Rethinking Vitamin A Deficiency: Its Causes, Ophthalmologic Presentation, and Management Gaps at a New England...

Area of Science:

• Ophthalmology
• Nutrition Science
• Internal Medicine

Background:

• Vitamin A deficiency (VAD) poses risks, including ocular disease, even in high-resource settings.
• Nutritional etiologies, clinical nutrition oversight, and deficiency severity impact outcomes.

Purpose of the Study:

• Evaluate ocular disease and eye care utilization in adults with VAD.
• Emphasize nutritional causes, clinical nutrition management, and outcomes related to VAD severity.

Main Methods:

• Retrospective chart review of adults with measured serum retinol concentrations (2019-2022).
• Detailed review for patients with VAD (serum retinol <32.5 µg/dL), including nutritional risk factors and ophthalmologic findings.
• Assessment of ocular symptoms, duration of deficiency, and vitamin A treatment.

Main Results:

• VAD identified in 27.7% of tested patients; 330 below WHO threshold (<20 µg/dL).
• Common causes include cirrhosis, post-bariatric surgery malabsorption, and pancreatic insufficiency.
• Only 9.6% with VAD had ophthalmologic evaluation; 21% showed xerophthalmia signs; 18% had corneal findings. Mortality strongly associated with VAD severity (p < 0.001).

Conclusions:

• VAD is prevalent in at-risk adults, driven by nutrition-related absorption and metabolism issues.
• VAD is underrecognized and undertreated, with infrequent links to ocular evaluation despite mortality risks.
• Highlights gaps in nutrition screening, interdisciplinary communication, and vitamin A assessment for complex adults.