Quiz: Difficulty Seeing at Night

A 21-year-old female presented for a routine exam with complaints of difficulty seeing while driving at night. Past ocular, medical and social history were unremarkable with the exception of oral contraceptive use. Family ocular history was notable only for senile macular degeneration in a maternal grandmother and moderate refractive errors in several family members.

Uncorrected visual acuity was 6/6 in both the right and left eyes. Refraction was -0.50 OU and color plate testing was normal in both eyes as were intraocular pressures. Anterior segments were unremarkable by slit-lamp examination. Posterior segments were as found in these photos:

Last Updated: October 31, 2022

10 thoughts on “Quiz: Difficulty Seeing at Night”

  1. Stephen Sinclair
    It’s true that VA doesn’t measure functional vision but color vision, visual field findings all show normal. As well as the OCT findings. I don’t think that granulomatous retinitis would provide such normal findings on all these tests.

  2. the diagnosis is absolutely incorrect- the night driving abnormality is due to the bilateral retinal infiltration with what appears to be granulomatous retinitis- active OD, inactive OS.

    • Thank you for your emphatic diagnosis Dr Sinclair. I believe what you are interpreting as granulomatous retinitis is in fact photographic artifact. Visual acuity is 6/6 (20/20) uncorrected in each eye. Patient was found to have a refractive error of -0.50 D and the optic nerve head pit was merely an incidental finding.


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