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Noemi Lois, MD, PhD; Graham E. Holder, PhD; Catey Bunce, MSc; Fredrick W. Fitzke, PhD; Alan C. Bird, MD

Arch Ophthalmol. 2001;119:359-369.

Objective  To determine if phenotypic subtypes exist in Stargardt macular dystrophy–fundus flavimaculatus (SMD-FFM).

Methods  A cross-sectional study of 63 patients with autosomal recessive SMD-FFM was undertaken. The age of onset, duration of symptoms, visual acuity, and clinical features on fundus examination, color fundus photographs, and fundus autofluorescence images were recorded. Electrophysiological tests, including pattern, focal, and full-field electroretinogram (ERG), electro-oculogram, and color-contrast sensitivity measurement, were also performed.

Results  Based on electrophysiological attributes (ERG), patients with SMD-FFM could be classified into 3 groups. In group 1, there was severe pattern ERG abnormality with normal scotopic and full-field ERGs. In group 2, there was additional loss of photopic function, and in group 3, there was loss of both photopic and scotopic function. Differences in scotopic or photopic function among groups were not explained on the basis of differences in age of onset or duration of disease.

Conclusions  Patients with SMD-FFM can be classified into 3 groups based on the absence or presence of generalized loss of either photopic or photopic and scotopic function. It appears that these 3 groups may represent distinct phenotypic subtypes in SMD-FFM.

From the Medical Retinal Service (Drs Lois and Bird) and Departments of Electrodiagnostics (Dr Holder) and Epidemiology (Ms Bunce), Moorfields Eye Hospital, and Department of Visual Science, Institute of Ophthalmology (Dr Fitzke), London, England. Dr Lois is now with the Retina Service, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland.

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