Retinal changes associated with multivitamin deficiency before and after supplementation

• Published in: Acta neurologica Scandinavica Vol. 144; no. 2; pp. 209 - 215
• Main Authors: Huang‐Link, Yumin, Mirabelli, Pierfrancesco, Lindehammar, Hans, Link, Hans
• Format: Journal Article
• Language: English
• Published: Denmark Hindawi Limited 01.08.2021
• Subjects: Acuity; Color vision; Dietary supplements; Differential diagnosis; Electroretinograms; Eye; ganglion cell plus inner plexiform layer; Inflammation; Latency; Medicin och hälsovetenskap; Nutrient deficiency; optical coherence tomography; Polyneuropathy; Retina; retinal nerve fiber layer; Structure-function relationships; Thinning; Vegetarian diet; Vegetarianism; Visual evoked potentials; Visual field; Visual perception; Vitamin A; vitamin deficiency; ganglion cell plus inner plexiform layer; vitamin deficiency; optical coherence tomography; retinal nerve fiber layer
• ISSN: 0001-6314; 1600-0404; 1600-0404
• DOI: 10.1111/ane.13438

Background Nutritional visual defects are apparently uncommon nowadays in developed nations. Retinal change‐related visual defects caused by hypovitaminoses may be underdiagnosed. Aim of the study To investigate the retinal structural and functional changes in a patient with multivitamin deficiency before and during vitamin supplementation. Methods A 51‐year‐old female had been on vegetarian diet as a child, and on restrict vegan diet during the last 2 years, developing severe bilateral deterioration of visual function and polyneuropathy. Blood test revealed low levels of vitamin A, B6 and D. The patient underwent examinations with optical coherence tomography (OCT), computerized visual field examination (VF), electroretinography (ERG), visual evoked potentials (VEP) and neurography before and after vitamin supplementation. Results Visual acuity (VA) was 20/1000 and VF examination showed central scotoma in both eyes. Color vision was significantly affected. Full‐field ERG showed normal rod and cone function, but a clearly reduced central peak was registered in multifocal ERG (mf‐ERG), indicating impaired fovea function. VEP showed delayed latency and low amplitude of P100 in both eyes. Neurography showed sensory polyneuropathy. OCT showed significant thinning of macular ganglion cell plus inner plexiform layer (GCIPL) with rapid progression. Retinal nerve fiber layer (RNFL) was preserved and normal, which is in contrast to neuroinflammatory conditions. After 2.5 years of multivitamin supplementation, the visual functions were improved. GCIPL thickness was stable without further deterioration. Conclusions Multivitamin deficiency results in progressive thinning of GCIPL with severe visual deterioration. In contrast to neuroinflammation, RNFL is preserved and normal. Stabilized GCIPL during vitamin supplementation was associated with improved visual function. OCT provides a sensitive and objective measure for differential diagnosis, monitoring retinal change and response to therapy.