Long-term visual prognoses in patients with retinitis pigmentosa: the Ludwig von Sallmann lecture

Retinitis pigmentosa can be followed over almost its entire course with narrow bandpassed, computer averaged cone electroretinograms (ERGs). The long-term rate of decline of these responses can be described by an exponential function. A cone ERG actuarial table based on 1039 patients and 6553 visits is presented to show the estimated number of years for an average patient with a given 30-Hz cone ERG amplitude to decline to 0.05 microV (i.e. virtual blindness). The table is based on a projected rate of loss of 10% of remaining cone ERG amplitude per year for those not on treatment and 8.3% per year for those on treatment with vitamin A palmitate 15,000 IU/day. The table can be used to provide an estimate of the average long-term visual prognosis from a single visit; more precise estimates for a specific patient require several additional visits over 2- to 3-year intervals. Evidence is presented to support the idea that patients with a projected cone amplitude of 3.5 microV or greater at age 40 (about 25% of our patient population with typical retinitis pigmentosa) would be expected, on average, to retain some useful vision for their entire lives without treatment. Knowledge of the amount of remaining cone function in the ERG often reduces patient anxiety and helps patients plan for their future.