Although rare, vitamin A retinopathy should be considered by the clinicians in their differentials for conditions that can lead to nyctalopia, especially in those patients who have undergone bariatric surgery. Patients must be educated on this potential delayed adverse effect of the surgery and possible lifelong vitamin A supplementation.
The purpose of this study was to report a rare case of delayed vitamin A retinopathy that occurred because of vitamin A malabsorption secondary to bariatric surgery.
A 55-year-old woman presented with nyctalopia and dark adaptation problems. The patient had a history of gastric bypass surgery 22 years earlier. Fundus examination revealed a large number of small white dots in the midperiphery of both eyes. Electrophysiology testing revealed flat-lined scotopic responses. Vitamin A levels were found to be severely reduced. Subsequent vitamin A supplementation resulted in the reversal of all signs and symptoms.
This case report demonstrates the importance of considering vitamin A deficiency in patients who present with symptoms of nyctalopia with a history of bariatric surgery. Clinicians should be aware of a possible delayed onset and refer for appropriate testing and treatment, as vitamin A retinopathy has been shown to be reversible. Because other conditions can present with nyctalopia and retinal white spots, clinicians also need to consider the appropriate differential diagnoses. Lifelong monitoring is indicated because reoccurrences have been reported.
1Southern California College of Optometry, Marshall B. Ketchum University, Fullerton, California
2Retina Consultants of Orange County, Los Alamitos, California *firstname.lastname@example.org
Submitted: February 22, 2018
Accepted: September 11, 2018
Funding/Support: None of the authors have reported funding/support.
Conflict of Interest Disclosure: None of the authors have reported a financial conflict of interest.
Author Contributions: Formal Analysis: RB; Project Administration: RB; Resources: RB, SA; Writing – Original Draft: RB, WHR; Writing – Review & Editing: RB, WHR.