Hi XXXXXXX Thank you for posting your query regarding Retinitis Pigmentosa here.


There is, unfortunately, no known cure for the disease as yet. The various treatment options that are being explored are essentially:

1) Modification of the loss of photoreceptors with vitamin and nutritional supplementation. Studies show that patients on vitamin A and E supplements have a slower progression.Vitamin E though is said to be beneficial only in doses of 800IU/dl. Below that can actually be harmful. and those on foods XXXXXXX in Omega 3 fatty acids like fish have a slower rate of progression of RP.

2) Gene therapy which has shown promising results but is still in experimental stages.

3)Stem cell transplantation and even photoreceptor transplantation in animal models are showing progress.

4)Retinal transducers implanted to stimulate the retina is also an avenue explored in animal models.

The only thing that is treatable is perhaps the complications as a result like macular oedema with an oral dose of acetazolamide and cataracts commonly seen in this population, which require cataract extraction.

Hope this helps answer your question.
Feel free to revert if you have anything more I can help you with.

Dr. Naseem.

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Hi,

Thanks for writing back.

Vesoret capsules are antioxidants and vitamins, they are believed to have neuroprotective properties and come under the photoreceptor protection theory.

Long term use of 3 months and off for a month is advocated. Dorzox eye drops are the acetazolamides that may be used in case of some macular edema which is associated with Retinitis Pigmentosa.

However, none of these are definitive and if at all , prevent rapid progression.

You can attach the reports in the query page or you can mail them to YYYY@YYYY intended to me. I shall see them and opine.

Waiting for your response,

Regards,

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Hi XXXXXXX

I have reviewed the reports sent by you.

The OCT and fundus pictures are classic textbook findings of Retinitis Pigmentosa.
OCT of both eyes show Macular Oedema for which Megabrom eye drops has been started. Patients with oedema due to many causes do improve following this medication over a long time. To know degree of improvement, you may be asked to repeat the OCT. There are other treatment options for the oedema. You may be asked to try oral acetazolamide (Diamox) tablets or an intravitreal injection if there is no improvement with Megabrom.

The fundus photograph shows things like disc pallor and bony spicules for which the Ocuguard or any other kind of antioxidant tablet is given. As I stated in my earlier conversation, this retards progression.

Coming to the epiretinal membrane, your vision is excellent in this situation so treatment like membrane peeling which is a surgical procedure is not advised right now. Being aware of distortion of images, flashing lights or a curtain like effect is important because that means it is pulling on the retina. Just make sure you test each eye separately.

Right now, continue the same treatment protocol and follow up more frequently to monitor the oedema and membrane for progression. Disc pallor and bony spicules cannot be controlled.

Do revert back with any further queries.
Regards.

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Hi XXXXXXX

DHA or Docosahexanoeic acid is a kind of Omega 3 fatty acid, which increases the amount of something called Neuroprotectin D synthesis in the retinal cells and retinal pigment epithelium. Essentially, this protects the retinal photoreceptors, which are being damaged in RP and even the brain cells. It is even helpful against macular degeneration.

Simply put, Omega 3 is a protector plus kind of like a delivery truck that carries vitamin A to the rods and from there to the cones.

This means that you need a vitamin A supplement along with the omega 3 to show best improvement. The levels should be 0000 IU of vit A to be useful.

Diets XXXXXXX in omega 3 are MAINLY oily fish. Hopefully you eat fish in which case fatty fish like tuna, salmon, herring, sardines and mackerel are best. You need 2 to 3 ounces of fish per week that means 3 servings per week.
If you cannot have fish, other sources are walnuts and walnut oil, flaxseeds, pumpkin seeds and oil, algae or seaweed and soyabeans. You could try to switch the oil you use to any of these. The amount should be more than 0.2g/ day.
However, fish sources are the best. Fish oil capsules are available and also Neuromins DHA 200mg gel caps once a day.

A combination of the right amount of vitamin A and omega 3 fatty acids over a long time (4 to 6) years shows much less progression of vision and keeps central vision better. However, do not overdose since there can be vitamin A toxicity.

Hope this helps. Do let me know if there is anything else.
Regards.

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Hi XXXXXXX I do not think the attachment of a written summary of your findings have been attached here. I wonder if you could resend the same. I am only able to view certain fundus photographs without a summary of your vision findings. Try and repeat the process of sending the written report.
Regards.

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Hi XXXXXXX
I have received your most recent reports and after evaluating them I believe that as of now your retinal condition is stable from the last time you were examined till now. The oedema at the macula seen with OCT is still present however, hence you have been asked to continue the Dorzox eye drops for further improvement. No other intervention is advised since your central vision for far and near is good.

The mention of a slight lens opacity even though you are young is inevitable in a patient with RP but needs no treatment just yet.

At this stage I would continue what you have been advised and follow up frequently since your central vision is good and any other intervention is not mandated at this stage. As I mentioned earlier, incorporate omega 3 fatty acid foods in your diet as much as you can as studies prove they afford long term protection.

Do let me know if you need any further advice.
Regards.

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