Correspondence Address:
S D Paul
Department of Ophthalmology, Postgraduate Institute of Medical Education & Research, Chandigarh
India

Full Text

It is a common clinical experi­ence that in tropical countries and also in black races macula is more pigmented. In cases having poor vision it becomes a problem whether to implicate that pigmen­tation for poor vision or to label the case as of primary amblyopia, more so if there is added associa­tion of anisometropia in some of these cases. It becomes, then diffi­cult to find out whether such cases fall in the category of primary amblyopia or secondary amblyo­pia.

Paul and Batra [1] pointed out the utility of macular illumination tests in assessing the macular function. In later studies the value of these tests for assessing the macular functions was confirmed

It was also pointed out that with the help of macular illu­mination tests it is possible to differentiate between macular degeneration and healed angios­pastic maculopathies [4],[5] . on the basis of experience gained. An effort is made to differentiate pri­mary and secondary amblyopes with the help of macular illumi­nation tests. The present commu­nication is a study of nine cases of amblyopia.

CASE No. I.

T. S. 13 years male presented with diminished vision left side. He was not sure of the duration.

Vision was OD 6/6 with +0.5D sph.; OS 6/18 with +6.5D sph.

Left eye was anisometropic hypermetropic. Fundus showed macular pigmentation on both sides, left more than right.

In this patient the problem that confronted on clinical examination was to find out whether left eve was amblyopic because of ari­sometropic hypermetropia or whether the macular pigmentation could be implicated in this.

Macular illumination tests showed the case to be of macular degeneration, both the eyes were affected. Thus it became clear that it was a case of secondary amblyopia.

CASE No. II.

HIC 15 years female presented with diminished vision left eye. Vision in R.E. 6/6 L.E. 6/24 with - 4.50D sph. Funds R.E. showed mild pigmentation of the fovea while the left fundus showed a black spot at the fovea which was diagnosed as a macular burn.

In this case L.E. was anisometro­pic myopic. The amblyopia had to be explained either on this basis or on the basis of macular pathology.

Macular illumination tests showed that left eye had angios­pastic maculopathy. In retrespect a doubtful history of having look­ed at an eclipse was forthcoming.

CASE No. III

H.S. 22 year male presented with diminished vision. There was a doubtful history of fogginess of vision a year back that remained for a day.

Vision R.E. 6/6 with - 1.25D sph.

L.E. 6/12 with - 1.OD sph.

Fundi: both fundi were normal.

Macular illumination tests on the basis of the result, it was held that probably he had deve­loped a mild C.S.R. that had com­pletely recovered on the right side, and partially on the left.

CASE No. IV.

H.N. 19 years male, presented with history of poor vision left eye. He observed this accidentally a month back.

Vision R.E. 6/5 with +0.50D sph. L.E. 6/60 with +2.00 D sph. Funds R.E. was Normal, while L.E. showed macular pigmentation with small white spots in between.

The anisometropia in this case was not high enough to explain amblyopia.

Macular illumination tests showed that both eyes were pathological.

The case was labelled as a case of macular degeneration. Right eye showed a sub clinical lesion.

CASE No. V.

H. S. 45 years male, had poor vision R.E. of 1 year duration.

Vision R.E. 6/9 with 1.0 D cyl. 90° L.E. 6/6 with +0.1D sph., 2.50 cyl. 90°.

Fundi: both fundi were normal.

Macular illumination tests: This case was diagnosed as a case of early senile macular degenera­tion.

CASE No. VI.

T.S. 50 years female presented with diminished vision. Vision R.E. 6/9 with +0.5D sph. L.E. 6/60 with ±1.50 with +0.75 cyl. @180˚

Fundus was labelled within nor­mal limits. Macular pigmentation was exaggerated.

Macular illumination tests: This case appears to be a case of macu­lar degeneration as evidenced from R.E. tests, left eye appears to have a very advanced lesion.

CASE No. VII.

T.K. 30 years female presented with diminished vision of uncer­tain duration.

Vision: R.E. 6/18 with ±3.5D sph. and L.E. 6/6 with +0.5D sph.

Fundus showed that RE macula was dull with a small black spot on one side of fovea. Left eye macula, though pigmented it was considered to be within normal limits.

Macular illumination tests: showed that it was not a case of anisometropic amblyopia. Left eye though normal, showed delayed response with red filter. The right eye showed as if he had developed eclipse burn some time back.

CASE no. VIII.

B.K. 20 years female. Complain­ed of slow progressive loss of vision.

Vision.: O.D. 6/6 with +1.OD sph. O.S. 6/12 with + 4.00 sph.

Fundus showed mild macular pigmentation especially on right side. Left macula was labelled as within normal limits.

Macular illumination tests: These showed that she was hav­ing bilatral macular degeneration rather than amblyopia due to ani­sometropia.

CASE No. IX.

PK. 20 years male presented with diminished vision for the last few years.

Vision: R.E. 6/6 with +1.00 sph. L.E. 6/24 with +6.OOD sph.

Fundus showed mild macular pig­mentation. Visual disturbance was thought to be due to anisometropia

Macular illumination tests also showed that macular pigmentation was normal and the case was of primary amblyopia.

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