These dystrophies are inherited through autosomal dominant, autosomal recessive, and X-linked recessive mechanisms. Patients usually manifest with loss of acuity, central scotomata, and defective color vision. In patients with cone dystrophy, cone ERG recordings are attenuated or extinguished, however rod ERG recordings may be minimally affected in the early stages of the disease.
Patients with cone-rod dystrophies will show markedly reduced or absent cone ERGs and reduced rod ERGs. The changes in both rod and cone ERG function will be determined by the disease type (cone vs. cone-rod) and the stage of the disease.
ERG: Dim Scotopic Flash, Moderate Scotopic Flash, Moderate Photopic Flash
Choroidal atrophy most frequently results in a decrease in acuity and (in the diffuse form) poor night vision, starting at age 40 to 50. Generally, the amplitude of the ERG parallels the clinically apparent fundus involvement. If ERG amplitudes are lower than expected, cone dystrophy should be suspected.
Patients with gyrate atrophy generally present between 20 and 30 years of age with poor night vision. The ERG cone and rod amplitudes are markedly reduced or completely absent. Gyrate atrophy is one of the few progressive night-blinding disorders in which a metabolic defect has been implicated and for which therapeutic trials with a low protein diet are under investigation.