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Hereditary Optic Nerve Disorders (Hereditary Optic Neuropathies)

by James Garrity, MD

Dominant optic atrophy and Leber hereditary optic neuropathy are uncommon, inherited disorders that damage the optic nerve, causing vision loss.

  • Vision loss develops in childhood or adolescence and affects both eyes.

  • People may also have abnormal heart or nervous system function.

  • Diagnosis is by a doctor's evaluation and sometimes confirmed by genetic testing.

  • The disorders cannot be reversed, but measures are taken to aid vision.


Dominant optic atrophy and Leber hereditary optic neuropathy are inherited disorders caused by abnormal genes. Both disorders are uncommon, particularly Leber hereditary optic neuropathy.

Dominant optic atrophy is inherited from the mother or father as a dominant gene (see Inheritance Patterns), meaning that only one copy of the gene is required for the disorder to develop. In other words, if either the father or the mother has the disease, then each child has a 50% chance of developing it.

Leber hereditary optic neuropathy is inherited through the mother only because the abnormal genes seem to be located in the mitochondria. Mitochondria are structures in cells that provide energy for the cell and have their own internal genes that are inherited from only the mother (see Inheritance Patterns : Abnormal Mitochondrial Genes). Leber hereditary optic neuropathy is more common among males.


In dominant optic atrophy, vision loss begins before the age of 10 years. Some people can also have vertigo (a false sensation of moving or spinning) or hearing loss. People also have trouble distinguishing shades of blue and yellow.

In Leber hereditary optic neuropathy, vision loss begins between the ages of 15 and 35. Some people have abnormal heart conduction or nervous system function.


  • A doctor's evaluation

Diagnosis is by a doctor's evaluation. Testing can identify some of the abnormal genes responsible for the disorders but not all. People who may have Leber hereditary optic neuropathy undergo electrocardiography to assess their heart.


  • Low-vision aids

There is no effective treatment. Limiting consumption of alcohol, which may affect the mitochondria, and not using tobacco products may help slow the rate of vision loss.

Magnifiers, large-print devices, and talking watches (low-vision aids) may help people with loss of vision.

Genetic counseling should be considered.

People who have heart or nervous system problems are sent to specialists.