title: Intrafamilial variation of phenotype in Stargardt macular dystrophy-Fundus flavimaculatus.
abstract: OBJECTIVE
  To evaluate the intrafamilial phenotypic variation in Stargardt macular dystrophy-Fundus flavimaculatus (SMD-FFM).
  
  
  METHODS
  Thirty-one siblings from 15 families with SMD-FFM were examined. Age of onset, visual acuity, and clinical features on fundus examination and fundus autofluorescence images, including presence or absence of central and peripheral atrophy and distribution of flecks, were recorded. In addition, electrophysiological studies were undertaken.
  
  
  RESULTS
  Large differences between siblings in age of onset (median, 12 years; range, 5-23 years) were observed in six of the 15 families studied, whereas in 9 families differences in age of onset between siblings were small (median, 1 year; range, 0-3 years). Visual acuity varied two or more lines among siblings in nine families. In 10 families (67%) siblings were found to have different clinical appearance on fundus examination and fundus autofluorescence images, whereas in 5 families (33%), affected siblings had similar clinical features. Electrodiagnostic tests were performed on affected members of 12 families and disclosed similar qualitative findings among siblings. In nine families there was loss of central function only; in two, global loss of cone function; and in one, global loss of cone and rod function.
  
  
  CONCLUSIONS
  In this series, although differences in age of onset, visual acuity, and fundus appearance were observed between siblings, electrophysiological studies demonstrated intrafamilial homogeneity in retinal function. The findings are difficult to reconcile with expression studies showing ABCR transcripts in rod photoreceptors but not in cones.
authors.affiliation: Medical Retinal Service, Moorfields Eye Hospital, London, United Kingdom.
authors.forename: N
authors.initials: N
authors.lastname: Lois
authors.forename: G E
authors.initials: GE
authors.lastname: Holder
authors.forename: F W
authors.initials: FW
authors.lastname: Fitzke
authors.forename: C
authors.initials: C
authors.lastname: Plant
authors.forename: A C
authors.initials: AC
authors.lastname: Bird
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D002648:Child; D002675:Child, Preschool; D015350:Contrast Sensitivity; D004585:Electrooculography; D004596:Electroretinography; D005260:Female; D005654:Fundus Oculi; D014644:Genetic Variation; D006801:Humans; D008268:Macular Degeneration / Q000235:genetics* / Q000473:pathology / Q000503:physiopathology; D008297:Male; D010375:Pedigree; D010641:Phenotype; D010775:Photic Stimulation; D012160:Retina / Q000503:physiopathology; D014792:Visual Acuity