Suspected case of benign familial fleck retina with functional loss

Abstract

Key Clinical MessageInherited retinal dystrophies typically affect vision in early childhood; however, this case highlights a late onset retinal dystrophy presenting in midlife and the need for extended visual electrophysiology testing to determine the etiology.AbstractA 53‐year‐old female was referred for visual electrophysiology following a routine optometric eye examination in which yellow flecks were noted in both fundi and the patient had reported a recent near accident whilst driving at night. There was no reported family history of eye disease. Retinal examination identified bilateral yellow punctate and irregularly shaped lesions throughout the posterior poles sparing the macula region. Fundus autofluorescence showed coinciding hyperfluorescence with the lesions and bilateral hypofluorescent crescents superior to the macular with corresponding retinal thinning. Visual fields and color vision were normal. ISCEV standard 20 min and extended 60‐min dark adapted electroretinograms were recorded. Recovery to normal b‐wave amplitudes was noted in the DA0.01 flash but reduced a‐wave amplitudes were noted in the DA3 and DA10 flash following both dark adapted periods. Cone function was reduced but within normal limits. Genetic screening revealed a previously unreported variant of unknown significance in the gene PLA2G5:c.40 + 5del (rs1364254561) which is a member of the phospholipase A2 family and is associated with familial benign flecked retina.

The Phospholipase A 2 Superfamily in Health and Disease: From Lipid Signaling to Inflammation, Cancer, and Neurodegeneration

“…sPLA 2 -V protects against metabolic dysfunction by limiting obesity and insulin resistance 51 and has been associated with benign flecked retina. 61 This isoform enhances Th2 immune responses, 62 promotes macrophage phagocytosis via LPE generation, 63 and regulates β-cell proliferation and insulin secretion. 64 …”

The Phospholipase A 2 Superfamily in Health and Disease: From Lipid Signaling to Inflammation, Cancer, and Neurodegeneration

“…sPLA 2 -V protects against metabolic dysfunction by limiting obesity and insulin resistance 51 and has been associated with benign flecked retina. 61 This isoform enhances Th2 immune responses, 62 promotes macrophage phagocytosis via LPE generation, 63 and regulates β-cell proliferation and insulin secretion. 64 …”

The Phospholipase A 2 Superfamily in Health and Disease: From Lipid Signaling to Inflammation, Cancer, and Neurodegeneration

“…sPLA 2 -V protects against metabolic dysfunction by limiting obesity and insulin resistance 51 and has been associated with benign flecked retina. 61 This isoform enhances Th2 immune responses, 62 promotes macrophage phagocytosis via LPE generation, 63 and regulates β-cell proliferation and insulin secretion. 64 …”

The Phospholipase A 2 Superfamily in Health and Disease: From Lipid Signaling to Inflammation, Cancer, and Neurodegeneration

“…sPLA 2 -V protects against metabolic dysfunction by limiting obesity and insulin resistance 51 and has been associated with benign flecked retina. 61 This isoform enhances Th2 immune responses, 62 promotes macrophage phagocytosis via LPE generation, 63 and regulates β-cell proliferation and insulin secretion. 64 …”