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Letter to the Editor

Clinical profile of amblyopia in a Table 1: Clinical profile of amblyopia

tertiary care teaching hospital in Clinical profile Number (percentage)
Southern India Total number of patients 160
Gender (%)
Sir, Male 110 (68.75)
Amblyopia is one of the common risk factors for visual
Female 50 (31.25)
impairment in children and adults,[1‑5] the prevalence of which
Age in years (%)
is usually underestimated in India, often because of lack of
awareness in public and among health‑care professionals and <10 25 (15.62)
inadequate attention to diagnosis and management.[2] There 10-20 95 (59.37)
are very few clinical studies[5] in India, elucidating the clinical 20-50 35 (21.87)
profile of patients with amblyopia as primary focus of attention. >50 5 (3.12)
In this tertiary care teaching hospital‑based prospective Affected eye (%)
observational study, all the patients who were diagnosed to Left 88 (55.00)
have amblyopia in the Outpatient Ophthalmology Department Right 45 (28.12)
were enrolled over a period of 24 months from August 2013 to Both 27 (16.87)
August 2015. Patients who could not comprehend the tests for Refractive error (%)
the assessment of binocularity were excluded from the study.
Hyperopic 60 (37.50)
The ocular examination included assessment of the unaided
Hyperopic astigmatism 40 (25.00)
and the best‑corrected spectacle visual acuity with the help
of Snellen’s visual acuity chart in patients >4 years of age and Myopic 3 (1.87)
Cardiff’s vanishing optotype charts in children <4 years of age. Myopic astigmatism 57 (35.62)
Refraction under appropriate cycloplegics depending on the age Type of amblyopia (%)
of the patient, assessment of the ocular alignment, ocular motility Strabismic 68 (42.50)
and associated deviation if any, and slit lamp examination Anisometropic 42 (26.25)
for the assessment of any anterior segment pathology was Meridional 25 (15.62)
performed. A detailed fundus examination was done to rule out
Combined 10 (6.25)
any posterior segment pathology and to determine the fixation
pattern. Assessment of the binocular status of the eye was Ametropic 8 (5.00)
performed whenever possible with the help of Worth four‑dot Stimulus deprivation 7 (4.37)
test, Bagolini striated glasses, TNO test, and random‑dot test. Type of deviation (%)
Esotropia 53 (33.12)
The clinical profile of 160 patients with amblyopia enrolled
in the study is summarized in Tables 1 and 2. In our study, Exotropia 35 (21.87)
amblyopia was most commonly seen in younger males in the first Orthotropia 72 (45.00)
two decades of life. The predominant prevalence of amblyopia Nystagmus (%)
in the left eye may be attributable to ocular dominance, Yes 8 (5.00)
microtropia, laterality in the development of refractive error, No 152 (95.00)
developmental or neurological factors, or a combination of the AV pattern (%)
above‑mentioned factors. Strabismic amblyopia is the most
Yes 12 (7.50)
common type of amblyopia seen in 68 patients (42.50%) with
No 148 (92.50)
associated constant or alternate tropias, especially esotropia
with small angle of deviations. Fixation was eccentric in Degree of amblyopia (%)
85 patients (53.12%) and central in 67 patients (41.87%) while Mild 36 (22.50)
8  patients  (5.00%) had nystagmus without any fixation. Moderate 97 (60.62)
Binocularity was present in 32 patients (20.00%) and absent in Severe 27 (16.87)
116 patients (72.50%). In 12 patients (7.50%), binocularity could
not be assessed as they were unable to comprehend the tests.
treatment protocols, response to treatment, and follow‑up
As amblyopia is often a diagnosis of exclusion, measures were not included in this study. We believe that this
ophthalmologist evaluation of the fixation pattern with the study would enable us to plan future surveys and strategies
standard direct ophthalmoscope should be an essential part of to screen and implement appropriate therapeutic measures for
an ophthalmic examination in a child, especially in preverbal treating amblyopia on a mass scale subsequently.
children, uncooperative children, and mentally challenged
children in the absence of the more expensive modalities of Financial support and sponsorship
assessing pediatric visual acuity. Nil.

As our study was a prospective observational study Conflicts of interest

evaluating the clinical profile of different types of amblyopia, There are no conflicts of interest.

© 2017 Indian Journal of Ophthalmology | Published by Wolters Kluwer - Medknow

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March 2017 Letter to the Editor 259

Table 2: Clinical profile of amblyopia – visual acuity References

Clinical profile Number (percentage) 1. Dandona  L, Dandona  R, Srinivas  M, Giridhar  P, Vilas  K,
Prasad MN, et al. Blindness in the Indian state of Andhra Pradesh.
Total number of patients 160 Invest Ophthalmol Vis Sci 2001;42:908‑16.
Uncorrected visual acuity right eye 2. Rahi  JS, Sripathi  S, Gilbert  CE, Foster A. Childhood blindness
Better than 6/18 61 (38.12) in India: Causes in 1318 blind school students in nine states.
6/18-6/60 70 (43.75) Eye (Lond) 1995;9(Pt 5):545‑50.

Worse than 6/60 29 (18.12) 3. Kalikivayi  V, Naduvilath  TJ, Bansal  AK, Dandona  L. Visual
impairment in school children in Southern India. Indian J
Uncorrected visual acuity left eye Ophthalmol 1997;45:129‑34.
Better than 6/18 40 (25.00) 4. Murthy  GV, Gupta  SK, Ellwein  LB, Muñoz SR, Pokharel  GP,
6/18-6/60 81 (50.62) Sanga L, et al. Refractive error in children in an urban population
Worse than 6/60 39 (24.37) in New Delhi. Invest Ophthalmol Vis Sci 2002;43:623‑31.
Best‑corrected visual acuity right eye 5. Menon V, Chaudhuri Z, Saxena R, Gill K, Sachdev MM. Profile
of amblyopia in a hospital referral practice. Indian J Ophthalmol
Better than 6/18 99 (61.87)
2005;53:227‑34.
6/18-6/60 50 (31.25)
Worse than 6/60 11 (6.87) This is an open access article distributed under the terms of the Creative
Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows
Best‑corrected visual acuity left eye others to remix, tweak, and build upon the work non‑commercially, as long as the
Better than 6/18 69 (43.12) author is credited and the new creations are licensed under the identical terms.

6/18-6/60 74 (46.25) Access this article online

Worse than 6/60 17 (10.62) Quick Response Code: Website:
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Himabindu Marthala, Gurudutt Kamath, DOI:

Manjunath Kamath, Sumana J Kamath 10.4103/ijo.IJO_930_15

Department of Ophthalmology, Kasturba Medical College, Mangalore, PMID:

Karnataka, India ***

Correspondence to: Dr. Himabindu Marthala,

Department of Ophthalmology, Kasturba Medical College,
Light House Hill Road, Hampankatta, Mangalore ‑ 575 001,
Karnataka, India.
E‑mail: drhima14@gmail.com
Cite this article as: Marthala H, Kamath G, Kamath M, Kamath SJ. Clinical
profile of amblyopia in a tertiary care teaching hospital in Southern India. Indian
J Ophthalmol 2017;65:258-9.
© 2017 Indian Journal of Ophthalmology | Published by Wolters Kluwer - Medknow