BACKGROUND: Nutritional visual defects are apparently uncommon nowadays in 
developed nations. Retinal change-related visual defects caused by 
hypovitaminoses may be underdiagnosed.
AIM OF THE STUDY: To investigate the retinal structural and functional changes 
in a patient with multivitamin deficiency before and during vitamin 
supplementation.
METHODS: A 51-year-old female had been on vegetarian diet as a child, and on 
restrict vegan diet during the last 2 years, developing severe bilateral 
deterioration of visual function and polyneuropathy. Blood test revealed low 
levels of vitamin A, B6 and D. The patient underwent examinations with optical 
coherence tomography (OCT), computerized visual field examination (VF), 
electroretinography (ERG), visual evoked potentials (VEP) and neurography before 
and after vitamin supplementation.
RESULTS: Visual acuity (VA) was 20/1000 and VF examination showed central 
scotoma in both eyes. Color vision was significantly affected. Full-field ERG 
showed normal rod and cone function, but a clearly reduced central peak was 
registered in multifocal ERG (mf-ERG), indicating impaired fovea function. VEP 
showed delayed latency and low amplitude of P100 in both eyes. Neurography 
showed sensory polyneuropathy. OCT showed significant thinning of macular 
ganglion cell plus inner plexiform layer (GCIPL) with rapid progression. Retinal 
nerve fiber layer (RNFL) was preserved and normal, which is in contrast to 
neuroinflammatory conditions. After 2.5 years of multivitamin supplementation, 
the visual functions were improved. GCIPL thickness was stable without further 
deterioration.
CONCLUSIONS: Multivitamin deficiency results in progressive thinning of GCIPL 
with severe visual deterioration. In contrast to neuroinflammation, RNFL is 
preserved and normal. Stabilized GCIPL during vitamin supplementation was 
associated with improved visual function. OCT provides a sensitive and objective 
measure for differential diagnosis, monitoring retinal change and response to 
therapy.