The Non-Malingering Syndrome

Juvenile Bilateral Functional Amblyopia


The following summary describes a vision syndrome which was first published in 1962 by Dr. John Streff and is often called the Streff Syndrome. The syndrome is now recognized internationally. Children who are having learning and/or behavior problems are the ones who most frequently exhibit this vision condition. Usually such children are of above average intelligence. The onset of the vision problem can be quite sudden. It is invariably associated with stress, often accompanied by either physical or psychological trauma. After developing the vision problem, coordination is poorer, learning is labored, and behavior is more erratic and somber.

Due to the lack of general understanding of this condition by eye care professionals, those suffering from the syndrome are often mislabeled as pretending that they have a vision loss for the purpose of trying to get glasses (malingering) or are called visual hysterics.


The syndrome is characterized by decreased visual acuity at both distance and near with both eyes, which is not improved by glasses. Also, there is decreased contrast sensitivity and an inability to "focus in" or "stick to" near visual tasks, all with no observable signs of disease. The harder the person tries to see and to work at near tasks, the worse the condition gets.

Generally, one also sees visual tracking problems, mild eye teaming problems, and severe focusing problems. Such children often lose their place, mix things up, and reverse numbers and letters, even when this had not been a previously observed problem. Preschool children may manifest blinking, head tuck when looking at objects, or an eye turning in or out when under stress. The most common complaint is "trouble seeing." Often the patient is a school-age child or a young teenager, with about 2 to 1 odds of being female.


The Non-Malingering Syndrome is a classic problem of stress. A simple explanation revolves about the understanding of the fight or flight response. When confronted with a stressor, a living organism generally chooses either to fight (to stay involved in the event and to continue to deal with or confront the stressor), or to fly away from the stress to resolve the conflict.

The Non-Malingering Syndrome appears because the individual is conflicted about how to resolve the stress. The conflict in the visual process becomes all consuming and effectively creates a variable blockage in the neural systems that normally handle the processing of the detailed part of our central vision.

Although the problems are many and seem difficult to deal with because regular eyeglasses will not immediately restore clear sight and contrast sensitivity, nearly all cases resolve over a relatively short period of time back to completely normal eyesight, contrast sensitivity and total visual performance with appropriate treatment. While different treatments may give temporary help, long term improvement and results are accomplished with the use of low powered plus lenses and optometric vision therapy. These treatment lenses often do not improve visual acuity immediately. They act on the visual attention mechanism to help to relieve some of the visual stress involved with working at sustained near activities. Over time, this reduction in stress in the visual attention mechanism allows the restoration of normal function. When the appropriate lenses are used at near, positive results can take place quite quickly, but optometric vision therapy is essential to assure potential gains and promote future performance in accordance with the patient's ability level.