To evaluate the phenotype of affected and carrier members of a family with mutations in RPE65 (a retinal pigment epithelium gene). Methods: RPE65 mutation screening was performed on DNA from 2 affected brothers, 1 unaffected brother, both parents, and 3 surviving grandparents using cycle sequencing. Ophthalmic examinations included ophthalmoscopic fundus examination; visual function testing; 2-color, static, dark-adapted threshold perimetry; and rod electroretinographic a-wave phototransduction analysis. Results: The 2 affected brothers carried RPE65 mutations in compound heterozygous form: a maternal Y368H (1156T→C) missense mutation and a paternal IVS1+5g→a splice-site mutation. Severe visual deficits and an absence of rod and cone electroretinographic responses were diagnosed in both affected boys before the age of 5 years. Visual acuities of about 20/100 during grade school declined to hand movements by the teenage years, and only a rudimentary peripheral temporal visual field remained by the ages of 25 and 29 years.