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Choroideremia

Synonyms of Choroideremia

  • Choroidal Sclerosis
  • Progressive Choroidal Atrophy
  • Progressive Tapetochoroidal Dystrophy
  • TCD

Disorder Subdivisions

  • No subdivisions found.

General Discussion

Choroideremia is a genetic disorder of sight that usually affects males. Female carriers may have mild symptoms without loss of vision. Major symptoms include a progressive loss of the peripheral field of vision and night blindness. Night blindness is usually the first noticeable symptom, usually occurring during childhood.

Symptoms

Choroideremia is characterized by extensive loss of all retinal layers in the eye. This disorder usually begins during childhood with wasting (atrophy) of the pigmented retinal epithelium, retina, and choroid of the eye. The retina is the light-sensitive, most internal surface of the eyeball consisting of many, nerve-containing layers. A layer of single pigmented cells is next outside the retina. The choroid is the next vascular layer (membrane) located outside the retina and inside the "white" section of the eye (sclera). The choroid contains many small branches of vessels called the choriocapillaries.

Degeneration of the vessels of the choroid and functional damage to the retina occur later in life and usually lead to progressive peripheral visual field loss and eventual blindness. The symptoms of Choroideremia may vary greatly between affected individuals. Female carriers usually have very mild symptoms without vision loss.

Causes

Choroideremia is an X-linked recessive genetic condition. X-linked recessive disorders are caused by an abnormal gene on the X chromosome. Females have two X chromosomes but one is 'turned off' and all of the genes on that chromosome are inactivated. Females who have a disease gene present on one of their X chromosomes are carriers for that disorder. Carrier females usually do not show symptoms of the disorder because it is usually the X chromosome with the abnormal gene that is 'turned off'. Males have one X chromosome and if they inherit an X chromosome that contains a disease gene, they will develop the disease. Males with X-linked disorders pass the disease to all of their daughters, who will be carriers. Males can not pass the X-linked gene to their sons because males always pass their Y chromosome instead of their X chromosome to male offspring. Female carriers of an X-linked disorder have a 25% chance with each pregnancy to have a carrier daughter like themselves, a 25% chance to have a non-carrier daughter, a 25% chance to have a son affected with the disease, and a 25% chance to have an unaffected son.

In 1991, Dr. Frans Cremers of the University of Nijmegen in the Netherlands isolated the gene responsible for Choroideremia. The gene makes a protein call Rab escort protein 1. This discovery may lead to a prenatal test and to treatment for the disease.

Affected Populations

Choroideremia affects males. Female carriers are generally asymptomatic. However, a small number of females have developed the disorder as a result of a genetic process that inactivates the normal gene and leaves only the dysfunctional gene active. In the Salla area of northern Finland, an unusually high concentration of cases has occurred, affecting approximately one in forty persons.

Related Disorders

Symptoms of the following disorders can be similar to those of Choroideremia. Comparisons may be useful for a differential diagnosis:

X-linked Retinitis Pigmentosa (RP) is one of a group of inherited vision disorders causing degeneration of the retina. When the retina degenerates, as in RP, the vision decreases and may be lost. X-linked RP is not usually associated with other conditions or illnesses. The X- linked form of RP is passed from a mother (who is a carrier) to a son. The early symptoms include night blindness. This is followed by "tunnel vision" (loss of peripheral vision). The rate and extent of progression of symptoms is extremely variable. (For more information on this disorder, choose "Retinitis Pigmentosa" as your search term in the Rare Disease Database.)

Diffuse Choriocapillaris Atrophy is characterized by degeneration of the choroid of the eye. The choroid is a vascular membrane located between the retina inside the eye and the "white" membrane outside the eye (sclera).

Gyrate Atrophy of the Choroid and Retina is characterized by a circular- patterned degeneration in the choroid and retina of the eye. This disorder of the eye is the direct result of the accumulation of abnormally high levels of the amino acid ornithine.

Standard Therapies

Treatment of Choroideremia is symptomatic and supportive. Organizations providing services to sight-impaired people will be of help to patients and their families. Genetic counseling is recommended for families affected by this disorder.

Investigational Therapies

Studies of families with Choroideremia are underway to determine the gene changes (mutations) responsible for the disorder. There is no common mutation that is found in all cases of choroideremia.

This disease entry is based upon medical information available through March 2000. Since NORD's resources are limited, it is not possible to keep every entry in the Rare Disease Database completely current and accurate. Please check with the agencies listed in the Resources section for the most current information about this disorder.

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.

For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:

Tollfree: (800) 411-1222
TTY: (866) 411-1010
Email: prpl@cc.nih.gov

For information about clinical trials sponsored by private sources, contact:
www.centerwatch.com

Organizations related to Choroideremia

References

TEXTBOOKS
Kanski JJ., ed. Clinical Ophthalmology, 4th ed. Woburn, MA: Butterworth-Heinemann; 1999:453-54.

REVIEW ARTICLES
Seabra MC, Mules EH, Hume AN. Rab GTPases, intracellular traffic and disease. Trends Mol Med. 2002;8:23-30.

Alory C, Balch WE. Organization of the Rab-GDI/CHM superfamily: the functional basis of choroideremia disease. Traffic. 2001;2:532-43.

Pereira-Leal JB, Hume AN, Seabra MC. Prenylation of Rab-GTPases: molecular mechanisms and involvement in genetic disease. FEBS Lett. 2001;498:197-200.

JOURNAL ARTICLES
Roberts MF, Fishman GA, Roberts DK, et al. Retrospective, longitudinal, and cross-sectional study of visual acuity impairment in choroideraemia. Br J Ophthalmol. 2002;86:658-62.

Grover S, Alexander KR, Fishman GA, et al. Comparison of intraocular light scatter in carriers of choroideremia and X-linked retinitis pigmentosa. Ophthalmology. 2002;109:159-63.

Laderman DJ, Szlyk JP, Kelsch R, et al. A curriculum for training patients with peripheral visual field loss to use bioptic amorphic lenses. J Rehabil Res Dev. 2000;37:607-19.

Hirakawa H, et al., Progression of defects in the central 10-degree visual field of patients with retinitis pigmentosa and choroideremia. Am J Ophthalmol. 1999;127:436-42.

Majid MA, et al., Unusual macular findings in a known choroideremia carrier. Eye. 1998;12:740-41.

MacDonald IM, et al., A practical diagnostic test for choroideremia. Ophthalmology. 1998;105:1637-40.

MacDonald IM, et al., Histopathology of the retinal pigment epithelium of a female carrier of choroideremia. Can J Ophthalmol. 1997;32:329-33.

Tallman KB, et al., A case study of choroideremia highlighting differential diagnosis and management with Fresnel prism therapy. J Am Optom Assoc. 1996;67:421-29.

FROM THE INTERNET
McKusick VA, ed. Online Mendelian Inheritance in Man (OMIM). Baltimore, MD; Johns Hopkins University Press: Entry Number; 303100: Last Update; 5/1/02, Entry No: 300390; Last Update; 5/1/02.

Choroideremia Research Foundation. Technical Description of Choroideremia, CHM. nd. 9pp.
www.choroideremia.org/CHMtechy.htlm

MacDonald I. (Ophthalmology - University of Alberta). Choroideremia Diagnostic Testing. nd. 1p.
www.ualberta.ca/~ophthalm/choroid.htm

CONSUMER RESOURCES
Choroideremia Research Foundation. Basic Description of Choroideremia. Nd. 2pp.
www.choroideremia.org/CHMplain.html

Choroideremia. EyeMDLink.com. nd. 1p.
www.eyemdlink.com/Condition.asp?ConditionID=108

Health-Nexus. Choroideremia. nd. 2pp.
www.health-nexus.com/choroideremia.htm

The information in NORD’s Rare Disease Database is for educational purposes only. It should never be used for diagnostic or treatment purposes. If you have questions regarding a medical condition, always seek the advice of your physician or other qualified health professional. NORD’s reports provide a brief overview of rare diseases. For more specific information, we encourage you to contact your personal physician or the agencies listed as “Resources” on this report.

Report last updated: 2008/05/13 00:00:00 GMT+0

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