Indian Journal of Ophthalmology

: 1971  |  Volume : 19  |  Issue : 3  |  Page : 112--116

Macular illumination tests in amblyopia

SD Paul, Kapalmit Singh 
 Department of Ophthalmology, Postgraduate Institute of Medical Education & Research, Chandigarh, India

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

How to cite this article:
Paul S D, Singh K. Macular illumination tests in amblyopia.Indian J Ophthalmol 1971;19:112-116

How to cite this URL:
Paul S D, Singh K. Macular illumination tests in amblyopia. Indian J Ophthalmol [serial online] 1971 [cited 2021 Apr 16 ];19:112-116
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Full Text

It is a common clinical experi苟nce 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 pigmen負ation for poor vision or to label the case as of primary amblyopia, more so if there is added associa負ion of anisometropia in some of these cases. It becomes, then diffi苞ult to find out whether such cases fall in the category of primary amblyopia or secondary amblyo計ia.

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 illu衫ination tests it is possible to differentiate between macular degeneration and healed angios計astic maculopathies [4],[5] . on the basis of experience gained. An effort is made to differentiate pri衫ary and secondary amblyopes with the help of macular illumi要ation tests. The present commu要ication is a study of nine cases of amblyopia.


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 ari貞ometropic 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.


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 anisometro計ic 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 angios計astic maculopathy. In retrespect a doubtful history of having look苟d at an eclipse was forthcoming.


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 deve衍oped a mild C.S.R. that had com計letely recovered on the right side, and partially on the left.


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.


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 degenera負ion.


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 nor衫al limits. Macular pigmentation was exaggerated.

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


T.K. 30 years female presented with diminished vision of uncer負ain 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.


B.K. 20 years female. Complain苟d 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 hav虹ng bilatral macular degeneration rather than amblyopia due to ani貞ometropia.


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 pig衫entation. 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.


Apart from clinical assessment the authors could not find men負ion of any other technique in ophthalmic literature by which distinction between primary and secondary amblyopia could be elu苞idated. It may be recalled here that the sphere of physiological苞um-morphological correlation in the ocular fundi overlap the gros貞ly pathological entities noticed. Consequently the grouping of am苑lyopia into primary and secon苓ary varieties may not be quite correct, to say the least. For ex苔mple an anisometrope may have an additional factor of macular pathology leading to amblyopia. The ophthalmoscopic picture and the functional damage to the macula do not go hand in hand. It has, therefore been suggested that the functional status of the macula should be judged by the differential macular illumination tests. It has also been pointed out in subsequent publications that differentiation of various macular lesions can be ventured on the basis of differential macu胡 ar illumination tests with red and green filters.

It has been observed in studies on C.S.R., macular burns and macular regenerations that a defi要ite pattern of recovery is ob貞erved following dazzling of the macula. In early cases of angios計astic maculopathy (C.S.R., solar burns), the recovery time is de衍ayed with red filter more than with green filter, while in the late cases it is the reverse. In cases of macular degeneration, on the other hand, recovery time is de衍ayed with the red filter in very early stages, while it is more de衍ayed with the green filter in the late cases.

The differentiation is more ex計licit provided the history, fundus picture and vision are taken into account.

In view of the findings reported earlier and the conclusions drawn it became apparent that some sort of classification of the amblyopia could be attempted on the basis of macular function tests. This would not take into account the often quoted clinical impression.

Case No. I. had hypermetropic anisometropia. The macular illu衫ination tests showed that he had in all probability macular degene訃ation. Case No. 2 had myopic an虹sometropia. The assessment fol衍owing macular illumination tests suggested that he might have developed angiospastic maculo計athy which later was confirm苟d by history of solar burn in retrospect.

Similarly in case No. 3 it was held that probably he developed C.S.R. which was in a stage of resolution at the time of examination. This case was interesting in the sense that it was labelled as a case of ametropic amblyopia, because apart from simple myopia there was no other ocular lesion. Macu衍ar illumination however, revealed the damaged macula.

Case V, VI, may be labelled as primary amblyopes but they re赳ealed sub clinical degeneration.

This test proved to be of great help in case No. 9 where it could be conclusively shown that the patient was having primary am苑lyopia while the macular pig衫entation was normal.

Hence it is apparant that these amblyopes can be basically divid苟d into two categories. One are those having normal macular functions, these are primary am苑lyopes and the second group is one where macular illumination tests show loss of function. This is the group of secondary amblyo計es these are the cases which are otherwise labelled as primary am苑lyopes on clinical assessment. Hence it is apparent that in defini負ion of amblyopia, it is essential to point out the function of the macula rather than the morpho衍ogical fundus picture.


Nine cases of amblyopia are presented. It has been pointed out that most of the clinically labelled primary amblyopes, show functio要al damage to the macula. There苯ore these cases should be labelled as "secondary amblyopes". For this differentiation, differential macular illumination tests are helpful.


1PAUL, S. D.; BATRA, D. V.: Macular illumination tests. A.J.O., 61: 99: 1966.
2PAUL, S. D.; BATRA, D. V.: Macular illumination tests in C.S.R A.J.O.: 63: 147: 1967.
3PAUL, S. D., SINGH K. M.: Macular illumination tests in C.S.R. (In press).
4PAUL, S. D., SINGH K. M.: Macular illumination tests in Macular Solar burn. (In press).
5PAUL, S. D., SINGH, K. M.: Macular illumination tests in Mac. degeneration. (In press).