What is the treatment for yellow to tinted vision in white dot syndrome?

Treatment for Yellow to Tinted Vision in White Dot Syndrome

For patients with yellow to tinted vision associated with white dot syndrome, local and/or oral corticosteroids are the recommended treatment to improve visual symptoms and reduce inflammation. 1

Clinical Presentation and Diagnosis

White dot syndrome (WDS) encompasses a group of inflammatory chorioretinopathies characterized by:

• Rapid onset with progressive marked vision loss and often slow recovery
• Female predominance and relatively young age of onset
• Multiple yellowish-white lesions (placoid) affecting the outer retina, RPE, and choroid
• Hypofluorescent changes on late-phase ICGA

Specific visual symptoms may include:

• Yellow or tinted vision (chromatopsia)
• Visual snow (tiny white and black dots in the visual field)
• Photopsia (flashes of light)
• Enlarged blind spots
• Scotomas (areas of diminished vision)

Treatment Algorithm

First-line Treatment:

1. Corticosteroid Therapy:
   • Local (topical/periocular) and/or oral corticosteroids 1
   • Typical regimen: 0.75 mg/kg/day oral prednisolone tapered over 3 weeks 2
   • Monitor for visual improvement, which can occur rapidly (within 1-3 weeks) 2

Second-line Treatment (for refractory cases):

1. Other systemic immunosuppressive medications when corticosteroids are insufficient or contraindicated 1

Additional Management:

• Anti-VEGF injections only if neovascularization develops as a complication 1
• Regular monitoring for resolution of symptoms and lesions

Evidence and Efficacy

Case reports demonstrate that patients with MEWDS presenting with yellow-tinged vision can experience spontaneous resolution without treatment, but corticosteroid therapy may accelerate recovery 3. In one documented case, a 31-year-old female with MEWDS treated with short-term oral corticosteroids showed improvement in visual acuity from 20/140 to 20/25 within one week, and to 20/20 within three weeks 2.

Prognosis

The prognosis for white dot syndrome is generally favorable:

• Most cases of MEWDS resolve spontaneously within weeks to months
• Visual acuity typically improves from a mean LogMAR BCVA of 0.35 at first visit to 0.01 at last visit 3
• Yellow-tinged vision usually resolves completely with appropriate treatment or spontaneously

Important Considerations and Pitfalls

1. Differential diagnosis is crucial: Multiple conditions can present with similar symptoms:

   • Acute posterior multifocal placoid pigment epitheliopathy (APMPPE)
   • Acute zonal occult outer retinopathy (AZOOR)
   • Birdshot chorioretinopathy
   • Serpiginous choroidopathy

2. Avoid misdiagnosis as visual snow syndrome: Patients with visual snow and yellow-tinged vision should be carefully evaluated for underlying MEWDS before diagnosing primary visual snow syndrome 3

3. Monitor for complications: Although rare, neovascularization can develop and require anti-VEGF therapy 1

4. Consider immunological etiology: These syndromes may represent immunological reactions to previous viral infections in genetically predisposed individuals 4, 5

By following this treatment approach, most patients with yellow to tinted vision in white dot syndrome can expect significant improvement in their visual symptoms and overall quality of life.