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Retinitis Pigmentosa - Vascular Narrowing 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.
Retinitis Pigmentosa Newly Diagnosed 55 Year Old695 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 Old528 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 Old545 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 Old495 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 Old504 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 Old578 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 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)	Retinitis Pigmentosa Newly Diagnosed 55 Year Old521 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 Old572 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 Old453 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 Old589 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 Old564 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 Old538 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 Old472 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 Old434 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 Old429 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 Old437 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 Old457 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 Old519 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 Old525 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 Old508 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 Old516 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 Old507 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 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)	Retinitis Pigmentosa Newly Diagnosed 55 Year Old450 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 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 Old545 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 Old621 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.