Electrophysiological findings in persons with nyctalopia

Abstract

Introduction: Ophthalmologists are occasionally confronted with an individual presenting with nyctalopia (i.e., a relatively greater difficulty seeing at night). When there is no accompanying abnormality seen in the fundus, visual electrophysiology becomes useful as an objective means of assessing rod (scotopic) photoreceptor function or pathway defects. Materials and Methods: A retrospective study was performed on 50 consecutive patients, aged less than 40 years, with seemingly normal fundi and good vision [visual acuity (VA) >6/12] presenting to the Visual Electrodiagnostic Unit, Singapore National Eye Centre, for the investigation of nyctalopia over a 2-year period. Subjective scotopic threshold sensitivity (STS) and objective full-field electroretinogram (ERG) were performed. Persons with abnormal test results were identified. Results: Normal ERG scotopic responses were obtained in 74% of subjects. There was no significant difference in age, refraction and STS levels between subjects with abnormal and normal ERG. In the group with abnormal scotopic ERG responses, 9 were identified to have non-specific rod dysfunction, 2 had rod-cone dystrophies and 2 had ERG changes suggestive of congenital stationary night blindness (CSNB). Conclusion: A large number of subjects presenting with nyctalopia had normal ERG findings. We can only assume that in these patients, no significant rod pathway dysfunction exists and that optical (e.g., night or instrument myopia) and psychological aetiologies should be considered. The fact that an abnormal result occurs in 26%, however, suggests that ncytalopia should be evaluated with electrophysiolgoical testing even when the fundi appear normal.