• Family history of blindness (can be autosomal recessive, which is more severe, or autosomal dominant, which is more benign)

• Decreased nocturnal vision

• Altered colour vision

• Loss of peripheral vision

• Blurry vision.

• Peripheral retina shows perivascular ‘bone spicule pigmentation’ and arteriolar narrowing (Fig. 207.1). The retinal veins (never the arteries) often have a sheath of pigmentation for part of their course. The pigment spots that lie near the retinal veins are seen to be anterior to them, and so they hide the course of the vessel. (In this respect, they differ from the pigment around the spots of choroidal atrophy in which the retinal vessels can be traced over the spots.)

• Optic disc is pale

• Maculopathy which is atrophic or cystoid.

• Look for polydactyly in the hands and feet (Laurence–Moon–Biedl syndrome)

• Comment on the white walking aid (if any) used by the registered blind

• Tell the examiner that you would like to check visual fields.