get to that point, how do you handle it? Those people usually don’t enjoy hearing the good news.”
Donin says he tries to offer young patients who have conjured up vision symptoms a graceful way to extricate themselves from a charade that may well have gotten out of their control. He recalls the case of a teen-age girl who came to see him, claiming to be unable to see out of one eye.
‘No Vision Loss’
“By that point, there was enormous reluctance on the part of the child to say, ‘Yes, I really can see,’ but I was able to see for myself objectively within 30 seconds that there was no vision loss,” he says. “I told the mother that I’d seen these kinds of things again and again and I wouldn’t be surprised if the girl woke up one morning in about two weeks and everything was fine again.
“Sure enough. Two weeks later to the day, they went to some healing service and the girl seemed to go into a trance-like state. Then suddenly, it was ‘Hallelujah!’ ”
