NM_000329.3:c.1328T>C(p.Val443Ala) is a predicted missense variant that replaces valine with alanine at position 443 in RPE65. The computational predictor REVEL gives a score of 0.877, which is above the ClinGen LCA / eoRD VCEP threshold of ≥ 0.773 and predicts a damaging effect on RPE65 function (PP3_Moderate). The splicing impact predictor SpliceAI gives a score of 0.27 for acceptor gain, which is above the ClinGen LCA / eoRD VCEP recommended threshold of ≥0.2 and predicts a damaging impact on splicing. This variant has been reported in at least 1 proband with early-onset severe retinal dystrophy who was homozygous for the variant (0.5 points, VCEP member-provided data, PM3_Supporting). At least one proband harboring this variant exhibits a phenotype including onset in early childhood (1 pt), night blindness (required, 0.5 pts), undetectable rod ERG (required, 0.5 pts), decreased peripheral vision (1 pt), poor color vision (1 pt), severely reduced cone ERG responses, reduced visual acuity (1 pt), waxy optic disc (0.5 pts) with optic disc drusen (0.5 pts), and mildly attenuated retinal vessels (0.5 pts), which together are specific for RPE65-related recessive retinopathy (6.5 points, PP4, PMID: 20811047). The variant has been reported to segregate with childhood-onset severe retinal dystrophy through the proband plus 1 similarly affected relative (PMID: 20811047, PP1). The variant is absent from gnomAD v2.1.1 (PM2_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: PM2_Supporting, PM3_Supporting, PP1, PP3_Moderate, and PP4. (VCEP specifications version 1.0.0; date of approval 09/21/2023).