Flecks of Pigment in Retina

[mooduk]

Dear Dr.

Our 10 year old daughter has been complaining of night blindness.  Its obvious that she doesn't see well in dim light, nor does she like bright lights.  The retina specialist said our daughter has flecks of pigment in the peripheral retinas and that combined with her night blindness and vitiligo is 'highly suggestive.'  He ordered an ERG and a visual field test.  I was a bit too rattled to ask the Dr. highly suggestive of what?  From what I've read, it seems possible that our daughter might have RP.  Is there anything else this could be?  There is no family history of RP on either side, nor is there any retinal disease of any kind.  So the retina specialists findings came as quite a surprise.

Thank you.

MooDuk

[Michael J Kutryb, MD]

First- it is way to early to jump to conclusions - but I know it must have you worried very much.  It must be very difficult not knowing what is going on and I totally sympathize with you.  You are probably already reading articles about RP or other retinal disorders and I know there has been at least some association with vitteligo in some studies.  I just pray that everthing turns out normal.  If a real retinal disorder turns up, please post again because I have so many encouraging words and links that would make you feel much, much better.

Michael Kutryb, MD

[Michael J Kutryb, MD]

Night blindness is a subjective complaint and can have great variability.  It like saying someone feels tired.  No concrete scientific way to measure it.  It may be that some of these people with vitiligo have some mild dysfunction of the photoreceptors, related to retinal pigment epithelial (RPE) issues,  but not enough to show up on the ERG which measure a global function of photoreceptors and would not be influenced much by mild changes or spotty changes in the retina.  The fact that the ERG is normal should be a great relief to you.  There is a test called a EOG that measures more the RPE - I'm curious what it would show.  I'm sorry but I don't have much more to offer.

MJK MD

[mooduk]

Dear Dr.Kutryb,

We finally got our daughter's results back.  She doesn't have RP, thank goodness!  Her VFs and ERG were normal.  However, the retina specialist still wants to see her back to follow up on the retinal pigment changes.  I am relieved that we worried over nothing - best possible outcome.

I have some questions I'm hoping you can answer.  A 1983 paper in BJO (http://bjo.bmj.com/cgi/content/abstract/67/3/153) states that 25% of persons with vitiligo complain of night blindness and about the same percentage have retinal pigment changes.  Three of those people had ERGS and two were normal.  Can you please explain how a person can be night blind and have retina pigment changes and have a normal ERG?  

Are you aware of any children with vitiligo who have retina pigment changes and night blindness and progress to any visual changes worse than 'just' night blindness?  Our daughter has had generalized vitiligo since she's been about 1.  When she gets a new spot on one side of her body, another appears in the same spot on the other side with some exceptions like her face, trunk and ankle.  Her vitilligo has been relatively stable until recently.

Here's another paper that might be of interest:  https://tspace.library.utoronto.ca/bitstream/1807/5627/1/dv06022.pdf

Thank you very much!!

Moo Duk

[mooduk]

Dr. Kutryb,

Yes we are worried.  But we realize that worrying can't change anything.  I asked the Dr. if this (whatever it is) would affect our daughter's education as she had an IEP meeting in the next few days.  The Dr. said, "Not yet."  Our daugther already has periventricular leukomalacia (not a preemie) which fortunately left her with only motor coordination problems and a left sided inattention as well as CVI with normal acuity, alternating intermittent esotropia, Balint's syndrome and CAPD and a bunch of other diagnoses (but things could be a lot worse). Our daughter walks and talks, is very bright, is far sighted and wears bifocals.  So when the Dr. asked how long our daughter had been night blind, I couldn't tell him - she's always had odd visual behaviors.  My husband thinks she's always had trouble seeing in the dark, though.  

The retina specialist also asked about our daughter's hearing since a borderline loss in the high frequencies showed up last year (on top of the CAPD).  So the pediatrician ordered a hearing test.  We'll have the hearing, ERG and VF results about mid-April and I'll post again then.

Thanks for your kind thoughts.

Mooduk