Highlights & Basics
- Night blindness can be caused by many disease processes, both inherited and acquired. Differentials that may cause blurred vision, and that are made worse by low light levels (e.g., cataracts, myopia, glaucoma) should be distinguished from true night blindness.
- Commonly reported by patients with inherited retinal or choroidal dystrophies; rarely associated with an underlying malignancy.
- Slit-biomicroscopy and electroretinography are often essential in narrowing the differential diagnosis.
- Vitamin A deficiency can cause night blindness and is often overlooked in patients with malabsorption and malnutrition.
- Vitamin A can treat both genetic and acquired night blindness.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Citations
Hartong DT, Berson EL, Dryja TP. Retinitis pigmentosa. Lancet. 2006 Nov 18;368(9549):1795-809.[Abstract]
Petzold A, Plant GT. Clinical disorders affecting mesopic vision. Ophthalmic Physiol Opt. 2006 May;26(3):326-41.[Abstract]
Goodwin P. Hereditary retinal disease. Curr Opin Ophthalmol. 2008 May;19(3):255-62.[Abstract]
Law WC, Rando RR. The molecular basis of retinoic acid induced night blindness. Biochem Biophys Res Commun. 1989 Jun 15;161(2):825-9.[Abstract]
- Cochrane Eyes and Vision Group: glossary
- WHO: global prevalence of vitamin A deficiency in populations at risk 1995-2005
- UN Standing Committee on Nutrition
- Retina UK: research
- American Academy of Ophthalmology. Eye health: what is retinitis pigmentosa?
- Retina UK
- Royal National Institute of Blind People
1. Joshi D, Dhawan A, Baker AJ, et al. An atypical presentation of cystic fibrosis: a case report. J Med Case Reports. 2008 Jun 12;2:201. [Abstract][Full Text]
2. Lee WB, Hamilton SM, Harris JD, et al. Ocular complications of hypovitaminosis A after bariatric surgery. Ophthalmology. 2005 Jun;112(6):1031-4.[Abstract]
3. Hartong DT, Berson EL, Dryja TP. Retinitis pigmentosa. Lancet. 2006 Nov 18;368(9549):1795-809.[Abstract]
4. Petzold A, Plant GT. Clinical disorders affecting mesopic vision. Ophthalmic Physiol Opt. 2006 May;26(3):326-41.[Abstract]
5. Khan N, Huang JJ, Foster CS. Cancer associated retinopathy (CAR): an autoimmune-mediated paraneoplastic syndrome. Semin Ophthalmol. 2006 Jul-Sep;21(3):135-41.[Abstract]
6. Goodwin P. Hereditary retinal disease. Curr Opin Ophthalmol. 2008 May;19(3):255-62.[Abstract]
7. Ferrari S, Di Iorio E, Barbaro V, et al. Retinitis pigmentosa: genes and disease mechanisms. Curr Genomics. 2011 Jun;12(4):238-49.[Abstract][Full Text]
8. Jayaram H, Downes SM. Midlife diagnosis of Refsum disease in siblings with retinitis pigmentosa--the footprint is the clue: a case report. J Med Case Reports. 2008 Mar 12;2:80.[Abstract][Full Text]
9. Zeitz C, Robson AG, Audo I. Congenital stationary night blindness: an analysis and update of genotype-phenotype correlations and pathogenic mechanisms. Prog Retin Eye Res. 2015 Mar;45:58-110.[Abstract][Full Text]
10. World Health Organization. Xerophthalmia and night blindness for the assessment of clinical vitamin A deficiency in individuals and populations. 2014 [internet publication].[Full Text]
11. McCauley ME, van den Broek N, Dou L, et al. Vitamin A supplementation during pregnancy for maternal and newborn outcomes. Cochrane Database Syst Rev. 2015 Oct 27;(10):CD008666.[Abstract][Full Text]
12. Sommer A. Vitamin A deficiency and clinical disease: an historical overview. J Nutr. 2008 Oct;138(10):1835-9.[Abstract][Full Text]
13. Law WC, Rando RR. The molecular basis of retinoic acid induced night blindness. Biochem Biophys Res Commun. 1989 Jun 15;161(2):825-9.[Abstract]
14. Potter MJ, Thirkill CE, Dam OM, et al. Clinical and immunocytochemical findings in a case of melanoma-associated retinopathy. Ophthalmology. 1999 Nov;106(11):2121-5.[Abstract]
15. Javadzadeh A, Gharabaghi D. Gyrate atrophy of the choroid and retina with hyper-ornithinemia responsive to vitamin B6: a case report. J Med Case Reports. 2007 Jun 12;1:27.[Abstract][Full Text]
16. Renner AB, Kellner U, Cropp E, et al. Choroideremia: variability of clinical and electrophysiological characteristics and first report of a negative electroretinogram. Ophthalmology. 2006 Nov;113(11):2066.e1-10. [Abstract]
17. UK Government Office for Health Improvement and Disparities. Vitamin A: migrant health guide. Advice and guidance on the health needs of migrant patients for healthcare practitioners. May 2021 [internet publication].[Full Text]
18. UK National Health Service. Vitamins and minerals: vitamins for children. April 2021 [internet publication]. [Full Text]
19. Radhika MS, Bhaskaram P, Balakrishna N, et al. Effects of Vitamin A deficiency during pregnancy on maternal and child health. BJOG. 2002 Jun;109(6):689-93.[Abstract]
20. Mayo-Wilson E, Imdad A, Herzer K, et al. Vitamin A supplements for preventing mortality, illness, and blindness in children aged under 5: systematic review and meta-analysis. BMJ. 2011 Aug 25;343:d5094.[Abstract][Full Text]
21. Imdad A, Mayo-Wilson E, Haykal MR, et al. Vitamin A supplementation for preventing morbidity and mortality in children from six months to five years of age. Cochrane Database Syst Rev. 2022 Mar 16;3(3):CD008524.[Abstract][Full Text]
22. UK National Health Service. Vitamins and minerals: vitamin A. August 2020 [internet publication].[Full Text]
23. Alio JL, Pinero D, Muftuoglu O. Corneal wavefront-guided retreatments for significant night vision symptoms after myopic laser refractive surgery. Am J Ophthalmol. 2008 Jan;145(1):65-74.[Abstract]
24. Stone EM, Andorf JL, Whitmore SS, et al. Clinically focused molecular investigation of 1000 consecutive families with inherited retinal disease. Ophthalmology. 2017 Sep;124(9):1314-31.[Abstract][Full Text]
25. Genead MA, Fishman GA, Lindeman M. Fundus white spots and acquired night blindness due to vitamin A deficiency. Doc Ophthalmol. 2009 Dec;119(3):229-33.[Abstract]
26. Byron LL (ed.) Electrophysiology of vision: clinical testing and applications. 1st ed. Boca Raton: CRC Press; 2005.
27. Yanoff M, Duker JS. Ophthalmology. 4th ed. Saunders; 2013.
28. Robson AG, Frishman LJ, Grigg J, et al. ISCEV Standard for full-field clinical electroretinography (2022 update). Doc Ophthalmol. 2022 Jun;144(3):165-77.[Abstract][Full Text]
29. Tanumihardjo SA. Assessing vitamin A status: past, present and future. J Nutr. 2004 Jan;134(1):290S-293S.[Abstract][Full Text]
30. Charman WN. Night myopia and driving. Ophthalmic Physiol Opt. 1996 Nov;16(6):474-85.[Abstract]
31. Owsley C, Jackson GR, White M, et al. Delays in rod-mediated dark adaptation in early age-related maculopathy. Ophthalmology. 2001 Jul;108(7):1196-202.[Abstract]
32. American Academy of Opthalmology. Pediatric eye evaluations: Preferred Practice Pattern. 2022 [internet publication].[Full Text]
33. American Academy of Opthalmology. Comprehensive adult medical eye evaluation: Preferred Practice Pattern. 2020 [internet publication].[Full Text]
34. American Academy of Opthalmology. Policy statement: frequency of ocular examinations. March 2015 [internet publication].[Full Text]
35. Bastos Maia S, Rolland Souza AS, Costa Caminha MF, et al. Vitamin A and pregnancy: a narrative review. Nutrients. 2019 Mar 22;11(3):681.[Abstract][Full Text]
36. Berson EL, Rosner B, Sandberg MA, et al. Vitamin A supplementation for retinitis pigmentosa. Arch Ophthalmol. 1993 Nov;111(11):1456-9.[Abstract]
37. Massof RW, Fishman GA. How strong is the evidence that nutritional supplements slow the progression of retinitis pigmentosa? Arch Ophthalmol. 2010 Apr;128(4):493-5.[Abstract]
38. Schwartz SG, Wang X, Chavis P, et al. Vitamin A and fish oils for preventing the progression of retinitis pigmentosa. Cochrane Database Syst Rev. 2020 Jun 18;6(6):CD008428.[Abstract][Full Text]
39. Welsh BM, Smith AL, Elder JE, et al. Night blindness precipated by isotretinoin in the setting of hypovitaminosis A. Australas J Dermatol. 1999 Nov;40(4):208-10.[Abstract]
40. Russell S, Bennett J, Wellman JA, et al. Efficacy and safety of voretigene neparvovec (AAV2-hRPE65v2) in patients with RPE65-mediated inherited retinal dystrophy: a randomised, controlled, open-label, phase 3 trial. Lancet. 2017 Aug 26;390(10097):849-60.[Abstract][Full Text]
41. Bainbridge JW, Mehat MS, Sundaram V, et al. Long-term effect of gene therapy on Leber's congenital amaurosis. N Engl J Med. 2015 May 4;372(20):1887-97.[Abstract][Full Text]
42. Jacobson SG, Cideciyan AV, Roman AJ, et al. Improvement and decline in vision with gene therapy in childhood blindness. N Engl J Med. 2015 May 14;372(20):1920-6.[Abstract][Full Text]
43. Bennett J, Wellman J, Marshall KA, et al. Safety and durability of effect of contralateral-eye administration of AAV2 gene therapy in patients with childhood-onset blindness caused by RPE65 mutations: a follow-on phase 1 trial. Lancet. 2016 Aug 13;388(10045):661-72.[Abstract][Full Text]
44. MacLaren RE, Groppe M, Barnard AR, et al. Retinal gene therapy in patients with choroideremia: initial findings from a phase 1/2 clinical trial. Lancet. 2014 Mar 29;383(9923):1129-37.[Abstract][Full Text]
45. Dimopoulos IS, Hoang SC, Radziwon A, et al. Two-year results after AAV2-mediated gene therapy for choroideremia: the Alberta experience. Am J Ophthalmol. 2018 Sep;193:130-42.[Abstract]
46. Cross N, van Steen C, Zegaoui Y, et al. Current and future treatment of retinitis pigmentosa. Clin Ophthalmol. 2022 Aug 31;16:2909-21.[Abstract][Full Text]
47. Berson EL, Rosner B, Sandberg MA, et al. Clinical trial of docosahexaenoic acid in patients with retinitis pigmentosa receiving vitamin A treatment. Arch Ophthalmol. 2004 Sep;122(9):1297-305.[Abstract]
48. Hoffman DR, Locke KG, Wheaton DH, et al. A randomized, placebo-controlled clinical trial of docosahexaenoic acid supplementation for X-linked retinitis pigmentosa. Am J Ophthalmol. 2004 Apr;137(4):704-18.[Abstract]
49. Berson EL, Rosner B, Sandberg MA, et al. Further evaluation of docosahexaenoic acid in patients with retinitis pigmentosa receiving vitamin A treatment: subgroup analyses. Arch Ophthalmol. 2004 Sep;122(9):1306-14.[Abstract]
50. Hoffman DR, Hughbanks-Wheaton DK, Pearson NS, et al. Four-year placebo-controlled trial of docosahexaenoic acid in X-linked retinitis pigmentosa (DHAX trial): a randomized clinical trial. JAMA Ophthalmol. 2014 Jul;132(7):866-73.[Abstract][Full Text]
51. Jackson ML, Virgili G, Shepherd JD, et al. Vision rehabilitation preferred practice pattern®. Ophthalmology. 2023 Mar;130(3):P271-335.
