RDH5 and hyperinsulinemic hypoglycemia, familial, 4: The presumed accumulation of cis-retinol and cis-retinyl esters in the RPE because of 11-cis-retinol dehydrogenase deficiency is responsible for the formation of white flecks in RDH5 mutation-associated fundus albipunctatus [36, 37] (Figure 7).