Visual acuity in children with colobomatous defects

Examining a child with a colobomatous defect can be challenging. The most important predictor of visual outcome is identification of normal foveal anatomy. The clinician should first evaluate the child for the associated systemic conditions. The next step is to identify the presence of normal foveal structures in the involved eye(s). If present, a trial of amblyopia treatment should be initiated. Anisometropic amblyopia is common and should be addressed. Retinal detachments are common and add uncertainty to predicting visual acuity.