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Colobomas and Amblyopia—Reply

Colobomas and Amblyopia—Reply In reply We appreciate the comments of Dr Lempert and his advocacy for the use of accurate nomenclature in scientific discourse. We also agree with the various definitions of amblyopia as supplied by Dr Lempert, summarized as reduced visual acuity in the absence of a structural ocular abnormality. However, (1) this study was a retrospective review and relied on the diagnoses made by pediatric ophthalmologists, (2) the presence of a coloboma is not mutually exclusive of amblyopia, and (3) strabismus often occurred in these patients, which is itself a risk factor for the development of amblyopia. That is, amblyopia was diagnosed in this retrospective report by pediatric eye specialists and can occur in concert with the vision-degrading effects of a colobomatous defect. Called “functional amblyopia” by some, it is characterized by visual loss superimposed on that caused by organic defects, including coloboma.1-3 Although difficult to diagnose, this form of amblyopia becomes evident with an improvement in visual acuity after a trial of occlusion.1-3 In our study, 4 of the 8 patients treated for a diagnosis of amblyopia demonstrated improvement in visual acuity by the final follow-up examination. Although the results of these 4 patients do not prove that all 8 had amblyopia (eg, the improvement may have been due to maturation alone), they do support the role of patching in children with unilateral or bilateral colobomas. In summary, we believe amblyopia can further limit the visual potential in patients with colobomas or other structural abnormalities, some of whom will demonstrate improved visual acuity with the use of patching. Back to top Article Information Correspondence: Dr Mohney, Department of Ophthalmology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (mohney@mayo.edu). Financial Disclosure: None reported. References 1. Kushner BJ. Functional amblyopia associated with abnormalities of the optic nerve. Arch Ophthalmol. 1984;102(5):683-6856721752PubMedGoogle ScholarCrossref 2. Kushner BJ. Functional amblyopia associated with organic ocular disease. Am J Ophthalmol. 1981;91(1):39-457234928PubMedGoogle Scholar 3. Bradford GM, Kutschke PJ, Scott WE. Results of amblyopia therapy in eyes with unilateral structural abnormalities. Ophthalmology. 1992;99(10):1616-16211454331PubMedGoogle Scholar http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 2011 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archophthalmol.2011.325
Publisher site
See Article on Publisher Site

Abstract

In reply We appreciate the comments of Dr Lempert and his advocacy for the use of accurate nomenclature in scientific discourse. We also agree with the various definitions of amblyopia as supplied by Dr Lempert, summarized as reduced visual acuity in the absence of a structural ocular abnormality. However, (1) this study was a retrospective review and relied on the diagnoses made by pediatric ophthalmologists, (2) the presence of a coloboma is not mutually exclusive of amblyopia, and (3) strabismus often occurred in these patients, which is itself a risk factor for the development of amblyopia. That is, amblyopia was diagnosed in this retrospective report by pediatric eye specialists and can occur in concert with the vision-degrading effects of a colobomatous defect. Called “functional amblyopia” by some, it is characterized by visual loss superimposed on that caused by organic defects, including coloboma.1-3 Although difficult to diagnose, this form of amblyopia becomes evident with an improvement in visual acuity after a trial of occlusion.1-3 In our study, 4 of the 8 patients treated for a diagnosis of amblyopia demonstrated improvement in visual acuity by the final follow-up examination. Although the results of these 4 patients do not prove that all 8 had amblyopia (eg, the improvement may have been due to maturation alone), they do support the role of patching in children with unilateral or bilateral colobomas. In summary, we believe amblyopia can further limit the visual potential in patients with colobomas or other structural abnormalities, some of whom will demonstrate improved visual acuity with the use of patching. Back to top Article Information Correspondence: Dr Mohney, Department of Ophthalmology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (mohney@mayo.edu). Financial Disclosure: None reported. References 1. Kushner BJ. Functional amblyopia associated with abnormalities of the optic nerve. Arch Ophthalmol. 1984;102(5):683-6856721752PubMedGoogle ScholarCrossref 2. Kushner BJ. Functional amblyopia associated with organic ocular disease. Am J Ophthalmol. 1981;91(1):39-457234928PubMedGoogle Scholar 3. Bradford GM, Kutschke PJ, Scott WE. Results of amblyopia therapy in eyes with unilateral structural abnormalities. Ophthalmology. 1992;99(10):1616-16211454331PubMedGoogle Scholar

Journal

Archives of OphthalmologyAmerican Medical Association

Published: Nov 10, 2011

References

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