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Bilateral Tapetal Reflex in a 12-Year-Old Girl

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1 Credit CME

Bilateral fundus examination of a 12-year-old girl with visual acuity 6/9, N6 OU, and myopia of −10 diopters in the right eye and −7 diopters in left eye revealed a golden metallic tapetal sheen sparing the central macula and peripheral retina in both eyes (Figure). She had no visual symptoms and no similar family history. Electroretinography (ERG) revealed nonrecordable scotopic responses with normal photopic responses and a negative b wave in dark-adapted 3.0 ERG and 10.0 ERG. A provisional diagnosis of Oguchi disease was made; however, prolonged dark adaptation to evaluate for Mizuo-Nakamura phenomenon could not be done. Oguchi disease is an autosomal recessive form of congenital stationary night blindness.1 It is characterized by a golden-brown fundus with a metallic sheen in the light-adapted state, which disappears after prolonged dark adaptation; this is called the Mizuo-Nakamura phenomenon.2 Tapetal-like reflex is also seen in carriers of X-linked retinitis pigmentosa and in juvenile-linked retinoschisis.3

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Article Information

Corresponding Author: Sashwanthi Mohan, MBBS, DNB, Sankara Nethralaya, No. 41 Old No. 18, College Road, Chennai 600006, India (sashu23@gmail.com).

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient’s mother for granting permission to publish this information.

References
1.
Rishi  P , Rishi  E , Abraham  S .  Oguchi disease with Mizuo-Nakamura phenomenon in a 7-year-old boy.   GMS Ophthalmol Cases. 2018;8:Doc07.PubMedGoogle Scholar
2.
Mittal  K , Chawla  R .  Mizuo-Nakamura phenomena.   Ophthalmic Surg Lasers Imaging Retina. 2016;47(11):1068. doi:10.3928/23258160-20161031-14PubMedGoogle ScholarCrossref
3.
Schatz  P , Bregnhøj  J , Arvidsson  H ,  et al.  A tapetal-like fundus reflex in a healthy male: evidence against a role in the pathophysiology of retinal degeneration?   Mol Vis. 2012;18:1147-1155.PubMedGoogle Scholar
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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