title: The hidden challenges of mixed amblyopia.
abstract: BACKGROUND
  This article will cover the subject of complex mixed amblyopia and its hidden challenges. Clarification of the terminology is followed by a clinical presentation of these difficult cases to illustrate their varied causes and many interactions. An examination of the evidence in the literature on treatment success is followed by a discussion on the challenges facing parents and members of the caring team in the management of complex mixed amblyopia.
  
  
  METHODS
  This exposé is both a critical summary of the literature on the subject and the result of 25 years of clinical experience in a busy tertiary care pediatric ophthalmic practice.
  
  
  RESULTS
  Very little high quality evidence is available on the results of the treatment of complex mixed amblyopia. Descriptive series, illustrative case reports and anecdotal comments are nevertheless a source of information worthy of careful consideration to help both orthopists and ophthalmologists involved. The severity of the loss of organic integrity, a realistic visual target, and close monitoring of the therapeutic efforts are essential components of a successful outcome.
  
  
  CONCLUSIONS
  The treatment of complex mixed amblyopia is the ultimate test for the orthoptist. While the evidence in the literature is empirical at best, the diagnostic and therapeutic challenges it represents can nevertheless be met.
authors.affiliation: From the Department of Ophthalmology and Visual Sciences, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: G Robert
authors.initials: GR
authors.lastname: Laroche