Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- redução da visão periférica
- cegueira noturna
- comprometimento da adaptação ao escuro
- acuidade central reduzida
- atrofia do epitélio pigmentar da retina
- pigmentação em espículas ósseas
Other diagnostic factors
- nervo óptico pálido em cera
- fotopsias
- erro de refração
- catarata
- atenuação vascular retiniana
- edema macular cistoide
- células vítreas
- ofuscamento por luzes fortes
- visão das cores anormal
- ceratocone
- glaucoma
- drusas da cabeça do nervo óptico
- retinopatia tipo Coats
- amaurose congênita de Leber
Risk factors
- história familiar
- presença de uma síndrome associada
Diagnostic tests
1st tests to order
- avaliação da acuidade visual
- perimetria total
- eletrorretinograma de campo total
Tests to consider
- limiar elevado final de adaptação ao escuro
- tomografia de coerência óptica (TCO)
- teste genético
- imagiologia óptica adaptativa
- autofluorescência de campo amplo de fundo do olho
Emerging tests
- sequenciamento completo do exoma
Treatment algorithm
todos os pacientes
Contributors
Authors
Mark E. Pennesi, MD, PhD

Professor
Casey Eye Institute
Oregon Health and Sciences University
Portland
OR
Disclosures
MEP serves on the scientific advisory board and executive committee for the Foundation Fighting Blindness.
Paul Yang, MD, PhD

Associate Professor
Casey Eye Institute
Oregon Health and Sciences University
Portland
OR
Disclosures
PY acted as a consultant for Applied Genetic Technologies Corp in 2019 and was paid for a meeting regarding XLRP gene therapy, for which there was no agreement to disseminate information.
Acknowledgements
Dr Mark E. Pennesi and Dr Paul Yang would like to gratefully acknowledge Dr Richard G. Weleber and Dr Peter J. Francis, previous contributors to this topic.
Disclosures
RGW has served as a consultant to Novartis, Pfizer, and Wellstat, is a member of the scientific advisory board for Applied Genetic Technologies Corp, and serves on the scientific advisory board for the Foundation Fighting Blindness (the relationship has been reviewed and managed by Oregon Health & Science University). RGW also reports having received grants and personal fees from the Foundation Fighting Blindness and Applied Genetic Technologies Corp, and other support from Sanofi-Fovea, all outside the submitted work. In addition, RGW has a patent (US patent 8,657,446, Method and apparatus for visual field monitoring, also known as Visual Field Monitoring and Analysis, or VFMA, which has not been issued). PJF declares that he has no competing interests.
Peer reviewers
Scott Fraser, MD, FRCS (Ed), FRCOphth
Consultant Ophthalmologist
Sunderland Eye Infirmary
Sunderland
UK
Disclosures
SF declares that he has no competing interests.
Elias Traboulsi, MD
Professor of Ophthalmology
Director
Center for Genetic Eye Diseases
Cole Eye Institute
Cleveland Clinic
Cleveland
OH
Disclosures
ET declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
American Academy of Ophthalmology. Comprehensive adult medical eye evaluation PPP. Nov 2020 [internet publication].Full text
American Academy of Ophthalmology. Guidelines on clinical assessment of patients with inherited retinal degenerations - 2022. Oct 2022 [internet publication].Full text
Robson AG, Frishman LJ, Grigg J, et al. ISCEV Standard for full-field clinical electroretinography (2022 update). Doc Ophthalmol. 2022 Jun;144(3):165-77.Full text Abstract
American Academy of Ophthalmology. Recommendations for genetic testing of inherited eye diseases. February 2014 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Rubéola congênita
- Sífilis
- Deficiência de vitamina A
More DifferentialsGuidelines
- Guidelines on clinical assessment of patients with inherited retinal degenerations
- Pediatric eye evaluations preferred practice pattern
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