Vitamin A deficiency and the retinal “double carrot” sign with optical coherence tomography

Mark P. Breazzano, Jin Kyun Oh, Sean A. Batson, Julia A. Kucherich, Rabia Karani, Caitlin M. Rohrmann, Janet R. Sparrow, Serena Fragiotta, Stephen H. Tsang

Research output: Contribution to journalArticlepeer-review


Background: Spectral-domain optical coherence tomography (SD-OCT) and full-field electroretinography (ERG) allow retinal assessment with vitamin A deficiency (VAD). Using SD-OCT, this study aimed to characterize and follow a novel retinal abnormality in patients with VAD and intramuscular supplementation. Methods: Patients with VAD were retrospectively reviewed, including SD-OCT and electroretinography. Results: Three patients had VAD following bariatric or colon surgery and varying supplementation. All had nyctalopia, extinguished scotopic rod-specific function with ERG, and decreased serum vitamin A. None demonstrated surface abnormalities. All received intramuscular vitamin A with subjective resolution of symptoms. On SD-OCT, four of six eyes exhibited homogenous foveal hyperreflectivity anterior to retinal pigment epithelium-Bruch complex, reminiscent of a “double carrot”, which improved following supplementation. ERG findings demonstrated improved scotopic rod-specific function in all cases; however, photopic function remained diminished in two cases. Conclusions: Structural improvement of the proposed “double carrot” sign occurs soon after vitamin A supplementation. While scotopic function improves rapidly following supplementation, cone function recovers more slowly. Therefore, foveal changes such as the “double carrot” sign suggest that structural recovery of cones precedes functional recovery.

Original languageEnglish (US)
Pages (from-to)1489-1495
Number of pages7
JournalEye (Basingstoke)
Issue number7
StatePublished - May 2023
Externally publishedYes

ASJC Scopus subject areas

  • Sensory Systems
  • Ophthalmology


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