Original ArticlesVisual acuity in children with coloboma1: Clinical features and a new phenotypic classification system☆,
Section snippets
Materials and methods
Children were recruited from special schools for the blind, integrated education programs, schools for the mentally handicapped, hospital clinic records and from a community based rehabilitation program in the Indian state of Andhra Pradesh between January 1998 and January 1999. Every child identified with coloboma was examined by use of the same methods by one general ophthalmologist (SJH) and an optometrist (SA). Examinations were performed in the schools or in nearby eye clinics. The ethics
Results
Colobomatous congenital malformations of the globe were found in 196 eyes of 113 individuals, 48 of whom were female (42.5%) and 65 male (57.5%). The remaining 30 eyes were either normal (n = 6) or had a noncolobomatous abnormality (n = 24). The age range was from 9 months to 20 years, with a mean of 11 years. Clinical findings are presented for individual eyes, and the results of VA and visual function are presented for the individual.
Discussion
The high proportion of children in this series with posterior segment colobomata, and the low number with purely unilateral disease, probably reflects recruitment bias in favor of those with lesions causing severe visual loss. Three quarters of the children (83 of 113) had bilateral signs with some form of coloboma in each eye, although asymmetry was common. Involvement of the macula by the posterior segment coloboma was associated with a poorer VA as shown in previous studies.21 Localizing
Conclusion
Measurement of corneal diameter and axial length is a useful adjunct to clinical examination in assessing the prognosis for vision in a baby or child with coloboma. The clinical classification system proposed in this article divides colobomatous disorders into four clinical groups. Eyes with microphthalmos and cyst and those with corneal diameters of 5 mm or less have very poor prognosis for vision. Colobomata associated with normal corneal size have a good prognosis apart from the risk of
Acknowledgements
The authors thank the dedicated field team of M. Ferozuddin, S. M. Fahrath, and B. Raju. Dr Xiaoling Liang translated reference 17 from Chinese into English.
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Supported by grants from the British Council for the Prevention of Blindness (London, England), the Tjissen Foundation (The Netherlands), Dark and Light (The Netherlands), and Christoffel Blinden Mission (Bensheim, Germany).
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The authors have no proprietary interest in any materials used in this study.