Retinitis natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Ilan Dock, B.S.Jyostna Chouturi, M.B.B.S [2]
Overview
If left untreated, patients with retinitis may progress to develop limited vision, night blindness, and blindness. Common complications may vary according to the underlying cause of the disease. Retinal genetic disorders, such as retinitis pigmentosa, will often lead to highly restricted tunnel-like vision. Retinitis as a result of an infectious agent may imply far more serious complications including respiratory or central nervous system infections. The prognosis is usually good for individuals with retinitis resulting form an infectious agent. Most often the symptoms and complication will subside with proper treatment. Certain infections such as tuberculosis and cytomegalovirus require closer attention during and after treatment. Retinal genetic disorders, unfortunately, lack treatment. Thus individuals suffering from retinal genetic disorders, such as retinitis pigmentosa, will most likely experience mild to severe vision loss.
Natural History
Retinitis Pigmentosa
- Retinitis pigmentosa progresses slowly and with much variation.
- There is no way of predicting the exact progression of vision loss with retinitis pigmentosa. However, future severity of the disease may be quantified by the severity of present symptoms.
Early Phase
- Often begins with floaters, progresses into tunnel vision and restriction of the patient's visual fields.
Later Phase
- As the disease progresses, patient's will suffer from very small visual fields, due to tunnel vision.
- Patients rarely become fully blind. Legal blindness is usually a result of highly restricted vision or, uncommonly, blurred vision.
Infectious Agents
- Depending on the infectious agent, retinitis will most often occur in later stages of infection.
- For many of these infections, retinitis is considered a potential complication, rather than the primary area of infection.
- Disease progression in the retinal tissue will begin with lesions, necrotizing granulomas, or infiltrates. Followed by a period of scarring, blindness, or retinal detachment.
Complications
Retinitis Pigmentosa
- Night blindness or nyctalopia
- Tunnel vision (due to loss of peripheral vision)
- Latticework vision
- Photopsia (blinking/shimmering lights)
- Photophobia (Aversion to glare)
- Development of bone spicules in the fundus
- Slow adjustment from dark to light environments and vice versa
- Blurred vision
- Poor color separation
- Loss of central vision
- Eventual blindness
Infectious Agents
- Retinitis is often an ocular complication associated with the progression of a disease.
- Possible general complications would include retinal detachment, scarring of the retinal tissue, and potential blindness.
- In the case of tuberculosis, necrotizing granulomas may cause permanent damage to retinal tissue.
- An ocular fungal infection is often a sign of potential complications in the respiratory tract.
- Ocular cytomegalovirus may be an indicator of a CNS-based cytomegalovirus infection.
Prognosis
Retinitis Pigmentosa
- The progressive nature and lack of a definitive cure for retinitis pigmentosa contributes to the discouraging outlook for patients with this disease.
- While complete blindness is rare,[1] the patient's visual acuity and visual field will continue to decline as initial rod cell photoreceptors and later cone cell photoreceptors degrade.
- While the psychological prognosis can be slightly alleviated with active counseling,[2] the physical implications and progression of the disease depend largely on the age of initial symptom manifestation and the rate of photoreceptor degradation.
Infectious Disease
- The prognosis for a retinitis infection caused by an infectious agent can vary depending on the amount of progression of the infection as well as the infection itself.
- Patients suffering from an HIV infection are at risk of retinal detachment when suffering from an ocular cytomegalovirus infection.
- Proper treatment may reduce the symptoms of an ocular CMV infection, however uveitis and chronic inflammation may persist after initial treatment.
- A poor prognosis for a patient with CMV retinitis is often a combination of a compromised immune-system and improper, poorly bioavailable therapy that results in a potential drug resistance.
- The prognosis for toxoplasmosis is usually good in immuno-competent patients.
- A poor prognosis may result from macular involvement in a toxoplasmosis infection of the retina.
- A tuberculosis infection of the retina tends to have a good prognosis.
- Proper treatment of tuberculosis will often lead to a full recovery, yet must be monitored over the course of treatment.
- A poor prognosis is usually the result of multi-drug-resistant tuberculosis.
- The prognosis for ocular syphilis depends on the progression of the disease.
- Since ocular syphilis is usually paired with neurosyphilis, the prognosis can be poor. However with proper, early, and effective treatment, a patient may experience a visual expansion as well as improvements with visual acuity.
References
- ↑ http://www.nytimes.com/health/guides/disease/retinitis-pigmentosa/overview.html
- ↑ "Attitudes regarding predictive testing for retinitis pigmentosa". Ophthalmic Genet. 28: 9–15. 2007. doi:10.1080/13816810701199423. PMID 17454742.