NM_000329.3(RPE65):c.1451G>T (p.Gly484Val) is a putative missense variant located in the first nucleotide of exon 14 that is predicted to cause the replacement of glycine with valine at codon 484. The computational predictor REVEL gives a score of 0.991, which is above the ClinGen LCA / eoRD VCEP threshold of ≥0.773 and predicts a damaging effect on RPE65 function. Additionally, the splicing impact predictor SpliceAI gives a score of 0.56, which is above the ClinGen LCA/eoRD VCEP recommended threshold of ≥0.2 and predicts a damaging impact on splicing (PP3_Moderate). Another missense variant at the same nucleotide, NM_000329.3(RPE65):c.1451G>A (p.Gly484Asp), has been classified as likely pathogenic for RPE65-related recessive retinopathy by the ClinGen LCA / eoRD VCEP and has a SpliceAI score of 0.23 for acceptor loss, indicating that both variants are predicted to have a damaging impact on splicing (PMID: 30025081, PMID: 34492281, PS1_Moderate). This variant is present in gnomAD v2.1.1 at a GrpMax allele frequency of 0.000002990, with 2 alleles / 111,040 total alleles in the European (Non-Finnish) population, which is lower than the ClinGen LCA/eoRD VCEP PM2_Supporting threshold of <0.0002 (PM2_Supporting). This variant has been reported in at least 3 unrelated probands with early-onset severe retinal dystrophy who are homozygous for the variant (1 pt, PMID: 33308271, PMID: 32531858, PMID: 33472769). The variant has also been reported in at least 1 proband with early-onset severe retinal dystrophy who was compound heterozygous with the NM_000329.3(RPE65):c.272G>A (p.Arg91Gln) variant confirmed in trans (1 pt, PMID: 38002999), which was previously classified pathogenic or likely pathogenic by the ClinGen LCA / eoRD VCEP (2 total pts, PM3_Strong). The variant has been reported to segregate with childhood-onset severe retinal dystrophy through the proband plus 2 similarly affected relatives, with the variant present in the homozygous state (PMID: 33308271, PP1_Moderate). At least one proband harboring this variant exhibits a phenotype including clinical diagnosis of Leber congenital amaurosis (0.5 pts), symptomatic onset at age 3 months (1 pt), extinguished ERG responses from rods (0.5 pts) and cones, optic nerve pallor (0.5 pts), macular atrophy (0.5 pts), decreased peripheral vision (1 pt), abnormal color vision (1 pt), decreased central visual acuity (1 pt), nystagmus (1 pt), which together are specific for RPE65-related recessive retinopathy (total 7 pts, PMID: 33308271, PP4). In summary, this variant meets the criteria to be classified as pathogenic for RPE65-related recessive retinopathy based on the ACMG/AMP criteria applied, as specified by the ClinGen LCA / eoRD VCEP: PS1_moderate, PM2_supporting, PM3_strong, PP1_moderate, PP3, and PP4. (VCEP specifications version 1.0.0; date of approval 09/21/2023).