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