Additional Vision Related Conditions

Leber Hereditary Optic Neuropathy (LHON)

A rare inherited condition that causes vision loss by damaging the retinal ganglion cells and optic nerve, the pathway that carries visual information from the eye to the brain.

Unlike inherited retinal diseases (IRDs), which primarily affect the retina’s light-sensing cells, LHON is an inherited optic neuropathy.

Understanding Leber Hereditary Optic Neuropathy

Leber Hereditary Optic Neuropathy (LHON) is a rare inherited condition that causes vision loss by damaging the retinal ganglion cells and optic nerve, the pathway that carries visual information from the eye to the brain.

Unlike inherited retinal diseases (IRDs), which primarily affect the retina’s light-sensing cells, LHON is an inherited optic neuropathy. It affects cells that transmit visual information from the retina to the brain and typically causes sudden, painless loss of central vision, often beginning in one eye and affecting the other eye within weeks or months.

LHON most commonly affects young adult males, although people of any sex can carry the genetic changes that cause the condition and may experience vision loss.

Advances in mitochondrial genetics, diagnosis, and gene-based therapies have increased understanding of LHON and created new opportunities for treatment and research.

Retina International works with people affected by LHON, patient organisations, researchers, clinicians, and partners worldwide to improve awareness, support patient involvement, and advance research into inherited vision conditions.

What is Leber Hereditary Optic Neuropathy?

Leber Hereditary Optic Neuropathy is an inherited optic neuropathy that causes degeneration of the retinal ganglion cells and optic nerve.

The optic nerve contains millions of nerve fibres that transmit visual signals from the eye to the brain. When these cells become damaged, the brain cannot receive complete visual information, resulting in vision loss.

LHON primarily affects the retinal ganglion cells, particularly those involved in central vision. Because of this, LHON is not considered an inherited retinal dystrophy (IRD), even though the affected cells are located within the retina.

The condition typically presents with:

· Sudden loss of central vision

· Reduced ability to see fine details

· Difficulty reading and recognising faces

· A central or central-to-peripheral blind spot

Peripheral vision is often preserved, although some people may experience broader visual changes.

LHON is a mitochondrial disease, meaning it is caused by changes in mitochondrial DNA (mtDNA), which affects how cells produce energy.

The condition is sometimes referred to as:

· Leber optic neuropathy

· Leber hereditary optic atrophy

1 in 30,000–50,000

Estimated prevalence in Northern Europe

~90%

Of cases are linked to three main genetic changes

97%

Typically develop vision loss in both eyes within one year

Symptoms

How LHON can affect vision

LHON usually begins with sudden, painless changes in central vision. Common symptoms include:
Blurred central vision

People may notice difficulty focusing on objects directly in front of them.

Loss of central vision

A blind spot may develop in the centre of vision, affecting:
· Reading
· Recognising faces
· Watching television
· Detailed tasks

Reduced colour vision

Some people experience reduced ability to distinguish colours.

Reduced visual sharpness

Central vision may become significantly impaired.

Vision loss in both eyes

LHON often affects one eye first, followed by the second eye within a period of weeks or months.

The severity of vision loss varies between individuals.

Some people experience partial recovery, while others have long-term significant central vision impairment.

Diagnosis

Identifying LHON

Diagnosis involves a combination of clinical examination, visual testing, and genetic analysis. Assessment may include:
Eye examination

An ophthalmologist examines the optic nerve and evaluates visual function.

Visual field testing

This measures areas of vision loss and helps identify central visual field defects.

Optical coherence tomography (OCT)

OCT can assess changes in the retinal nerve fibre layer and retinal ganglion cells.

Colour vision testing

This evaluates changes in colour perception.

Genetic testing

Genetic testing of mitochondrial DNA can identify LHON-associated mutations.
A genetic diagnosis can help:

  • · Confirm the condition
  • · Distinguish LHON from other causes of optic nerve damage
  • · Support family counselling
  • · Identify eligibility for clinical research
Treatment & Management

Supporting vision and exploring treatment options

There is currently no treatment that restores normal vision for everyone with LHON. However, advances in research have led to new therapies and supportive approaches.
Approved treatments

Some individuals may benefit from approved therapies designed to support mitochondrial function and visual outcomes. Treatment decisions should always be discussed with a specialist.

Low vision support

People living with LHON may benefit from:
· Magnification devices
· Screen readers
· Accessibility technology
· Orientation and mobility support

Lifestyle considerations

Because certain factors may influence whether vision loss develops, individuals with LHON may be advised to discuss:
· Smoking cessation
· Alcohol consumption
· General health management
with their healthcare provider.

Genetic counselling

Genetic counselling can help individuals and families understand:
· Mitochondrial inheritance
· Family risks
· Testing options

Emerging therapies

Research continues into:
· Gene therapy
· Mitochondrial-targeted treatments
· Neuroprotective approaches

Living With LHON

Adapting to sudden vision loss

Unlike many inherited retinal diseases, LHON often begins suddenly, meaning people may need to adapt quickly to significant changes in vision.

The impact may affect:

  • Education
  • Employment
  • Mobility
  • Independence
  • Emotional wellbeing

Support may include:

  • Low vision rehabilitation
  • Assistive technology
  • Workplace and educational accommodations
  • Peer support
  • Patient organisations

Early access to practical and emotional support can help people adapt and maintain independence.

The experiences of people living with LHON are important in shaping research, healthcare services, and advocacy priorities.

Take the Next Step

Leber Hereditary Optic Neuropathy highlights the importance of genetic understanding, mitochondrial research, and patient-centred innovation in advancing treatments for inherited vision conditions.

Although LHON is inherited, it is not an inherited retinal dystrophy (IRD). It is an inherited optic neuropathy that primarily affects retinal ganglion cells and the optic nerve.

Through collaboration between patients, researchers, clinicians, and organisations worldwide, progress continues towards improved diagnosis, stronger support, and new therapies that may preserve or restore vision.

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