Peter Swann


A 12 year old white male was examined by the authors because of a worsening, bilateral, unexplained vision loss. His eye problems first became apparent 3 years ago when a School Health examination disclosed visual acuities of R 20/30, L 20/30. An optometrist examined the child and diagnosed amblyopia. There followed a long series of optometric, ophthalmological and psychiatric investigations. An ophthalmologist labelled the patient an "unintentional malingerer" whereas the psychiatrist stated that he was completely normal. Our examination revealed visual acuities or R 20/60, L 20/60. Pinhole, however, gave no improvement. His anterior segments, intraocular pressure, confrontation fields and binocular vision were normal. Pupils showed no afferent defects. Amsler grid testing gave equivocal results and colour vision investigation indicated an acquired defect. Ophthalmoscopy revealed a granular, pigmentary disturbance at each macula. Fluorescein angiography showed central RPE defects and a probable diagnosis of Stargardt's disease was made. The diagnosis of malingering was dismissed! Stargardt's disease should always be considered in any child who presents with a bilateral, symmetrical, vision loss. In this case, however, previous examinations were inadequate and the diagnosis of malingering was unfortunate, based on spurious evidence and caused great distress to the family. This case illustrates the need for a careful, complete evaluation of such patients before any conclusions are drawn.


Year: 1992

Program Number: Poster 35

Author Affiliation: n/a

Co-Authors: Dr. Bruce, Aphrodite Livanes

Co-Author Affiliation: n/a

Room: Great Hall