central scotoma

Choroidal Dystrophy, Central Areolar 2

Clinical Characteristics
Ocular Features: 

Slowly progressive loss of vision is noted in the 4th and 6th decades with a mean age of onset at 46 years. ERG recordings suggest that the cone dysfunction is more severe and occurs earlier than rod deterioration.  Night blindness is usually not a major complaint.  A central scotoma is usually present but peripheral fields may be relatively intact.  Dyschromatopsia is often present.  Early in the disease the RPE may have a granular appearance but in later stages there is usually a sharply demarcated area of central RPE atrophy (sometimes called geographic atrophy).

Autoflourescence, pattern ERGs, and fine matrix mapping can reveal abnormalities before patients become symptomatic.

Systemic Features: 

No systemic features are known.

Genetics

This is a clinically and genetically heterozygous disorder.  Multiple mutations in the PRPH2 gene (6p21.1) have been identified in this condition.  Some of the clinical variation may be mutation-specific.

For a somewhat similar disorder see choroidal dystrophy, central areolar 1 (215500).

CACD is a genetically heterogeneous disorder with mutations in several genes responsible.  The majority of patients have one of several mutations in the PRPH2 gene (6p21.1-cen) and the inheritance pattern seems to be autosomal recessive (CACD2).  Other family trees in which mutations in PRPH2 were excluded suggest autosomal dominant inheritance (CACD3; 613144).   

The gene product of PRPH2 is important to the integrity and stability of the structures that contain light-sensitive pigments (e.g., photoreceptors). More than 100 mutations have been identified. The resultant phenotype can be highly variable, even within members of the same family but most affected individuals have some degree of pigmentary retinopathy within the macula or throughout the posterior pole.

The altered gene product resulting from mutations in PRPH2 often leads to symptoms beginning in midlife as a result of the slow degeneration of photoreceptors. This database contains at least 11 disorders in which PRPH2 mutations have been found.

Pedigree: 
Autosomal dominant
Treatment
Treatment Options: 

No effective treatment is known.

References
Article Title: 

Central areolar choroidal dystrophy

Boon CJ, Klevering BJ, Cremers FP, Zonneveld-Vrieling MN, Theelen T, Den Hollander AI, Hoyng CB. Central areolar choroidal dystrophy. Ophthalmology. 2009 Apr;116(4):771-82, 782.e1.

PubMed ID: 
19243827

Cone Dystrophy 3

Clinical Characteristics
Ocular Features: 

The evidence for the existence of pure cone dystrophies is inconclusive.  Certainly some patients at least early in the disease seem to have pure cone dysfunction but eventually rod involvement becomes apparent.  Loss of central acuity and color vision occurs in young adults between the ages of 20 and 40 years.   Symptoms usually worsen with age and most patients eventually are legally blind.  Photophobia is common.  Pigmentary mottling in the retina may be evident before symptoms appear.  Thinning of the retina, especially the macula, is seen late in the disease.  Peripheral visual fields and rod function are often normal for many years although scotopic responses on the ERG eventually become attenuated. 

Systemic Features: 

No systemic disease is associated with cone dystrophies. 

Genetics

There is considerable genetic and clinical heterogeneity in photoreceptor disease.  Heterozygous mutations in the GUCA1A (GCAP1) gene located at 6p21.1 seem to be responsible for this form of cone dystrophy, and inheritance therefore follows an autosomal dominant pattern.  However, mutations in the same gene are also associated with macular dystrophy.  The same region contains the RDS (PRPH2) gene which is also known to cause retinitis pigmentosa (608133) and fundus albipunctatus (136880).  RDS (PRPH2) mutations have also been reported in some cases of so-called adult-onset vitelliform macular dystrophy (AVMD)(608161).

Another autosomal dominant cone dystrophy, RCD1, has been linked to a locus at 6q25-q26 but the gene has not yet been identified (180020).  There is also a cone dystrophy with primarily peripheral involvement (609021). 

Pedigree: 
Autosomal dominant
Treatment
Treatment Options: 

No treatment for the disease is available but low vision aids can be helpful in selected patients.  Red tinted lenses may provide comfort in bright light. 

References
Article Title: 
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