Blue cone monochromacy (BCM) is an X-linked ocular disease characterized by
poor visual acuity, nystagmus, and photodysphoria in males with severely r
educed color discriminatisn. Deletions, rearrangements and point mutations
in the I ed and green pigment genes have been implicated in causing BCM. We
assessed the spectrum of genetic alternations in ten families with BCM by
Southern blot, polymerase chain reaction, and sequencing analysis, and the
phenotype was characterized by ophthalmoscopy, fluorescein angiography, and
a battery of tests to assess color vision in addition to routine ophthalmo
logical examination. All families showed clinical features associated with
BCM. Acuities were reduced in all affected males. and photopic b-wave was r
educed by more than 90% in seven families. In three families, however, the
photopic b-wave response showed uncharacteristic relative preservation of 3
0-80% (of the clinical low-normal value). The color vision was unusually pr
eserved in two affected males, but this was not correlated with photopic el
ectroretinography retention. Progressive macular atrophy was observed in af
fected members of two BCM families while the rest of the families presented
with normal fundus. In nine families deletions were identified in the gene
encoding the red-sensitive photopigment and/or in the region up to 17.8 kb
upstream of the red gene which contains the locus control region and other
regulatory sequences. In the same nine families the red pigment gene showe
d a range of deletions from the loss of a single exon to loss of the comple
te red gene. In one family no mutation was found in the exons of the red ge
ne or the locus control region but showed loss of the complete green gene.
No association was observed between the phenotypes and genotypes in these f
amilies.