The California Syndrome: Functional Visual Complaints with Potential Economic Impact

The records of 84 patients with functional visual loss (59 adults and 25 children) were reviewed over a six-year period. The patients were between 7 and 69 years of age. In the young patients, psychosocial problems relating to parental divorce, poor school performance and attention-getting behavior were common, while in adult patients, financial gain was present in 51 of 59 (86%) individuals. Over 90% of the claimed abnormalities related to the afferent visual system. Fifty-three percent of the patients had underlying organic problems with functional overlay. Inconsistent test results were the most reliable means of identifying the malingering patients. In California, both ophthalmologists and optometrists are able to declare a patient legally blind as well as visually disabled for the purpose of income tax, workers' compensation, and disability benefits. The potential financial impact of malingering patients is discussed.