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The Vitamin Miracle Cure
River City Retina Club
Doug Sigford, M.D.
University of Louisville
Department of Ophthalmology and Visual Sciences
June 19, 2014
Patient Presentation CC:”I am going blind”
HPI: 65 y/o WM with gradually decreasing vision OU for the past 8-10 months. His vision was worse at night and indoors. He had no pain or photophobia.
He was told by an outside ophthalmologist that he will eventually go blind and there is no treatment available for his condition. He came to our clinic for second opinion.
Patient Presentation Past ocular history:
Foreign bodies in cornea removed (4 years ago)
Past medical History:
Gastric bypass 1998 Kidney failure on Dialysis 2010 Diabetes from 2008 Hypertension
Social history: EtOH abuser, heavy smoker
ROS: Neuropathy
Allergy: NKDA
Exam
VA cc P TTP
EOM: Full OU CVF: Full OU
Anterior segment: mild nuclear sclerotic cataracts OU
20/200
42mm
42mm
16
17(-) RAPD
20/200
Red free
Autofluorescence
OCT
OD
OCT
OS
Fluorescence angiography
Fluorescence angiography
Fluorescence angiography
Visual field
OS OD
HVF 24-2: Paracentral scotoma OD
Centeral scotoma OS
Assessment and plan
68 y/o WM with gradual vision loss OU and subfoveal deposits OU and history of gasteric resection.
Vitamin deficiency
Pattern dystrophy
PlanPt started on vitamins (Ocuvite) and ERG and EOG ordered
EOG shows an attenuated Arden Ratio OU.
The full-field ERG reveals severe rod and cone dysfunction OU.
Arden Ratio
=1.5 OD
Arden Ratio
=1.1 OS
Follow up
Pt returned in 8 months with improved symptoms and BCVA of 20/20 OD and
20/40 OS
Follow up
Follow up OCT
OD
OS
Follow up
Vitamin ACompounds with 20-carbon structure.
Contain a methyl substituted cyclohexenyl ring (-ionone ring),
and an isoprenoid side chain
B-Carotene
11-cis-retinal
Retinol
Retinoic Acid
Can’t be reduced to retinol or retinal in the body.
All-trans-retinal
Vitamin A Deficiency
Xerophthalmia refers to the ocular
manifestations associated with vitamin A
deficiency.
These include xerosis, keratomalacia,
nyctalopia and Bitot’s spots.
Visual cycle
Miyazono S et al. PNAS 2008;105:16051-16056
Case report
A case report of 61 year old male with history of bariatric gastric surgery present with night blindness and fundus white spots. After treatment with oral Vitamin A for 2 months vision and ERG changes improved.
Fishman et al. Fundus white spots and acquired night blindness due to vitamin A deficiency. Doc Ophthalmo 2009;119UIC chicago
Full-Field electroretinogram (ERG) responses before and after therapy with Vitamin A in dark-adapted (A) and light adabted (B) conditions
Thank You