This 8 year old boy noticed decreased vision in dim light on Halloween the previous year. He had early difficulty hearing and received a cochlear implant in the right year at age 1 and the left ear at age 3. He did not learn to walk until 22 months. He has a homoplasmic mitochondrial variant A1115G known to be associated with aminoglycoside hearing loss (it is uncertain if he ever received a single dose of aminoglycoside).