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Indian J Ophthalmol. 2019 Apr;67(4):523-529. doi: 10.4103/ijo.IJO_1480_18.

Enhanced S-cone syndrome: Clinical spectrum in Indian population.

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Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, College Road, Chennai, Tamil Nadu, India.



Enhanced S-cone syndrome (ESCS), a rare disorder, is often misdiagnosed as other forms of retinal degenerations, which have a poorer prognosis than ESCS. The aim of this study is to report the varied clinical features of ESCS and distinguish it from other similar disorders.


We retrospectively scrutinized the records of patients with confirmed diagnosis of ESCS and analyzed the findings.


We included 14 patients (age range 4-39 years) who were confirmed to have ESCS according to pathognomonic electroretinography (ERG) showing reduced photopic, combined responses, and 30 Hz flicker with reduced L, M cone responses and supernormal S cone responses. The disease presented in the 1st decade with night blindness and was almost stationary or minimally progressive. Mid-peripheral fundus changes in form of nummular pigmentary alterations, yellow punctate lesions, and macular schisis were noted. The vision ranged from 6/6 to 6/36 with follow-up ranging from 1month to 22 years.


ESCS shows varied clinical features ranging from unremarkable fundus to pigment clumping and atrophic lesions. It has good prognosis with patients mostly maintaining their vision. ERG is diagnostic. More awareness and knowledge about this entity can help to differentiate it from other forms of night blindness.


Electroretinography; enhanced S-cone syndrome; night blindness; retinal degeneration; stationary night blindness

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