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Nov 2011

Colobomas and Amblyopia—Reply

Author Affiliations

Author Affiliations: Department of Ophthalmology, Mayo Clinic (Dr Mohney), and Mayo Clinic College of Medicine (Ms Nakamura), Rochester, Minnesota.

Arch Ophthalmol. 2011;129(11):1505-1506. doi:10.1001/archophthalmol.2011.325

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.13 Although difficult to diagnose, this form of amblyopia becomes evident with an improvement in visual acuity after a trial of occlusion.13 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.

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