Vision loss in PXE is usually associated with retinal disease as you mentioned. If there is optic neuropathy, then consider another cause.
Optic nerve drusen is more common in PXE and can be a cause of visual field loss:
http://www.ncbi.nlm.nih.gov/pubmed/...ez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
Am J Ophthalmol. 1991 Aug 15;112(2):166-70.
Disk drusen and angioid streaks in pseudoxanthoma elasticum.
Coleman K, Ross MH, Mc Cabe M, Coleman R, Mooney D.
Royal Victoria Eye and Ear Hospital, Dublin, Ireland.
Visual field loss secondary to optic disk drusen became evident before the development of angioid streaks in a patient with pseudoxanthoma elasticum. The incidence of optic disk drusen in cases of pseudoxanthoma elasticum is 20 to 50 times greater than that in the healthy population. We postulate that the abnormal aggregation of macromolecules with a high affinity for calcium (resulting in abnormalities in elastin in cases of pseudoxanthoma elasticum) also develops at the cribriform plate, disrupting axonal flow and leading to disk drusen formation. Pseudoxanthoma elasticum is associated with marked cardiovascular and gastrointestinal morbidity. Moreover, macular hemorrhage and precipitation of angioid streaks have frequently been noted after trauma. Prompt diagnosis of pseudoxanthoma elasticum will allow necessary prophylaxis and must be considered in patients with optic disk drusen.
PMID: 1867300 [PubMed - indexed for MEDLINE
