Retinitis Pigmentosa - Late Onset

This 49-year-old patient complained of a gradual decrease in vision in both eyes. She also complained of trouble driving at night for approximately two years. She noticed trouble with peripheral vision in the left eye recently. Her external exam and slit lamp exam were unremarkable with the exception of trace cataracts in both eyes. The fundus exam revealed retinal pigment epithelium mottling and bone spicule pigment hyperplasia in the periphery; the left eye was worse than the right eye (turquoise arrows top row of images). Although the patient denied any family history of retinitis pigmentosa, these findings were indicative for a mild, late onset of the disease. Electroretinography (bottom row of images) showed decreased amplitudes of both rod and cone mediated waveforms in both eyes, left worse than right.