DISRUPTION OF THE OUTER SEGMENTS OF THE PHOTORECEPTORS ON OPTICAL COHERENCE TOMOGRAPHY AS A FEATURE OF VITAMIN A DEFICIENCY
Open accessAbstract
Purpose: To describe the optical coherence tomography features of vitamin A deficiency. Methods: Case series includes three male patients aged 50 to 66 years with vitamin A deficiency and visual symptoms ranging from 2 to 8 months. Examination included optical coherence tomography (OCT), fundus autofluorescence imaging, full-field electroretinography6 and laboratory work-up. Results: Patient 1 had inoperable pancreatic neuroendocrine tumor and presented with worsening nyctalopia. The electroretinography showed absent rod function 2 months after the onset of symptoms, followed by a decrease of the cone function eight months after the onset. Optical coherence tomography showed poorly distinguishable outer segments of the photoreceptors with the disappearance of the interdigitation zone. At that time, vitamin A deficiency along with several other deficiencies was confirmed. After the initiation of parenteral nutrition, a substantial improvement of the patient's overall well-being was noted and the OCT showed normalization of the retinal structure. Two other patients were diagnosed with vitamin A deficiency based on similar OCT features. Conclusion: Disruption of the outer segments of the photoreceptors and the disappearance of the interdigitation zone on OCT may be helpful in recognition of vitamin A deficiency. Early detection and malnutrition evaluation are especially important in patients with a history of gastrointestinal disorders who may have several other underlying deficiencies. Treatment with either enteral or parenteral nutrition not only leads to resolution of visual symptoms but vastly improves their general condition and quality of life.
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Vitamin A replacement results in improvement of retinal function as well as structure, but long-term deficiency can lead to permanent degeneration of photoreceptors.
“Vitamin A replacement results in improvement of retinal function as well as structure, however long-term deficiency can lead to permanent degeneration of photoreceptors [31,80,81,83,84,85,86,87,88,90].”
From The Role of Vitamin A in Retinal Diseases (2022) · cites this paper as [83]
The Case Reports figure captions report complete recovery of rod and cone function and improved photoreceptor outer-segment appearance after treatment in Patient 1. The Discussion also describes normalization of OCT features after treatment. Our copy does not say that long-term vitamin A deficiency causes permanent photoreceptor degeneration. (LLM, conf=0.88)
Experimental — accuracy not yet measuredOptical coherence tomography has been shown to be a useful diagnostic method for vitamin A deficiency, showing abnormalities at the level of photoreceptor outer segments.
“Recently, optical coherence tomography (OCT) has been shown as a useful diagnostic method, which shows abnormalities at the level of photoreceptor outer segments [83] (Figure 2).”
From The Role of Vitamin A in Retinal Diseases (2022) · cites this paper as [83]
Vitamin A is needed for normal visual function, and vitamin A deficiency (hypovitaminosis A) results in visual dysfunction that is reversible with vitamin A supplementation.
“Vitamin A is needed for normal visual function and vitamin A deficiency (hypovitaminosis A) results in visual dysfunction that is reversible with vitamin A supplementation.”
From The Role of Vitamin A in Retinal Diseases (2022) · cites this paper as [83]
Hypovitaminosis A has been associated with reversible ganglion cell thinning.
“Interestingly, hypovitaminosis A has also been associated with reversible ganglion cell thinning [83], the reason for which is not understood but may reflect other vitamin A roles in the retina.”
From The Role of Vitamin A in Retinal Diseases (2022) · cites this paper as [83]
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Cites
Functions, Therapeutic Applications, and Synthesis of Retinoids and Carotenoids
Álvarez, R., Vaz, B., Gronemeyer, H., & de Lera, Á. R. (2014) · Chemical Reviews · doi:10.1021/cr400126u · Cited by 260 · see citing works
Retinal structure in vitamin A deficiency as explored with multimodal imaging
Aleman, T. S., Garrity, S. T., & Brucker, A. J. (2013) · Documenta Ophthalmologica · doi:10.1007/s10633-013-9403-0 · Cited by 81 · see citing works
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Lima de Carvalho, J. R., Tsang, S. H., & Sparrow, J. R. (2022) · RETINAL Cases & Brief Reports · doi:10.1097/icb.0000000000000931 · Cited by 14 · see citing works
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The Role of Vitamin A in Retinal Diseases
Sajovic, J., Meglič, A., Glavač, D., Markelj, Š., Hawlina, M., & Fakin, A. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms23031014 · Cited by 109 · see citing works
“Interestingly, hypovitaminosis A has also been associated with reversible ganglion cell thinning [83], the reason for which is not understood but may reflect other vitamin A roles in the retina.”
BackgroundInfluentialSelf-citation
- Authors
- Jevnikar, K., Šuštar, M., Kozjek, N. R., Štrucl, A. M., Markelj, Š., Hawlina, M., & Fakin, A.
- Affiliations
- Ljubljana University Medical Centre (SI)
- Institute of Oncology Ljubljana (SI)
- Corresponding author
- Jevnikar, Kristina
- Šuštar, Maja
- Markelj, Špela
- Hawlina, Marko
- Fakin, Ana
- Venue
- RETINAL Cases & Brief Reports
- Published
- 2020-11-06
- Volume
- 16
- Issue
- 5
- Pages
- 658-662
- ISSN
- 1935-1089 (ISSN-L)
- PMC
- PMC9394498
- OpenAlex
- W3102030185
- Cited by
- 6
- References
- 4
- Citations by year
- 2024: 1 · 2023: 3 · 2022: 2
- FWCI
- 0.41
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Retinal Cases & Brief Reports (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Retinal Development and Disorders
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Health Sciences › Medicine › Ophthalmology › Retinal and Optic Conditions
- Keywords
- vitamin A deficiency, photoreceptor outer segments, interdigitation zone, optical coherence tomography findings, night blindness, rod and cone function, electroretinogram, malnutrition, pancreatic neuroendocrine tumors, parenteral nutrition, enteral nutrition, gastrointestinal diseases
- MeSH terms
- Electroretinography, Fluorescein Angiography, Humans, Male, Quality of Life, Visual Acuity, Vitamin A Deficiency, Tomography, Optical Coherence
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