Uniform white dots are symmetrically distributed in the midportion and periphery of the retina but the central portion of the macula is usually relatively spared in early stages of the disease. These flecks are present in the first decade of life increasing in density and covering larger areas of the retina in older individuals. Difficulties with night vision are also noted early and visual acuity may be compromised, in the range of 20/40. By the fifth and sixth decades there may be retinal pigment atrophy in the midperiphery and this eventually progresses to geographic atrophy of the macular RPE as the visual field becomes more constricted. The fundus in older individuals resembles that seen in retinitis pigmentosa with retinal vascular attenuation, frank bone spicule pigmentation, macular disease, and pallor of the optic nerves with significant loss of vision. The ERG shows reduction in scotopic responses and mild reductions in photopic amplitudes.
This form of flecked retina is sometimes considered to be a variant of fundus albipunctatus (136880). In favor of this argument are the observations in families in which some young members have the fundus picture of fundus albipunctatus (136880) while older ones with more advanced disease have all of the features of retinitis punctata albescens. Also supportive is the fact that mutations in RLBP1 have been identified in both conditions.
However, many individuals with fundus albipunctatus (136880) are described as having a stable disease with night blindness as the major symptom while many patients reported with retinitis albescens clearly have a more progressive and more serious disease with a fundus picture in late stages resembling retinitis pigmentosa. The relationship of these two conditions should become clearer once we learn more about the natural history of these rare disorders.