{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T11:23:17Z","timestamp":1787656997741,"version":"build-2736575974"},"reference-count":19,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,8,16]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:p>Straatsma syndrome is a rare condition defined by the triad of unilateral high axial myopia, amblyopia and myelinated retinal nerve fibre layer (MRNFL). Visual prognosis is often guarded when myelination is extensive, the macula is involved, or anisometropia is high. We present a case of classic Straatsma syndrome in a boy in his middle childhood from the Arabian Gulf region. In the right eye, he had extensive type 2 MRNFL involving the superior macula, high axial myopia and amblyopia. Given his age and extensive MRNFL, retinoblastoma was excluded. We describe his longitudinal clinical course and multimodal imaging findings. Despite recommended occlusion therapy and refractive correction, the family declined treatment, and best-corrected visual acuity remained at counting fingers at 1-year follow-up. The case highlights the value of dilated fundus examination in children with anisometropic amblyopia or unilateral high myopia to facilitate timely diagnosis and appropriate prognostic counselling.<\/jats:p>","DOI":"10.1136\/bcr-2026-273925","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T11:05:21Z","timestamp":1787655921000},"page":"e273925","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Straatsma syndrome: the diagnostic value of dilated funduscopy in anisometropic amblyopia"],"prefix":"10.1136","volume":"19","author":[{"given":"Daniah","family":"Albaloul","sequence":"first","affiliation":[{"name":"Ophthalmology, Kuwait Ministry of Health, Sulaibikhat, Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noor","family":"Alali","sequence":"additional","affiliation":[{"name":"General Surgery, Kuwait Ministry of Health, Sulaibikhat, Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aseel","family":"AlKandari","sequence":"additional","affiliation":[{"name":"Ophthalmology, Kuwait Ministry of Health, Sulaibikhat, Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alaa","family":"Al-Ali","sequence":"additional","affiliation":[{"name":"Ophthalmology, Kuwait Ministry of Health, Sulaibikhat, Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"2026082504051397000_19.8.e273925.1","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/0002-9394(81)90345-7","article-title":"Myelinated Retinal Nerve Fibers","volume":"91","author":"Straatsma","year":"1981","journal-title":"Am J Ophthalmol"},{"key":"2026082504051397000_19.8.e273925.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.survophthal.2007.08.016"},{"key":"2026082504051397000_19.8.e273925.3","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1097\/ICB.0000000000000137","article-title":"Bilateral Straatsma syndrome with nystagmus","volume":"9","author":"Juhn","year":"2015","journal-title":"Retin Cases Brief Rep"},{"key":"2026082504051397000_19.8.e273925.4","doi-asserted-by":"crossref","first-page":"398","DOI":"10.4274\/tjo.galenos.2021.32470","article-title":"Straatsma Syndrome: Should Visual Prognostic Factors Be Taken into Account? 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Reverse straatsma syndrome?","volume":"23","author":"Wang","year":"2008","journal-title":"Binocul Vis Strabismus Q"},{"key":"2026082504051397000_19.8.e273925.11","doi-asserted-by":"publisher","DOI":"10.1001\/archopht.1987.01060070079033"},{"key":"2026082504051397000_19.8.e273925.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2004.09.018"},{"key":"2026082504051397000_19.8.e273925.13","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1080\/09273972.2025.2564760","article-title":"Insights into Straatsma syndrome: a pediatric case report","volume":"34","author":"Ben Addou Idrissi","year":"2026","journal-title":"Strabismus"},{"key":"2026082504051397000_19.8.e273925.14","article-title":"Ocular Findings Associated With Myelinated Retinal Nerve Fibers","volume":"13","author":"Kera","year":"2021","journal-title":"Cureus"},{"key":"2026082504051397000_19.8.e273925.15","doi-asserted-by":"crossref","first-page":"56","DOI":"10.31080\/ASOP.2020.04.0219","article-title":"Straatsma Syndrome - Report of Two Cases","volume":"4","author":"Manuel Baptista","year":"2021","journal-title":"Act Sci Oph"},{"key":"2026082504051397000_19.8.e273925.16","doi-asserted-by":"crossref","first-page":"563","DOI":"10.18231\/j.ijceo.v.11.i.3.32","article-title":"Straatsma syndrome: A case report","volume":"11","author":"Ashwini","year":"2025","journal-title":"IJCEO"},{"key":"2026082504051397000_19.8.e273925.17","article-title":"Unilateral Myelinated Retinal Nerve Fiber Layer, High Myopia, and Amblyopia: A Case Report","volume":"14","author":"Pereira","year":"2022","journal-title":"Cureus"},{"key":"2026082504051397000_19.8.e273925.18","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2021-244362","article-title":"Straatsma syndrome: unilateral myelinated retinal nerve fibre layer, high myopia, strabismus and amblyopia","volume":"14","author":"Jain","year":"2021","journal-title":"BMJ Case Rep"},{"key":"2026082504051397000_19.8.e273925.19","doi-asserted-by":"crossref","first-page":"2364","DOI":"10.1097\/IAE.0000000000001093","article-title":"Prevalence and associations of myelinated retinal nerve fibers: results from the population-based Gutenberg Health Study","volume":"36","author":"Elbaz","year":"2016","journal-title":"Retina"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2026-273925","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T11:05:23Z","timestamp":1787655923000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2026-273925"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":19,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,25]]},"published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1136\/bcr-2026-273925"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2026-273925","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]}}}