PREDICTING VISUAL-ACUITY IN CHILDREN WITH COLOBOMAS INVOLVING THE OPTIC-NERVE

Background: This study evaluates the relationship to visual acuity of four ophthalmoscopic features of colobomas involving the optic nerve. The goal was to identify those features that could predict potential v isual acuity of children with these colobomas. Methods: Fundus photogr aphs of 23 eyes with colobomas involving the optic nerve met the entry criteria and were evaluated by two masked observers. The following fe atures were evaluated: coloboma size, optic nerve color, foveal develo pment, and subfoveal retinal pigment epithelial changes. Simple linear regression was used to identify the feature that most closely correla ted with visual acuity. Refractive status was assessed by cycloplegic refraction. Results: The only component that correlated with the devel opment of good visual acuity was the degree of foveal involvement by t he optic nerve coloboma (P=.002, R=0.8). Significant refractive error and anisometropia were common in patients with colobomas involving the optic nerve. Conclusion: Central visual acuity in children born with colobomas involving the optic nerve correlates with the development of normal foveal anatomy, regardless of the size of the coloboma, the co lor of the optic nerve, or the presence of subfoveal pigmentary change s. Because refractive error is common, these children should receive a n accurate refraction and amblyopia treatment.