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Small KW, Jampol LM, Bakall B, Small L, Wiggins R, Agemy S, Udar N, Avetisjan J, Vincent A, Shaya FS. Best Vitelliform Macular Dystrophy (BVMD) is a phenocopy of North Carolina Macular Dystrophy (NCMD/MCDR1). Ophthalmic Genet 2021; 43:1-11. [PMID: 34895015 DOI: 10.1080/13816810.2021.2010771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/16/2021] [Accepted: 11/21/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE North Carolina Macular Dystrophy (NCMD) and Best Vitelliform Macular Dystrophy (BVMD) are rare autosomal dominant macular dystrophies. Both BVMD and NCMD have markedly variable expressivity. In some individuals, it can be difficult to differentiate between the two disease entities. METHODS Clinical findings including fundus photography, fundus autofluorescence (FAF), and spectral domain optical coherence tomography (SD-OCT) were evaluated in 5 individuals with NCMD and 3 with BMD. Electrooculography (EOG) was performed in 2 NCMD subjects. Molecular diagnosis was performed using Sanger DNA sequencing. IRB approval was obtained. RESULTS Five NCMD subjects had clinical findings indistinguishable from three of our BVMD subjects. Molecular diagnosis was confirmed in all but one BVMD subject who had an abnormal EOG prior to discovery of the BEST1 gene. Two NCMD subjects had an abnormal EOG with a normal ERG, which has been considered a unique feature of BVMD. SD-OCT in one BVMD subject demonstrated a small lucency/excavation into the choroid similar to that in grade 3 lesions of NCMD. Two NCMD subjects had elevated sub-macular lesions giving a pseudo-vitelliform appearance on OCT similar to BVMD. CONCLUSION Best Vitelliform Macular Dystrophy can be a phenocopy of NCMD. There is considerable clinical overlap between NCMD and BVMD, which can cause diagnostic inaccuracies. Our new findings demonstrate that like BVMD, NCMD can also have an abnormal EOG with a normal ERG. The overlapping phenotypes of BVMD with NCMD may provide insights into the mechanisms of the macular changes.
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Affiliation(s)
- Kent W Small
- Department of ophthalmology, Molecular Insight Research Foundation, Glendale and Los Angeles, California, USA
- Department of ophthalmology, Macula and Retina Institute, Glendale and Los Angeles, California, USA
| | - Lee M Jampol
- Department of ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Benjamin Bakall
- Department of ophthalmology, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Leslie Small
- Department of ophthalmology, University of California San Francisco, San Francisco, California, USA
| | - Robert Wiggins
- Department of ophthalmology, Asheville Eye Associates, North Carolina, USA
| | - Steven Agemy
- Department of ophthalmology, SUNY Downstate Medical Center University, Brooklyn, New York, USA
| | - Nitin Udar
- Department of ophthalmology, Molecular Insight Research Foundation, Glendale and Los Angeles, California, USA
- Department of ophthalmology, Macula and Retina Institute, Glendale and Los Angeles, California, USA
| | - Jessica Avetisjan
- Department of ophthalmology, Molecular Insight Research Foundation, Glendale and Los Angeles, California, USA
- Department of ophthalmology, Macula and Retina Institute, Glendale and Los Angeles, California, USA
| | - Andrea Vincent
- Department of ophthalmology, University of Auckland, New Zealand Eye Centre, Auckland, New Zealand
| | - Fadi S Shaya
- Department of ophthalmology, Molecular Insight Research Foundation, Glendale and Los Angeles, California, USA
- Department of ophthalmology, Macula and Retina Institute, Glendale and Los Angeles, California, USA
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