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Breazzano MP, Oh JK, Batson SA, Kucherich JA, Karani R, Rohrmann CM, Sparrow JR, Fragiotta S, Tsang SH. Vitamin A deficiency and the retinal "double carrot" sign with optical coherence tomography. Eye (Lond) 2023; 37:1489-1495. [PMID: 35840717 PMCID: PMC10169789 DOI: 10.1038/s41433-022-02137-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 04/30/2022] [Accepted: 06/10/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Spectral-domain optical coherence tomography (SD-OCT) and full-field electroretinography (ERG) allow retinal assessment with vitamin A deficiency (VAD). Using SD-OCT, this study aimed to characterize and follow a novel retinal abnormality in patients with VAD and intramuscular supplementation. METHODS Patients with VAD were retrospectively reviewed, including SD-OCT and electroretinography. RESULTS Three patients had VAD following bariatric or colon surgery and varying supplementation. All had nyctalopia, extinguished scotopic rod-specific function with ERG, and decreased serum vitamin A. None demonstrated surface abnormalities. All received intramuscular vitamin A with subjective resolution of symptoms. On SD-OCT, four of six eyes exhibited homogenous foveal hyperreflectivity anterior to retinal pigment epithelium-Bruch complex, reminiscent of a "double carrot", which improved following supplementation. ERG findings demonstrated improved scotopic rod-specific function in all cases; however, photopic function remained diminished in two cases. CONCLUSIONS Structural improvement of the proposed "double carrot" sign occurs soon after vitamin A supplementation. While scotopic function improves rapidly following supplementation, cone function recovers more slowly. Therefore, foveal changes such as the "double carrot" sign suggest that structural recovery of cones precedes functional recovery.
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Grants
- R01 EY024091 NEI NIH HHS
- R21 AG050437 NIA NIH HHS
- R01 EY018213 NEI NIH HHS
- U01 EY030580 NEI NIH HHS
- U54 OD020351 NIH HHS
- R01 EY026682 NEI NIH HHS
- R24 EY027285 NEI NIH HHS
- P30 CA013696 NCI NIH HHS
- R24 EY028758 NEI NIH HHS
- R01 EY024698 NEI NIH HHS
- P30 EY019007 NEI NIH HHS
- U.S. Department of Health & Human Services | NIH | National Eye Institute (NEI)
- Foundation Fighting Blindness (Foundation Fighting Blindness, Inc.)
- Research to Prevent Blindness (RPB) Physician-Scientist Award, and unrestricted funds from RPB, New York, NY, USA
- U.S. Department of Health & Human Services | NIH | National Cancer Institute (NCI)
- U.S. Department of Health & Human Services | NIH | NIH Office of the Director (OD)
- U.S. Department of Health & Human Services | NIH | National Institute on Aging (U.S. National Institute on Aging)
- The Schneeweiss Stem Cell Fund, New York State [SDHDOH01-C32590GG-3450000], Nancy & Kobi Karp, the Crowley Family Funds, The Rosenbaum Family Foundation, Alcon Research Institute, the Gebroe Family Foundation, the Research to Prevent Blindness (RPB) Physician-Scientist Award, and unrestricted funds from RPB, New York, NY, USA.
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Affiliation(s)
- Mark P Breazzano
- Jonas Children's Vision Care, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY, USA
- Department of Ophthalmology, New York University Langone Health, New York, NY, USA
- Manhattan Eye, Ear and Throat Hospital, Lenox Hill Hospital, Northwell Health, New York, NY, USA
- Wilmer Eye Institute, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Retina-Vitreous Surgeons of Central New York, Liverpool, NY, USA
- Department of Ophthalmology & Visual Sciences, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Jin Kyun Oh
- Jonas Children's Vision Care, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY, USA
| | | | - Julia A Kucherich
- Department of Nutrition & Therapeutic Services, Morgan Stanley Children's Hospital at New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, USA
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Johns Hopkins Hospital, Johns Hopkins Children's Center, Baltimore, MD, USA
| | - Rabia Karani
- Jonas Children's Vision Care, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY, USA
| | - Caitlin M Rohrmann
- Department of Nutrition & Therapeutic Services, Morgan Stanley Children's Hospital at New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, USA
| | - Janet R Sparrow
- Jonas Children's Vision Care, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY, USA
- Department of Pathology & Cell Biology, Columbia University, New York, NY, USA
| | - Serena Fragiotta
- Department of Medical-Surgical Sciences and Biotechnologies, U.O.S.D. Ophthalmology, Sapienza University of Rome, Rome, Italy
| | - Stephen H Tsang
- Jonas Children's Vision Care, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY, USA.
- Department of Pathology & Cell Biology, Columbia University, New York, NY, USA.
- Columbia Stem Cell Initiative, and Institute of Human Nutrition, Columbia University, New York, NY, USA.
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