Fluorescein angiography revealed diffuse areas of early hyperfluorescence in both eyes ( See Figure 2). As the disorder in this patient is progressive, the stationary disorder fundus albipunctatus is ruled out. The differential diagnosis of an otherwise healthy young male presenting with nyctalopia and macular and midperipheral subretinal flecks is the family of fleck retinal dystrophies including Stargardt disease, fundus flavimaculatus, retinitis punctata albescens, familial fleck retina, and fleck retina of Kandori, among others. In the right eye there was some pigmentary disruption temporal to the macula, but the posterior pole was otherwise normal with the exception of a depleted nerve fiber layer reflex.
Dilated fundus examination revealed a few scattered macular and midperipheral subretinal flecks in both eyes ( See Figure 1). Ishihara color plates were test plate only in both eyes. Intraocular pressure by applanation tonometry was 10 mmHg OU. Pupillary responses were normal and there was no relative afferent pupillary defect. Visual acuity was 20/25 in the right eye and 20/30 in the left eye. He denied tobacco and illicit drug use, and used alcohol socially. Family history was unremarkable for ophthalmic disease. In the past, he was involved in amateur boxing, but denied any eye trauma during that time. The patient reported having no other medical problems. He was no longer able to drive at night, as his visual responsiveness to an oncoming threat had become significantly impaired.
Additionally, the patient reported that he has had difficulty seeing moving objects over the past six months. A 30-year-old Ukrainian male presented to Wills Eye Institute for the evaluation of progressive nyctalopia over the past three years.
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