title: Thirty-Year follow-up of an African American family with macular dystrophy of the retina, locus 1 (North Carolina macular dystrophy).
abstract: OBJECTIVE
  To describe clinical characteristics, including visual acuity (VA), genetic analysis, and management of complications, over a 30-year period in an African American family with macular dystrophy of the retina, locus 1 (MCDR1), commonly referred to as "North Carolina macular dystrophy."
  
  
  METHODS
  Observational, cohort study.
  
  
  METHODS
  Twelve family members from a 4-generation pedigree.
  
  
  METHODS
  A total of 12 African American patients in an affected family were examined. Clinical examination was documented during 2 different follow-up periods from 1979 to 1982 in 10 patients and from 2005 to 2009 in 11 patients. Genetic analysis was performed in 4 affected members during this time. Foveal microperimetry, fundus autofluorescence, and spectral domain optical coherence tomography (OCT) data were also obtained.
  
  
  METHODS
  Change in VA of 8 members followed over 3 decades and clinical data and management of complications for all patients.
  
  
  RESULTS
  Nine of 11 living family members had classic findings ranging from disease grade 2 (confluent foveal drusen, 8 eyes) to grade 3 (central coloboma-like lesion, 10 eyes). Two members developed choroidal neovascularization (CNV) requiring laser ablation, and 1 member developed non-clearing vitreous hemorrhage and underwent 25-gauge pars plana vitrectomy. Another family member developed exotropia and amblyopia in 1 eye by age 7 years. Those without CNV had no significant change in VA over 30 years. Linkage studies of 4 affected family members showed the same short tandem repeats on markers spanning D6S249 and D6S283 within the MCDR1 region of chromosome 6q16. Microperimetry analysis of an affected member with grade 3 MCDR1 revealed absent function in the region of the central coloboma-like lesions, corresponding to photoreceptor absence on OCT, although there were preserved foveal function and intact photoreceptors adjacent to the lesion.
  
  
  CONCLUSIONS
  This African American family shares similar clinical findings as other MCDR1 pedigrees and the same haplotype as the originally described family from North Carolina. Clinical characteristics, including retinal features and stable VA in the absence of amblyopia and CNV, are similar to those in other reports. Eccentric viewing around impaired photoreceptors may explain good VA in patients with clinically severe-appearing macular lesions. Sequencing of the MCDR1 interval may help identify a protein responsible for early macular development.
  
  
  BACKGROUND
  Proprietary or commercial disclosure may be found after the references.
authors.affiliation: University of Illinois, Department of Ophthalmology and Visual Sciences, Chicago, IL, USA.
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Kiernan
authors.forename: Rohan J
authors.initials: RJ
authors.lastname: Shah
authors.forename: Seenu M
authors.initials: SM
authors.lastname: Hariprasad
authors.forename: Michael A
authors.initials: MA
authors.lastname: Grassi
authors.forename: Kent W
authors.initials: KW
authors.lastname: Small
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Kiernan
authors.forename: William F
authors.initials: WF
authors.lastname: Mieler
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000235:genetics*; D000368:Aged; D000550:Amblyopia / Q000235:genetics; D020256:Choroidal Neovascularization / Q000235:genetics; D002874:Chromosome Mapping; D002896:Chromosomes, Human, Pair 6; D015331:Cohort Studies; D003103:Coloboma / Q000235:genetics; D005099:Exotropia / Q000235:genetics; D005136:Eye Proteins / Q000235:genetics*; D005260:Female; D005500:Follow-Up Studies; D005654:Fundus Oculi; D008040:Genetic Linkage; D006239:Haplotypes; D006801:Humans; D008268:Macular Degeneration / Q000150:complications / Q000235:genetics* / Q000473:pathology / Q000503:physiopathology; D008297:Male; D018895:Microsatellite Repeats; D008875:Middle Aged; D010375:Pedigree; D012160:Retina / Q000473:pathology; D012720:Severity of Illness Index; D041623:Tomography, Optical Coherence; D014792:Visual Acuity; D014823:Vitreous Hemorrhage / Q000209:etiology; D055815:Young Adult
chemical_list: D005136:Eye Proteins; C402686:MCDR1 protein, human