Systematic review demonstrates high diagnostic accuracy of objective tests for ocular malingering, indicating strong utility for clinical and medico-legal visual assessments.
Key Points
To evaluate the diagnostic accuracy of objective testing modalities, including visual evoked potentials, pupillometry, and eye-tracking, in identifying fabricated visual impairment.
Conducted a systematic review following PRISMA guidelines across PubMed, Web of Science, Scopus, EMBASE, and Cochrane Library through June 2025.
Extracted diagnostic accuracy metrics and evaluated risk of bias using QUADAS-2 across 10 included studies published between 1993 and 2017 (sample sizes N=20 to N=222).
Visual evoked potentials (VEP) were the most evaluated tool and demonstrated high sensitivity across studies, with pattern-reversal VEP effective in adults and military conscripts, and step VEP achieving 100% specificity in pediatric cohorts.
Pupillometry and specialized color vision testing modalities achieved sensitivity and specificity rates ranging from 80% to 94%.
Most studies displayed a low risk of bias regarding index tests and reference standards, although methodological heterogeneity limits broad generalizability.