BMJ  2004;328:348 (7 February), doi:10.1136/bmj.328.7435.348-b

Letter

Treatment of unilateral visual impairment on preschool vision screening

Mild amblyopia should still be treated

The first 150 words of the full text of this article appear below.

EDITOR—In their randomised controlled trial Clarke et al showed directly for the first time that treatment improves visual acuity, at least for moderate amblyopia.1

However, we take issue with the conclusion that vision of 6/12 in one eye and 6/9 in the other should not be treated. There are several possible reasons why no effect of treatment was found for this group.

6/9 is likely to be within the normal range of results for this age group for the crowded test used rather than for a single letter test, in which 6/9 would be more likely to be subnormal at this age.

Some of these children may well have had simple uncorrected refractive error rather than amblyopia because there was no refraction before randomisation and treatment.

Test-retest data for children show that visual acuity varies by at least one line between different occasions.2 3

A ceiling effect at the . . . [Full text of this article]

Richard Harrad, consultant ophthalmologist

R.A.Harrad@bristol.ac.uk

Cathy Williams, consultant ophthalmologist, John Sparrow, consultant ophthalmologist

Bristol Eye Hospital, Bristol BS1 2LX


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