Differential Diagnosis for Seeing Different Colors

The patient's complaint of seeing less vivid colors in one eye suggests a potential issue with the visual pathway. Here's a differential diagnosis, categorized for clarity:

• Single most likely diagnosis
  • Cataract: A cataract in the affected eye can cause a decrease in color perception, making colors appear less vivid. This is a common condition, especially in older adults, and can be diagnosed with a slit-lamp examination.
• Other Likely diagnoses
  • Age-related macular degeneration (AMD): AMD can affect color vision, especially in the advanced stages. It's a leading cause of vision loss in older adults and can be diagnosed with optical coherence tomography (OCT) and fundus examination.
  • Diabetic retinopathy: This condition can cause color vision changes, particularly if there's significant retinal damage. A comprehensive eye exam, including fundus photography and OCT, can help diagnose diabetic retinopathy.
  • Glaucoma: Certain types of glaucoma, such as congenital or angle-closure glaucoma, can affect color vision. A thorough eye exam, including visual field testing and optic disc evaluation, is necessary for diagnosis.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Optic neuritis: This condition, often associated with multiple sclerosis, can cause sudden vision loss, including changes in color perception. Prompt diagnosis and treatment are crucial to prevent long-term vision damage.
  • Retinal detachment: A retinal detachment can cause sudden changes in vision, including color perception. Immediate medical attention is necessary to prevent permanent vision loss.
• Rare diagnoses
  • Achromatopsia: A rare genetic disorder that affects the retina, causing sensitivity to light, blurred vision, and reduced color vision. Diagnosis is typically made in childhood, but some cases may be diagnosed later in life.
  • Cone dystrophy: A group of rare genetic disorders that affect the cone cells in the retina, leading to progressive vision loss and color vision defects. Diagnosis is often made with electroretinography (ERG) and genetic testing.