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1. Case Study
OF Retinitis Pigmentosa
By 3rd year Student
Shagufta Kadri (SY003)
From Aditya Jyot Institute of Optometry

2. Retinitis Pigmentosa
• Definition: The Primary Pigmentary retinal dystrophy
is a hereditary disorder predominantly affecting the
rods more than cones.

3. Retinitis Pigmentosa
• Inheritance: Most common mode is autosomal
recessive, followed by autosomal dominant, X linked
recessive is the least common.
• Incidence: 5 person per 1000
• Age: Appears in childhood and progresses slowly
• Race: No race is prone to it
• Sex: Males are commonly affected than female 3:2
• Laterality: Bilateral

4. Clinical features
• Ocular association: Myopia, POAG,
Micropthalmos, Keratoconous, Posterior
Subcapsular cataract vitreous detachment.
• Systemic association: Laurence-Moon Biedl
syndrome, Cockayne’s syndrome, Refsum’s
syndrome.

5. Clinical features
• Atypical RP:
RP punctate albescens
Sector RP
Pericentral RP
RP with exudative vasculopathy

8. Clinical features
• Fundus changes: The classical clinical triad of
RP are as follow
• Retinal arterioles are attenuated
• Optic disc become pale and waxy
• Retinal pigmentary changes: It show
perivascular ‘bone spicule’
• Other changes include Choroidal sclerosis,
CM, Atrophic or cellophane maculopathy.

10. Clinical features
Visual symptoms:
Bilateral involvement
Tunnel vision
Nyctalopia

12. Clinical features
• Visual field changes: It shows annular or ring
shaped scotoma which expands both peripherally
and centrally
• Electro physiological changes: ERG is subnormal or
abolished
• EOG shows absence of light
• Colour Vision: Normal

14. Case Presentation

15. Demographic data
• Name: XYZ
• Age: 27/F
• Add: Mumbai
• Occupation: Therapist
• Education: Studied in normal school
• Financial status: Middle class
• Marital status: Single

16. History

17. History
• H/O ocular disease: RP in (BE) since 10
years
• H/O Trauma: NiL
• H/O ocular medication: NiL
• H/O Glasses: Since 6 months
• Complaint: C/O cannot see far for distance
since childhood

18. History
• Systemic History: NiL
• Any Medication: NiL
• Allergic to medication: Not aware of
any.
• Accompanied by: Mother and Brother

19. History
• Family History: Positive H/O consangnuity.
1)Brother
Normal
2)Patient
RP
3)Sister
RP
4)Sister
RP
5)Brother
Normal

20. Task Related problem
• Distance Vn task problem: Patient cannot
see TV and Bus No.
• Intermediate Vn task problem:Difficulty in
scanning utensils while cooking.
• Near Vn task problem: Patient can’t read
normal print books.

21. Task Related Problem
• Mobility: Patient can’t go alone in new
place.
• Glare Problem: Delayed dark adaptation.
• Difficulty in Night

22. Quantitative Examination

23. Quantitative Examination
• PGP: (RE): -11.00DS/-1.50DC x 160
(LE): -14.00DS
• Vn(aided): (Distance)
• RE: 1.16 LogMAR
• LE: 1.28 Log MAR NI with PH
• Near Vn: RE: N36
• LE: N24 @12cm

24. Refraction
• Objective:
• Retino: (RE): -8.00/-0.75X180
• (LE): -11.00DS
• Subjective: Acceptance
• RE: -11.00DS/-1.50DCX 160 1.16LogMAR (Vn)
• LE: -14.00DS 1.28LogMAR (Vn)

25. Slit Lamp Examination
(BE)
Eyelid: Flat
Conjuctiva: Normal
Cornea: Clear
Lens: Clear
Ant Chamber: Normal
Fundus: pale optic disc,macula healthy,Bone
spicule pigmentary changes in periphery

26. Qualitative Examination

27. Qualitative Examination
• Contrast sensitivity: (Pelli Robson)
• RE: 0.15
• LE: 0.15 @1mt
• BE: 0.15
• Amsler chart: NA
• Colour Vision: Basic Colour discrimination
present

28. Qualitative Examination
• Visual Field: Confrontation
• RE LE

29. Confrontation test
• Area not seen
•
• Area seen
• Confrontation test is done at one arm distance
with patient’s corresponding eyes.

33. Trial
• Distance: Reverse Galilean telescope.
• Full Field telescope.
• Near: Stand Magnifier 3X 4X
• Hand aheld Magnifier 4X 5X
• Patient is comfortable with Stand magnifier 4X

34. Functional Adaptive devices
• Retinitis Pigmentosa patients are required to
use broad conical beam search light for
mobility.
• Reading stand for heavier books.
• Use foldable cane with light.
• Use large print books.

35. Rehabilitation Centre
• Low Vision Rehabilitation centre

36. Rehabilitation centre
• A low vision centre is incomplete without
Rehabilitation centre.
• Mobility and orientation training: To teach
orientation and mobility and equip one with
techniques to maintain independent lifestyle.
• Patient & Family Counselling/Psychological
consultation:
• The psychiatrist should counsel how to face about
the hardest challenge that is adapting to life with
impaired vision

37. Rehabilitation centre
• Vocational counseling: To help the patient
refer for his disability certification and to further
guide him regarding employment and placements.
• Funding issues: Patient should get help from
NGO or government in finding funding.
• Optical Aids: To be trained how to use
prescribed devices for near and distance.
• Features and Magnification of device should be
explained on how to use them.

38. Management
• Final Prescription:
• RE: -11.00DS/-1.50DCX 160 1.16LogMAR
(Vn)
• LE: -14.00DS 1.28LogMAR (Vn)
• Telescope:
• Near: (BE) Stand Magnifier with 4X N18

39. Management
• Vitamin A and lutien may slow the progress
• Genetic Counselling for no consanguinous
marriage
• Final: Follow up after 6 months
• Continue same glasses