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It Is Not Always Amblyopia

From the Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.

Correspondence: Requests for reprints should be addressed to: Carole M. Panton, C.O., O.C.(C.), Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada M5G 1X8; e-mail:carole.panton{at}sickkids.ca

A child is referred because of reduced visual acuity in one or both eyes. This scenario is equally familiar to the ophthalmologist, orthoptist, electrophysiologist, and imaging specialist. Each specialty is looking for markers for disease and / or dysfunction to aid in diagnosis. This paper describes three cases in which strabismic, anisometropic, or nonorganic amblyopia was suspected initially, but proved not to be the underlying cause of reduced vision. The role of visual electrophysiology in assessing retinal and visual pathway function in each case is described and emphasized. To determine the pathologic cause for vision loss these specific scenarios required effective interdisciplinary collaboration and communication. The combined interdisciplinary approach often leads to a diagnosis earlier in the disease process, thus facilitating current or future treatment and / or recovery. As advancing technologies allow more detailed understanding of both function and structure, questions are raised regarding the underlying pathophysiology of eye disease including amblyopia.

Key words: electroretinogram, visual evoked potential, nonorganic vision loss, amblyopia, pediatric