The NM_000329.3(RPE65):c.1590C>A (p.Phe530Leu) variant is a missense variant in RPE65 causing a substitution of phenylalanine with leucine at position p.530. This variant is absent from gnomAD v4.1.0 (PM2_Supporting). The computational predictor REVEL gives a score of 0.888, which is above the ClinGen LCA / eoRD VCEP threshold of ≥0.773 and predicts a damaging effect on RPE65 function (PP3_Moderate). This variant has been reported in at least 2 probands with early-onset severe retinal dystrophy who were compound heterozygous with the c.200T>G, p.L67R variant confirmed in trans (1 pt) or the c.118G>A p.Gly40Ser variant confirmed in trans (1 pt) (PMIDs: 36729443, 26047050), which were previously classified as pathogenic by the ClinGen LCA / eoRD VCEP (2 total points, PM3_Strong). This variant has also been reported in the compound heterozygous state with the p.Ala507Val and the c.335G>A p.Cys112Tyr, but were not counted for additional points to avoid circularity. At least one proband harboring this variant exhibits a phenotype including severely decreased rod ERG responses (0.5), symptomatic onset between birth and age five years (1), evidence of cone involvement on ERG (1), white/yellow dots on color photography in the context of severe retinal dysfunction (2), previous 100+ retinal dystrophy gene panel testing that did not provide an alternative explanation for visual impairment (2), which together are specific for RPE65-related recessive retinopathy (6.5 points, PMID: 33952291, PP4). In summary, this variant meets the criteria to be classified as likely pathogenic for RPE65-related recessive retinopathy based on the ACMG/AMP criteria applied, as specified by the ClinGen LCA / eoRD VCEP: PM2_Supporting, PP3_Moderate, PM3_Strong, PP4 (VCEP specifications version 1.0.0; date of approval 09/21/2023).