NM_000329.3(RPE65):c.430T>G is a missense variant predicted to replace tyrosine with aspartic acid at position 144. This variant is absent from gnomAD v2.1.1 (PM2_Supporting). This variant has been reported in at least 2 apparently unrelated probands with early-onset severe retinal dystrophy who were homozygous for the variant (1 pt, PMID: 19117922, PMID: 11462243, PMID: 28127548, PM3). At least one proband harboring this variant exhibits a phenotype including diagnosis of Leber congenital amaurosis (0.5 pts), reduced visual acuity (1 pt), macular atrophic changes (0.5 pts), abnormal electroretinogram responses, visual field constriction (1 pt), retinal vessel attenuation (0.5 pts), and retinal pigment epithelium depigmentation and granularity in the fundus (0.5 pts), which together are specific for RPE65-related recessive retinopathy (total 4 pts, PMID: 19117922, PP4). The computational predictor REVEL gives a score of 0.977, which is above the ClinGen LCA / eoRD VCEP threshold of ≥0.773 and predicts a damaging effect on RPE65 function (PP3_Moderate). The variant exhibited no detectable enzymatic activity in a retinoid isomerase assay relative to the wild-type control, which is lower than the ClinGen LCA / eoRD VCEP PS3_Supporting threshold of <10% activity, indicating that it triggers a severe defect in protein function (PMID: 16828753, PS3_Supporting). 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: PS3_Supporting, PM2_Supporting, PM3, PP3_Moderate, and PP4. (VCEP specifications version 1.0.0; date of approval 09/21/2023).