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Leber congenital amaurosis 1(LCA1)

MedGen UID:
419026
Concept ID:
C2931258
Disease or Syndrome
Synonyms: AMAUROSIS CONGENITA OF LEBER I; Congenital absence of the rods and cones; GUCY2D-Related Leber Congenital Amaurosis; LCA1; Leber's congenital tapetoretinal degeneration; Leber's congenital tapetoretinal dysplasia; Retinal blindness, congenital
 
Gene (location): GUCY2D (17p13.1)
 
Monarch Initiative: MONDO:0008764
OMIM®: 204000

Definition

Leber congenital amaurosis is also associated with other vision problems, including an increased sensitivity to light (photophobia), involuntary movements of the eyes (nystagmus), and extreme farsightedness (hyperopia). The pupils, which usually expand and contract in response to the amount of light entering the eye, do not react normally to light. Instead, they expand and contract more slowly than normal, or they may not respond to light at all.

Leber congenital amaurosis, also known as LCA, is an eye disorder that is present from birth (congenital). This condition primarily affects the retina, which is the specialized tissue at the back of the eye that detects light and color. People with this disorder typically have severe visual impairment beginning at birth or shortly afterward. The visual impairment tends to be severe and may worsen over time.

A specific behavior called Franceschetti's oculo-digital sign is characteristic of Leber congenital amaurosis. This sign consists of affected individuals poking, pressing, and rubbing their eyes with a knuckle or finger. Poking their eyes often results in the sensation of flashes of light called phosphenes. Researchers suspect that this behavior may contribute to deep-set eyes in affected children.

In very rare cases, delayed development and intellectual disability have been reported in people with the features of Leber congenital amaurosis. Because of the visual loss, affected children may become isolated. Providing children with opportunities to play, hear, touch, understand and other early educational interventions may prevent developmental delays in children with Leber congenital amaurosis.

At least 20 genetic types of Leber congenital amaurosis have been described. The types are distinguished by their genetic cause, patterns of vision loss, and related eye abnormalities. [from MedlinePlus Genetics]

Clinical features

From HPO
Hyperthreoninuria
MedGen UID:
436041
Concept ID:
C2673931
Finding
An increased concentration of threonine in the urine.
Growth delay
MedGen UID:
99124
Concept ID:
C0456070
Pathologic Function
A deficiency or slowing down of growth pre- and postnatally.
Hepatomegaly
MedGen UID:
42428
Concept ID:
C0019209
Finding
Abnormally increased size of the liver.
Sensorineural hearing loss disorder
MedGen UID:
9164
Concept ID:
C0018784
Disease or Syndrome
A type of hearing impairment in one or both ears related to an abnormal functionality of the cochlear nerve.
Photophobia
MedGen UID:
43220
Concept ID:
C0085636
Sign or Symptom
Excessive sensitivity to light with the sensation of discomfort or pain in the eyes due to exposure to bright light.
Eye poking
MedGen UID:
115926
Concept ID:
C0233593
Mental or Behavioral Dysfunction
Repetitive pressing, poking, and/or rubbing in the eyes.
Intellectual disability
MedGen UID:
811461
Concept ID:
C3714756
Mental or Behavioral Dysfunction
Intellectual disability, previously referred to as mental retardation, is characterized by subnormal intellectual functioning that occurs during the developmental period. It is defined by an IQ score below 70.
Inherited threoninemia
MedGen UID:
336439
Concept ID:
C1848861
Finding
An increased concentration of threonine in the blood.
Keratoconus
MedGen UID:
44015
Concept ID:
C0022578
Disease or Syndrome
A cone-shaped deformity of the cornea characterized by the presence of corneal distortion secondary to thinning of the apex.
Night blindness
MedGen UID:
10349
Concept ID:
C0028077
Disease or Syndrome
Inability to see well at night or in poor light.
Nystagmus
MedGen UID:
45166
Concept ID:
C0028738
Disease or Syndrome
Rhythmic, involuntary oscillations of one or both eyes related to abnormality in fixation, conjugate gaze, or vestibular mechanisms.
Optic disc drusen
MedGen UID:
14495
Concept ID:
C0029128
Disease or Syndrome
Optic disc drusen are acellular, calcified deposits within the optic nerve head. Optic disc drusen are congenital and developmental anomalies of the optic nerve head, representing hyaline-containing bodies that, over time, appear as elevated, lumpy irregularities on the anterior portion of the optic nerve.
Cataract
MedGen UID:
39462
Concept ID:
C0086543
Disease or Syndrome
A cataract is an opacity or clouding that develops in the crystalline lens of the eye or in its capsule.
Reduced visual acuity
MedGen UID:
65889
Concept ID:
C0234632
Finding
Diminished clarity of vision.
Blindness
MedGen UID:
99138
Concept ID:
C0456909
Disease or Syndrome
Blindness is the condition of lacking visual perception defined as a profound reduction in visual perception. On the 6m visual acuity scale, blindness is defined as less than 3/60. On the 20ft visual acuity scale, blindness is defined as less than 20/400. On the decimal visual acuity scale, blindness is defined as less than 0.05. Blindness is typically characterized by a visual field of no greater than 10 degrees in radius around central fixation.
Decreased light- and dark-adapted electroretinogram amplitude
MedGen UID:
326793
Concept ID:
C1839025
Finding
Decreased amplitude of eletrical response upon electroretinography.
Fundus atrophy
MedGen UID:
382226
Concept ID:
C2673929
Finding
Attenuation of retinal blood vessels
MedGen UID:
480605
Concept ID:
C3278975
Finding
Pigmentary retinopathy
MedGen UID:
1643295
Concept ID:
C4551715
Disease or Syndrome
An abnormality of the retina characterized by pigment deposition. It is typically associated with migration and proliferation of macrophages or retinal pigment epithelial cells into the retina; melanin from these cells causes the pigmentary changes. Pigmentary retinopathy is a common final pathway of many retinal conditions and is often associated with visual loss.

Recent clinical studies

Etiology

Huckfeldt RM, Grigorian F, Place E, Comander JI, Vavvas D, Young LH, Yang P, Shurygina M, Pierce EA, Pennesi ME
Mol Vis 2020;26:423-433. Epub 2020 Jun 3 PMID: 32565670Free PMC Article
Feng X, Wei T, Sun J, Luo Y, Huo Y, Yu P, Chen J, Wei X, Qi M, Ye Y
PLoS One 2020;15(4):e0231115. Epub 2020 Apr 7 doi: 10.1371/journal.pone.0231115. PMID: 32255808Free PMC Article
Radha Rama Devi A, Naushad SM, Lingappa L
Pediatr Neurol 2020 May;106:43-49. Epub 2020 Feb 4 doi: 10.1016/j.pediatrneurol.2020.01.012. PMID: 32139166

Diagnosis

Yang P, Pardon LP, Ho AC, Lauer AK, Yoon D, Boye SE, Boye SL, Roman AJ, Wu V, Garafalo AV, Sumaroka A, Swider M, Viarbitskaya I, Aleman TS, Pennesi ME, Kay CN, Fujita KP, Cideciyan AV
Lancet 2024 Sep 7;404(10456):962-970. doi: 10.1016/S0140-6736(24)01447-8. PMID: 39244273
Huang L, Lai Y, Sun L, Li S, Ding X
Retina 2024 Jan 1;44(1):117-126. doi: 10.1097/IAE.0000000000003934. PMID: 38117582
Huckfeldt RM, Grigorian F, Place E, Comander JI, Vavvas D, Young LH, Yang P, Shurygina M, Pierce EA, Pennesi ME
Mol Vis 2020;26:423-433. Epub 2020 Jun 3 PMID: 32565670Free PMC Article
Feng X, Wei T, Sun J, Luo Y, Huo Y, Yu P, Chen J, Wei X, Qi M, Ye Y
PLoS One 2020;15(4):e0231115. Epub 2020 Apr 7 doi: 10.1371/journal.pone.0231115. PMID: 32255808Free PMC Article
Radha Rama Devi A, Naushad SM, Lingappa L
Pediatr Neurol 2020 May;106:43-49. Epub 2020 Feb 4 doi: 10.1016/j.pediatrneurol.2020.01.012. PMID: 32139166

Therapy

Yang P, Pardon LP, Ho AC, Lauer AK, Yoon D, Boye SE, Boye SL, Roman AJ, Wu V, Garafalo AV, Sumaroka A, Swider M, Viarbitskaya I, Aleman TS, Pennesi ME, Kay CN, Fujita KP, Cideciyan AV
Lancet 2024 Sep 7;404(10456):962-970. doi: 10.1016/S0140-6736(24)01447-8. PMID: 39244273
Boye SL, Peshenko IV, Huang WC, Min SH, McDoom I, Kay CN, Liu X, Dyka FM, Foster TC, Umino Y, Karan S, Jacobson SG, Baehr W, Dizhoor A, Hauswirth WW, Boye SE
Hum Gene Ther 2013 Feb;24(2):189-202. doi: 10.1089/hum.2012.193. PMID: 23210611Free PMC Article

Prognosis

Ma DJ, Lee HS, Kim K, Choi S, Jang I, Cho SH, Yoon CK, Lee EK, Yu HG
BMC Med Genomics 2021 Mar 10;14(1):74. doi: 10.1186/s12920-021-00874-6. PMID: 33691693Free PMC Article

Clinical prediction guides

Yang P, Pardon LP, Ho AC, Lauer AK, Yoon D, Boye SE, Boye SL, Roman AJ, Wu V, Garafalo AV, Sumaroka A, Swider M, Viarbitskaya I, Aleman TS, Pennesi ME, Kay CN, Fujita KP, Cideciyan AV
Lancet 2024 Sep 7;404(10456):962-970. doi: 10.1016/S0140-6736(24)01447-8. PMID: 39244273
Hanany M, Shalom S, Ben-Yosef T, Sharon D
Cold Spring Harb Perspect Med 2024 Feb 1;14(2) doi: 10.1101/cshperspect.a041277. PMID: 37460155Free PMC Article
Ma DJ, Lee HS, Kim K, Choi S, Jang I, Cho SH, Yoon CK, Lee EK, Yu HG
BMC Med Genomics 2021 Mar 10;14(1):74. doi: 10.1186/s12920-021-00874-6. PMID: 33691693Free PMC Article
Radha Rama Devi A, Naushad SM, Lingappa L
Pediatr Neurol 2020 May;106:43-49. Epub 2020 Feb 4 doi: 10.1016/j.pediatrneurol.2020.01.012. PMID: 32139166
Verrier JD, Madorsky I, Coggin WE, Geesey M, Hochman M, Walling E, Daroszewski D, Eccles KS, Ludlow R, Semple-Rowland SL
PLoS One 2011;6(5):e20553. Epub 2011 May 27 doi: 10.1371/journal.pone.0020553. PMID: 21647387Free PMC Article

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