• Oppositional defiance disorder
• fluorescein angiogram
• methylphenidate
• optical coherence tomography
• solar maculopathy
• retina
• degeneration
• child health (paediatrics)

A young Caucasian child presented 2 years after diminished visual acuity was first recorded by a primary care physician. The patient had passed school vision tests previously. The patient was unaware of nyctalopia, hemeralopia or diminished colour vision. Since seeking ophthalmic attention, the visual acuity in each eye had fluctuated between 20/50 and 20/150. The patient had first seen a retinal specialist 14 months prior to presentation, and bilateral circumscribed foci of subfoveal retinal pigment epithelium (RPE) altered pigmentation had been noted. Mild bilateral disc elevation, of unknown significance, had also been noted. An ERG had been reported as essentially normal, and an EOG had shown Arden ratios above 2.4 in both eyes. The patient's mother recalled that approximately 2 years before presentation to us, she noticed at least once that the patient had a prolonged period of mydriasis. She took her child to the local emergency room where she was told that the mydriasis was related to methylphenidate use.

There was no relevant family history. The patient had been treated with methylphenidate for attention deficit hyperactivity disorder for 6 years. One year before presentation, an additional diagnosis of oppositional defiance disorder was made. At this stage, the medications were changed to dexmethylphenidate and aripiprazole.

Best corrected visual acuity was 20/80 in the right eye and 20/63 in the left. …