Organic visual loss measured by kinetic perimetry and retinal electrophysiology in children with functional amblyopia

Abstract

Purpose

To demonstrate an organic (retinal) amblyogenic defect in functional amblyopes not responding to treatment.

Methods

Twenty-four children (Mean age: 5.9 ± 1.8 years; range: 4–10 years) with functional amblyopia were recruited for this study. All these children underwent complete ophthalmic and orthoptic evaluation. In addition, Kinetic Goldman Visual Fields (KGVF), Spectral Domain Optical Coherence Tomography (SD-OCT), full field flash electroretinograms (ffERG) and multifocal electroretinograms (mfERG) were also performed. Ratios were subsequently derived by comparing the amplitudes obtained from the amblyopic eye (AE) to the good eye (GE) for the a- and b-waves of the ffERG, as well as for the ring analysis of the mfERG.

Results

KGVF showed a central scotoma of varying size (3°–7°) and density (absolute to relative), with increasing target size in 14/24 patients whose best post-treatment vision in the AE ranged from 20/100 to 20/40. The scotoma decreased in size and density with improving vision until a plateau of recovery was reached. The remaining 10/24 patients with a vision ≥ 20/30 showed no scotoma. SD-OCT showed no significant difference between the AE and GE. ffERG and mfERG were obtained in 18/24 patients. The ffERG AE/GE ratio was abnormal in 7 patients, 5 of which had large scotomas on KGVF. The mfERG ring 1 AE/GE ratio was significantly (p < .05) attenuated in 9/18 patients out of which 3 were no longer amblyopic. However, there was no significant difference (p > .05) in ring 1 AE/GE amplitude ratio between those who achieved 20/50–20/40 (.81 ± .26) and those with ≥ 20/25(.86 ± .25).

Conclusions

The combined findings of central scotoma on KGVF and mfERG anomalies in patients who did not achieve optimal vision with treatment suggest an underlying organic defect impairing macular function.

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Data availability

Not applicable.

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Funding

This study was funded by The Research Institute of the McGill University Health Centre, Montreal Children’s Hospital Foundation New Directions in Research Grant (awarded to ALD, RB, AK and PL).

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Authors

Contributions

Raquel Beneish and Allison L. Dorfman equally contributed to this study and should therefore be considered as equal-first authors. RB contributed to study conception and design, orthoptic evaluations, amblyopia treatment, perimetry, data analysis and manuscript preparation. ALD contributed to full field ERG and multifocal ERG recordings and interpretation, data analysis and manuscript preparation. AK contributed to ophthalmic evaluations and manuscript preparation. RCP contributed to ophthalmic evaluations. PL contributed to data analysis and interpretation, manuscript preparation and revision, final approval and submission.

Corresponding author

Correspondence to Pierre Lachapelle.

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All procedures performed on human participants were done so in accordance with the ethical standards of the Institutional Review Board of the McGill University Health Center and in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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All subjects freely consented to participate in this study, and an informed consent was obtained from all participants (or their parents) included in the study.

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Beneish, R., Dorfman, A.L., Khan, A. et al. Organic visual loss measured by kinetic perimetry and retinal electrophysiology in children with functional amblyopia. Doc Ophthalmol (2021). https://doi.org/10.1007/s10633-020-09811-x

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Keywords

  • Amblyopia
  • Kinetic perimetry
  • Retinal function
  • Electroretinogram
  • Multifocal electroretinogram
  • Human