To the Editor.
—I would like to suggest a different diagnosis for the case presented by DuBois et al1 in the August 1988 issue of the Archives. The patient was, in fact, suffering from uncomplicated, early retinitis pigmentosa (RP), not vascular insufficiency caused by complicated migraine.The patient's electroretinogram was typical for RP but inconsistent with vascular insufficiency. The cone responses had a mildly delayed implicit time and a mildly reduced B-wave amplitude that was about 70% of normal. With a response amplitude of about 5% to 10% of normal, the rod was severely impaired. There is no possible vascular insult that could destroy simultaneously all the rods in both eyes while largely sparing the cones.The other findings were also classic for RP. The patient's final dark-adapted threshold was elevated. The visual fields were not shown, but they were described as constricted with what sounds like partial-ring scotomata,
MacKay CJ. Retinitis Pigmentosa Misdiagnosed as Complicated Migraine. Arch Ophthalmol. 1991;109(2):174–175. doi:10.1001/archopht.1991.01080020020008
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