| ORIGINAL ARTICLE |
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| Year : 2009 | Volume
: 57
| Issue : 5 | Page : 365-370 |
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Retinal nerve fiber layer thickness analysis in suspected malingerers with optic disc temporal pallor
Mustafa Civelekler, Ismail Halili, Fatih C Gundogan, Gungor Sobaci
Department of Ophthalmology, Gulhane Military Medical Academy, Ankara, Turkey
Correspondence Address:
Gungor Sobaci
Gulhane Askeri Tip Akademisi, Goz Hastaliklari A.D, 06018 Etlik-Ankara
Turkey
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0301-4738.55077
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Purpose: To investigate the value of temporal retinal nerve fiber layer (RNFL temporal ) thickness in the prediction of malingering.
Materials and Methods: This prospective, cross-sectional study was conducted on 33 military conscripts with optic disc temporal pallor (ODTP) and 33 age-and sex-matched healthy controls. Initial visual acuity (VA i ) and visual acuity after simulation examination techniques (VA aset ) were assessed. The subjects whose VA aset were two or more lines higher than VA i were determined as malingerers. Thickness of the peripapillary RNFL was determined with OCT (Stratus OCT™, Carl Zeiss Meditec, Inc.). RNFL temporal thickness of the subjects were categorized into one of the 1+ to 4+ groups according to 50% confidence interval (CI), 25% CI and 5% CI values which were assessed in the control group. The VAs were converted to LogMAR-VAs for statistical comparisons.
Results: A significant difference was found only in the temporal quadrant of RNFL thickness in subjects with ODTP ( P =0.002). Mean LogMAR-VA increased significantly after SETs ( P <0.001). Sensitivity, specificity, positive and negative predictive values of categorized RNFL temporal thickness in diagnosing malingering were 84.6%, 75.0%, 68.8%, 88.2%, respectively. ROC curve showed that RNFL temporal thickness of 67.5 µm is a significant cut-off point in determining malingering ( P =0.001, area under the curve:0.862). The correlations between LogMAR-VAs and RNFL temporal thicknesses were significant; the correlation coefficient for LogMAR-VA i was lower than the correlation for LogMAR-VA aset (r=-0.447, P =0.009 for LogMAR-VA i ; r=-0.676, P <0.001 for LogMAR-VA aset ).
Conclusions: RNFL temporal thickness assessment may be a valuable tool in determining malingering in subjects with ODTP objectively. |
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