Dark adaptation in vitamin A-deficient adults awaiting liver transplantation: improvement with intramuscular vitamin A treatment.
OBJECTIVE
Although vitamin A deficiency is common in chronic liver disease, limited data exist on impairment of dark adaptation and response to therapy. The aims were (1) to assess dark adaptation in patients, (2) to assess the relationship between dark adaptation and vitamin A status, zinc and Child-Pugh score, (3) to compare perceived and measured dark adaptation and (4) to assess the dark adaptation response to intramuscular vitamin A.


METHODS
This was a prospective study of 20 patients (alcoholic liver disease 10, other parenchymal diseases six, cholestatic diseases four) awaiting liver transplantation. Selection was based on low serum retinol. There were 15 age-matched controls. Dark adaptation was measured with a SST-1 dark adaptometer and perception by questionnaire. Eight patients received 50, 000 IU of retinyl palmitate, and dark adaptation was repeated at 1 month.


RESULTS
Forty per cent of patients had impaired dark adaptation. Patients with alcoholic liver disease were more impaired than those with other parenchymal diseases (p=0.015). No relationship was found between dark adaptation and the biochemical indicators or Child-Pugh score. Seventy-five per cent of patients with impairment did not perceive a problem. After intervention, light of half the previous intensity could be seen (p=0.05).


CONCLUSIONS
Dark-adaptation impairment was common, was worse in alcoholic liver disease, was largely not appreciated by the patients and improved with vitamin A treatment.
Abbott-Johnson
Winsome J
WJ
Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Australia. winsome@universal.net.au
Kerlin
Paul
P
Abiad
Ghassan
G
Clague
Alan E
AE
Cuneo
Ross C
RC
D000328:Adult; D016022:Case-Control Studies; D003623:Dark Adaptation / Q000502:physiology*; D004224:Diterpenes; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D008107:Liver Diseases / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D000084562:Retinyl Esters; D016896:Treatment Outcome; D014801:Vitamin A / Q000008:administration & dosage* / Q000031:analogs & derivatives; D014802:Vitamin A Deficiency / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D014815:Vitamins / Q000008:administration & dosage*; D015032:Zinc / Q000097:blood
D004224:Diterpenes; D000084562:Retinyl Esters; D014815:Vitamins; D014801:Vitamin A; C014794:retinol palmitate; D015032:Zinc