Three things go wrong in a Balinese before age 7: the retina, the heart muscle, and the protein handling that fails in systemic amyloidosis. The order below follows the age at which each first becomes visible, not the age at which it becomes obvious: a DNA swab at 8 weeks, an eye exam at 6 months, an echo plus a urine protein at 12 months, then annual repeats. Published rates for this breed are limited on all 3, so the evidence is thin and the numbers are protocol, not prevalence.
8 weeks: one swab settles the eye question
Progressive retinal atrophy is inherited and irreversible, and the commercial panels sold for Siamese-derived lines cover the variants that matter here. Swab at 8 weeks, or any time before breeding. A clear result removes the largest single eye risk from the plan; it does not remove the 6 month exam, because other retinal disease exists. A carrier result changes nothing about the cat's life and everything about the mating plan: pair a carrier only with a clear cat, and expect roughly 50 percent carriers in the litter, none affected.
6 months: what an ophthalmologist can actually see
PRA starts at the back of the eye and moves forward, so the first visible change is a brighter tapetal reflection, then narrowed retinal vessels, then a dilated pupil that stays wide in a lit room. Dilated fundic exam at 6 months, then at 12, then annually; the exam takes 10 minutes and costs less than the DNA test. If the cat is a breeding candidate, add an electroretinogram, which detects loss of rod function before any lesion is visible, at 300 to 600 dollars. Night vision goes first, which is why owners report a cat that stops jumping onto furniture after dusk long before anyone notices blindness.
12 months: echo plus the first urine protein
Hypertrophic cardiomyopathy is the heart item, and the same 12 month echo applies: wall thickness at end-diastole, 6.0 mm as the usual upper limit, 5.5 to 5.9 mm a 6 month recheck, left atrium to aorta ratio 1.5 as the line where the interval shortens and clopidogrel enters the conversation, a platelet inhibitor available only by veterinary prescription. The amyloid item is cheaper and easier to miss: protein in urine. Ask for a urine protein to creatinine ratio, not a dipstick, because a dipstick reads positive on concentrated urine with no disease at all. A ratio under 0.2 is normal, 0.2 to 0.4 is a recheck in 8 weeks, and above 0.4 means a full renal workup with blood pressure, SDMA and sediment.
24 months: the recheck that catches drift
Two normal years do not end screening. At 24 months repeat the echo, the ratio and the fundic exam on 1 visit, then compare the 3 numbers with year 1 rather than reading them alone. A wall that moved from 4.8 to 5.6 mm, a ratio that moved from 0.1 to 0.3, or a vessels score that dropped 1 grade is a trend, and a trend is the finding. Cats with amyloidosis in the kidney often show a ratio rise 6 to 18 months before creatinine leaves the reference range, which is the whole reason to measure it early.
The ladder in one table
| Age | Test | Finds | Repeat every |
|---|---|---|---|
| 8 weeks | PRA DNA panel | inherited retinal variant | 1 time |
| 6 months | Dilated fundic exam | tapetal change, vessel narrowing | 6 months to age 2 |
| 12 months | Echocardiogram | wall 6.0 mm, LA/Ao 1.5 | 12 months |
| 12 months | Urine protein ratio | 0.2 normal, 0.4 proteinuric | 12 months |
| 12 months | Blood pressure | systolic 160 as the line | 12 months |
| 24 months | All 3 repeated | trend across 2 years | 12 months |
Four things you can see at home
- Dusk behaviour. A cat that nails a toy in daylight and misses it at 8 pm is showing rod loss, not laziness. Test weekly with a toy at low light and note the hour.
- Pupil width. In normal room light the pupil should sit at roughly a third of the iris; a pupil that stays over half wide in daylight is a late sign, and 1 photo a month makes it objective.
- Water and clumps. Over 60 ml per kg per day, which is 270 ml for a 4.5 kg cat, or more than 3 clumps a day, is a urine test within 7 days.
- Sleeping respiratory rate. 30 seconds while asleep, doubled. Three readings above 30 per minute in a week moves the echo to within 72 hours.
Emergency thresholds, in hours
| Sign | Threshold | Vet within | Concern |
|---|---|---|---|
| Sudden blindness, both eyes | onset under 24 hours | 12 hours | retinal detachment, hypertension |
| Open-mouth breathing at rest | 1 min or longer | 0 hours, now | heart failure |
| Sleeping respiratory rate | over 40 per min | 1 hour | pulmonary edema |
| Hind limbs cold and dragging | 5 min from onset | 2 hours | aortic thromboembolism |
| No urine, straining | 12 hours | 3 hours | obstruction, uremia |
| Pale gums, collapse | onset to 5 min | 0 hours, now | bleeding, hepatic amyloid |
What the ladder costs
| Item | USD | CNY | When |
|---|---|---|---|
| PRA DNA panel | 60 to 120 | 430 to 870 | once, 8 weeks |
| Dilated fundic exam | 80 to 180 | 400 to 950 | 6, 12, 24 months |
| Electroretinogram | 300 to 600 | 1,500 to 3,200 | breeding cats only |
| Echocardiogram | 250 to 500 | 1,200 to 2,600 | 12 months |
| Urine protein ratio | 40 to 90 | 200 to 450 | 12 months |
| Blood pressure | 30 to 60 | 150 to 320 | 12 months |
| Abdominal fat aspirate | 150 to 400 | 750 to 2,000 | if ratio rises |
CNY figures are mainland clinic prices rather than a currency conversion, and the gap is widest on the electroretinogram, which few Chinese clinics run at all. Year 1 lands at 450 to 950 dollars, and the 3 year total at 1,100 to 2,200, with the eye exam doing most of the cheap work.
Five steps for the first 2 years
- Swab for PRA before the kitten meets the other cats; results take 10 to 14 days.
- Book the 6 month fundic exam with a vet who owns an indirect ophthalmoscope, not every practice does.
- At 12 months, ask for the ratio in numbers and the wall thickness in millimetres on 1 page.
- Photograph the pupils monthly in the same room light, and log the sleeping breath count weekly.
- At 24 months, bring year 1 numbers to the visit; a trend chart beats a single normal result.
The cheapest failure mode here is a cat that sees nothing wrong for 3 years and then arrives with a ratio of 1.2 and a creatinine of 3.4 mg/dL, when the number had been drifting since month 14. Blindness is not an emergency in a cat that adapts, but it is a reason to stop breeding, and hypertension behind a detached retina is treatable if it is found in the same week. For how the same eye and heart items look in 2 related breeds, read the Turkish Van screen and the Tonkinese screen, or use the breed quiz if the pedigree is unreadable.
Terms mentioned in this article
Frequently asked
If the PRA DNA test is clear, can I skip the eye exams?
No. A clear panel removes the inherited variant it covers, which is the biggest single risk, but retinal disease has other causes, including hypertension and later-onset changes. The 6 month dilated exam is 10 minutes and costs less than the swab, and it is the test that catches a problem the DNA panel was never designed to see.
Why a urine protein ratio instead of a dipstick?
A dipstick reacts to protein concentration, so a normal cat with concentrated urine can read positive and a proteinuric cat with dilute urine can read negative. The urine protein to creatinine ratio corrects for urine concentration, which makes 0.2 and 0.4 usable thresholds, and a rising ratio often appears 6 to 18 months before creatinine moves.
How early can amyloidosis be found?
Usually through urine protein, not through imaging or a blood count. A ratio above 0.4 with a rising trend justifies a full renal workup, and in some cats an abdominal fat aspirate confirms the diagnosis. There is no validated DNA test for this breed, so the ratio and the trend carry the screening weight.