Retinitis Pigmentosa - Vascular Narrowing
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This pleasant 55-year-old man was seen in the office on 6/17/08. He noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. He has been getting along nicely driving. He had a metal injury a long time ago in his right eye that was treated in the emergency room. Surgery was not needed for this injury. He does not have a significant family history of retinal diseases, although most family members do wear glasses. He does smoke cigarettes, but he is going to try to quit.
VISUAL ACUITY: Vision OD is 20/100, OS is 20/50. IOP: OD 15, OS 13. Color vision OD 7 out of 10 correction, OS 8 out of 10 correct.
AMSLER GRID: Normal OU.
SLIT LAMP EXAM: There is 3+ nuclear sclerosis in both eyes.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.2. There is a posterior vitreous separation with 2+ vitreous cells. There is 2+ cystoid macular edema. There is peripapillary atrophy, chorioretinal scarring, and bone spicules 360° at the equator, touching the macula.
OS: Vertical C/D ratio is 0.2. There is a posterior vitreous separation and 2+ macular edema. Again, there is peripapillary atrophy and there are bone spicule pigment irregularities 360° at the equator.
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
FLUORESCEIN ANGIOGRAPHY: Photos confirm clinical findings. FA shows hyperfluorescence in the periphery 360° around the macula, consistent with retinitis pigmentosa. The fovea has had minimal staining with fluorescein in the late frames.
IMPRESSION:
1. POSSIBLE RETINITIS PIGMENTOSA – BOTH EYES
2. POSSIBLE CHORIORETINAL INFLAMMATORY INFECTIOUS CHORIORETINOPATHY – BOTH EYES
3. MACULAR EDEMA – BOTH EYES
DISCUSSION: I explained to the patient he does have macular edema in both eyes, limiting his vision. I put him on Xibrom and Econopred drops to see if that will eliminate the macular edema. If it is from retinitis pigmentosa, sometimes Acetazolamide will help.
Since he has a new diagnosis of retinitis pigmentosa and since this is atypical in that the symptoms are presenting so late in life, I am going to obtain blood tests to rule out possible infectious or inflammatory etiologies. He does not have any health problems that point to any specific diagnosis except for arthritis. He will return for check in 6-8 weeks, sooner should he notice any problems.
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Retinitis Pigmentosa Newly Diagnosed 55 Year Old680 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
(0 votes)
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Retinitis Pigmentosa Newly Diagnosed 55 Year Old509 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
(0 votes)
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Retinitis Pigmentosa Newly Diagnosed 55 Year Old526 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
(0 votes)
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Retinitis Pigmentosa Newly Diagnosed 55 Year Old478 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
(0 votes)
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Retinitis Pigmentosa Newly Diagnosed 55 Year Old489 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
(0 votes)
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Retinitis Pigmentosa Newly Diagnosed 55 Year Old559 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
(0 votes)
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Retinitis Pigmentosa Newly Diagnosed 55 Year Old496 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
(0 votes)
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Retinitis Pigmentosa Newly Diagnosed 55 Year Old506 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
(0 votes)
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Retinitis Pigmentosa Newly Diagnosed 55 Year Old555 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
(0 votes)
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Retinitis Pigmentosa Newly Diagnosed 55 Year Old436 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
(0 votes)
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Retinitis Pigmentosa Newly Diagnosed 55 Year Old567 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
(0 votes)
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Retinitis Pigmentosa Newly Diagnosed 55 Year Old514 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
(0 votes)
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|
Retinitis Pigmentosa Newly Diagnosed 55 Year Old550 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
(0 votes)
|
|
Retinitis Pigmentosa Newly Diagnosed 55 Year Old527 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
(0 votes)
|
|
Retinitis Pigmentosa Newly Diagnosed 55 Year Old460 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
(0 votes)
|
|
Retinitis Pigmentosa Newly Diagnosed 55 Year Old423 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
(0 votes)
|
|
Retinitis Pigmentosa Newly Diagnosed 55 Year Old415 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
(0 votes)
|
|
Retinitis Pigmentosa Newly Diagnosed 55 Year Old422 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
(0 votes)
|
|
Retinitis Pigmentosa Newly Diagnosed 55 Year Old441 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
(0 votes)
|
|
Retinitis Pigmentosa Newly Diagnosed 55 Year Old502 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
(0 votes)
|
|
Retinitis Pigmentosa Newly Diagnosed 55 Year Old510 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
(0 votes)
|
|
Retinitis Pigmentosa Newly Diagnosed 55 Year Old483 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
(0 votes)
|
|
Retinitis Pigmentosa Newly Diagnosed 55 Year Old499 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
(0 votes)
|
|
Retinitis Pigmentosa Newly Diagnosed 55 Year Old498 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
(0 votes)
|
|
Retinitis Pigmentosa Newly Diagnosed 55 Year Old498 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
(0 votes)
|
|
Retinitis Pigmentosa Newly Diagnosed 55 Year Old439 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
(0 votes)
|
|
Retinitis Pigmentosa Newly Diagnosed 55 Year Old540 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
(0 votes)
|
|
Retinitis Pigmentosa Newly Diagnosed 55 Year Old533 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
(0 votes)
|
|
Retinitis Pigmentosa Newly Diagnosed 55 Year Old603 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
(0 votes)
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This pleasant 55-year-old man was seen in the office on 6/17/08. He noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. He has been getting along nicely driving. He had a metal injury a long time ago in his right eye that was treated in the emergency room. Surgery was not needed for this injury. He does not have a significant family history of retinal diseases, although most family members do wear glasses. He does smoke cigarettes, but he is going to try to quit.
VISUAL ACUITY: Vision OD is 20/100, OS is 20/50. IOP: OD 15, OS 13. Color vision OD 7 out of 10 correction, OS 8 out of 10 correct.
AMSLER GRID: Normal OU.
SLIT LAMP EXAM: There is 3+ nuclear sclerosis in both eyes.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.2. There is a posterior vitreous separation with 2+ vitreous cells. There is 2+ cystoid macular edema. There is peripapillary atrophy, chorioretinal scarring, and bone spicules 360° at the equator, touching the macula.
OS: Vertical C/D ratio is 0.2. There is a posterior vitreous separation and 2+ macular edema. Again, there is peripapillary atrophy and there are bone spicule pigment irregularities 360° at the equator.
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
FLUORESCEIN ANGIOGRAPHY: Photos confirm clinical findings. FA shows hyperfluorescence in the periphery 360° around the macula, consistent with retinitis pigmentosa. The fovea has had minimal staining with fluorescein in the late frames.
IMPRESSION:
1. POSSIBLE RETINITIS PIGMENTOSA – BOTH EYES
2. POSSIBLE CHORIORETINAL INFLAMMATORY INFECTIOUS CHORIORETINOPATHY – BOTH EYES
3. MACULAR EDEMA – BOTH EYES
DISCUSSION: I explained to the patient he does have macular edema in both eyes, limiting his vision. I put him on Xibrom and Econopred drops to see if that will eliminate the macular edema. If it is from retinitis pigmentosa, sometimes Acetazolamide will help.
Since he has a new diagnosis of retinitis pigmentosa and since this is atypical in that the symptoms are presenting so late in life, I am going to obtain blood tests to rule out possible infectious or inflammatory etiologies. He does not have any health problems that point to any specific diagnosis except for arthritis. He will return for check in 6-8 weeks, sooner should he notice any problems.
