Blue Cone Monochromacy

Clinical Characteristics
Ocular Features: 

This is usually a stationary cone dysfunction disorder in which the causative mechanism has yet to be worked out.  Typical patients have severe visual impairment from birth and some have pendular nystagmus and photophobia similar to other achromatopsia disorders.  Vision seems to be dependent solely on blue cones and rod photoreceptors.  The ERG always shows relatively normal rod function whereas the cones are usually dysfunctional. 

In some families, however, there is evidence of disease progression with macular RPE changes and myopia.  This has led to the designation of 'cone dystrophy 5' for such cases even though the mutation locus impacts the same cone opsin genes at Xq28 that are implicated in the more typical BCM phenotype.

Systemic Features: 

None.

Genetics

This is an X-linked recessive form of colorblindness in which DNA changes in the vicinity of Xq28 alters the red and green visual pigment cluster genes via recombination or point mutations.  Alternatively, the control locus adjacent to the cluster may be altered.  In either case, the result may be a loss of function of these genes leaving blue-cone monochromacy.

The mutation for cone dystrophy 5 maps to Xq26.1-qter but the locus encompasses the opsin gene complex at Xq28 as well. 

At least a quarter of individuals with blue cone monochromacy, however, do not have mutations in the vicinity of Xq28 suggesting that additional genetic heterogeneity remains.

Treatment
Treatment Options: 

Low vision aids can be helpful.  Tinted lenses for photophobia allow for greater visual comfort.  A magenta (mixture of red and blue) tint allows for best visual acuity since it protects the rods from saturation while allowing the blue cones to be maximally stimulated. 

References
Article Title: 

X-linked cone dystrophy caused by mutation of the red and green cone opsins

Gardner JC, Webb TR, Kanuga N, Robson AG, Holder GE, Stockman A, Ripamonti C, Ebenezer ND, Ogun O, Devery S, Wright GA, Maher ER, Cheetham ME, Moore AT, Michaelides M, Hardcastle AJ. X-linked cone dystrophy caused by mutation of the red and green cone opsins. Am J Hum Genet. 2010 Jul 9;87(1):26-39.

PubMed ID: 
20579627

Genetic heterogeneity among blue-cone monochromats

Nathans J, Maumenee IH, Zrenner E, Sadowski B, Sharpe LT, Lewis RA, Hansen E, Rosenberg T, Schwartz M, Heckenlively JR, et al. Genetic heterogeneity among blue-cone monochromats. Am J Hum Genet. 1993 Nov;53(5):987-1000.

PubMed ID: 
8213841

Molecular genetics of human blue cone monochromacy

Nathans J, Davenport CM, Maumenee IH, Lewis RA, Hejtmancik JF, Litt M, Lovrien E, Weleber R, Bachynski B, Zwas F, et al. Molecular genetics of human blue cone monochromacy. Science. 1989 Aug 25;245(4920):831-8.

PubMed ID: 
2788922

References

Gardner JC, Webb TR, Kanuga N, Robson AG, Holder GE, Stockman A, Ripamonti C, Ebenezer ND, Ogun O, Devery S, Wright GA, Maher ER, Cheetham ME, Moore AT, Michaelides M, Hardcastle AJ. X-linked cone dystrophy caused by mutation of the red and green cone opsins. Am J Hum Genet. 2010 Jul 9;87(1):26-39.

PubMedID: 20579627

Nathans J, Maumenee IH, Zrenner E, Sadowski B, Sharpe LT, Lewis RA, Hansen E, Rosenberg T, Schwartz M, Heckenlively JR, et al. Genetic heterogeneity among blue-cone monochromats. Am J Hum Genet. 1993 Nov;53(5):987-1000.

PubMedID: 8213841

Nathans J, Davenport CM, Maumenee IH, Lewis RA, Hejtmancik JF, Litt M, Lovrien E, Weleber R, Bachynski B, Zwas F, et al. Molecular genetics of human blue cone monochromacy. Science. 1989 Aug 25;245(4920):831-8.

PubMedID: 2788922