Best disease

Best disease is a form of juvenile macular degeneration. While there is no cure for it, there are options that can slow the progression of the disease and improve visual function.

Best disease in Olympia

What is best disease?

Best disease, also known as Best vitelliform macular dystrophy, is a genetic form of juvenile macular degeneration. In macular degeneration (AMD), the macula, the central part of the retina, is progressively damaged, causing loss of central vision. The prevalence of Best disease is estimated at 1 in 16,500 to 1 in 21,000 people. According to another estimate, about 1 in 15,000 people suffer from it.

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How can a low vision optometrist help?

People with Best disease and other conditions that cause vision loss may benefit from low vision optometrists who undergo advanced training in this field. Their advanced knowledge of the latest vision technologies helps improve vision both practically and functionally.

They may recommend you use low vision aids such as magnifying devices, CCTVs, tinted lenses, prisms, and digital devices. Once the doctor understands what matters to you, they will help you find the devices that will maximize your vision for the tasks you care about. People with this disease and similar conditions have now been able to do things they never thought they could with the help of state-of-the-art custom low vision optical glasses and devices.

Can you drive if you have Best disease?

With Best disease, the macula which is responsible for central vision is affected. It is vital to have a healthy macula so that you can drive safely and read road signs. Even though vision is affected by the disease, for most people it does not impair their ability to drive. The use of low vision glasses allows many patients with this condition to keep their licenses until late in life.

In the majority of states, low vision optometrists can assist you in maintaining your license and regaining your driving ability through bioptic telescopes customized to your prescription.

A bioptic telescope consists of a pair of glasses with a telescope attached above your normal line of sight. These can be attached to your regular eyeglasses and can be used either for one or both of your eyes. Bioptic lenses magnify images just like binoculars and help you see things better. Using these lenses allows you to see things that are much further away, which is one of their main benefits.

See our page on the driving laws in Washington with low vision.

Can you drive if you have Best disease?
Can you drive if you have Best disease?

Can you drive if you have Best disease?

The average age at which Best disease begins is between 5 and 10 years old, but it can vary from person to person. In the beginning, individuals with this condition have normal vision, but may experience the following symptoms with time:

  • Blurred vision
  • Reduced sharpness or clarity of vision
  • Objects that appear distorted (metamorphosis)
  • Loss of central vision

Many people with this disorder are unaware that their vision is declining and may be diagnosed during a routine eye examination. Others experience significant loss of vision, due to blood vessels forming under the macula and retina. It is possible for each eye to suffer from different degrees of visual loss. In most cases, individuals with Best disease have one eye more severely affected than the other, but with the assistance of a low vision optometrist can still engage in daily activities such as driving well into their old age.

Causes of Best disease

Best is inherited genetically from one parent through an autosomal dominant pattern. That means that a faulty gene is responsible for the condition. A defective gene inherited from one parent dominates the healthy gene inherited from the other parent. Another possibility is that the mutated gene was not passed down from the parent to the child, in which case the child would not inherit the disease. If one parent has the disease, there is a 50/50 chance of inheriting it.

Can you drive if you have Best disease?

How is Best disease diagnosed?

Best disease can be diagnosed by looking for lesions that resemble egg yolks at the back of the eye, seen in the vitelliform stage. There are other tests available to confirm the diagnosis.

  • OCT is useful for localizing the lesion and determining its thickness, which may reveal lipofuscin and fluid buildup in the RPE.
  • Autofluorescent imaging can detect the build-up of fatty deposits in the back of the eye.
  • Best disease can also be detected in patients through an electrophysiological test called an EOG. An EOG test measures the health and activity of the RPE cells in the back of the eye. EOG recordings are used to calculate Arden ratios, which are generally 1.5 or lower in patients with Best disease.
  • The ERG test is also used in the diagnosis of patients with the Best disease. It is used to measure retinal function.
  • Another way to diagnose the Best disease is by genetic testing.

What are the different stages of Best disease?

Best disease progresses through six stages. They are discussed below:

Stage I - Pre Vitelliform

At this point, you are likely to not be experiencing symptoms and you have not yet developed the yellow material below your retina.

Stage II - Vitelliform

This term vitelliform means shaped like an egg. At this stage, yellow material is forming an egg-like shape. You may still have good vision.

Stage III - Pseudohypopyon

It is possible that the yellow material that was forming under the retina at stage 2 will develop into a cyst.

Stage IV - Vitelliruptive

Your retina may begin to be damaged by the yellow material, and your vision may be affected.

Stage V- Atrophic

As the yellow material disappears, it leaves scars and damaged cells behind. This stage is considered to be the final phase of Best disease by some researchers.

Stage VI - Choroidal neovascularization or CNV

There are some researchers who believe that CNV is the final stage of Best disease, while there are others who believe that it is a complication of it. About 20% of people with Best disease develop CNV. Choroid neovascularization refers to the development of new blood vessels. Those blood vessels may leak, causing your vision to deteriorate.

Can you drive if you have Best disease?
Can you drive if you have Best disease?

Treatment and prevention of best disease

Unfortunately, as of now, there is no effective medical or surgical treatment for Vitelliform macular degeneration. There is currently research being conducted on gene therapy for the treatment of different types of inherited macular dystrophies. By replacing the faulty gene with a new functioning gene, gene therapy aims to correct the problem. The research is in the beginning stages and may take a while before it could potentially become a useful treatment, however this kind of research is a positive step in the right direction.

Clinical Trials using gene therapy for Best’s disease

One of the most exciting trials is in the field of gene therapy used for treating Best’s disease. Research was done at the University of Pennsylvania and the University of Florida that demonstrated the efficacy of treating best disease through gene therapy in Dogs. The approach taken has also been used in the FDA approved retinal gene therapy for Leber’s congenital amaurosis. The hope is that this approach that has been shown to work in both dogs and in other FDA approved treatments for retinal disease, will also translate into an effective treatment for Best’s disease. Clinical trials are underway, and your low vision optometrist or ophthalmologist will inform you if the treatment becomes available.


Head trauma may increase the risk of developing the Best disease. Therefore, If you're at risk for a head injury, it's a good idea to take extra precautions, such as avoiding contact sports and wearing a helmet while cycling.

Anti-VEGF injections

Laser therapy and anti-VEGF injections can be used to treat new blood vessels. It may not lead to a significant improvement in sight, but treating blood vessels can prevent the macula and eyes from further damage.

Diet and smoking

There is evidence that smoking accelerates other forms of macular disease, so stopping smoking might help delay progression of Best disease as well. Currently, no research has indicated that diet can help to slow the progression of the Best disease. A diet high in fresh fruit and vegetables, however, may be beneficial for maintaining eye health.

Common Questions

No, while Best’s disease can lead to severe loss of central vision, it does not result in blindness as it does not harm your peripheral or side vision. Low vision optometrists can usually help maximize remaining vision in most cases. Best disease only affects the macula of your retina and does not affect peripheral vision. Therefore, your peripheral vision, which is your vision on the sides, remains intact.
Best disease
Dr. Zurcher cartoon


Best disease, also known as Best vitelliform macular dystrophy, is a genetic form of juvenile macular degeneration. In macular degeneration (AMD), the macula, the central part of the retina, is progressively damaged, causing loss of central vision. People with Best disease and other conditions that cause vision loss may benefit from low vision optometrists who undergo advanced training in this field. Their advanced knowledge of the latest vision technologies helps improve vision both practically and functionally. They may recommend you use low vision aids such as magnifying devices, CCTVs, electronic devices, lighting, tints, and prisms to help you regain your independence.

Patients visit our low vision clinic from all over Washington, and we are proud to be a leading low vision provider in , Lakewood, Tacoma, Lacey. 

You can schedule a low vision evaluation with our low vision optometrist by calling (360) 491-2121


Such a nice optician. My grandson is only 4 and needs glasses. We were so sad, but he explained the issues, and we will follow up as he suggested.

Anna P.

I had such a good experience with the clinic. Very friendly staff and doctor, did not have to wait for long to be called, and was treated respectfully. Thanks, American Family.

June S.

Dr. Zurcher has gone above and beyond what any other eye doctor has ever done to figure out what is going on with my eyes. Very happy with American Family Vision.

Christine R.

Family Vision Clinic changed our lives! My daughter was frequently car sick, and she was getting headaches every day, often painful enough that they brought her to tears. We saw a string of doctors and therapists, but we made no progress. Finally, we found Dr. Levi Zurcher and his eye therapist Rain. After ten weeks of eye therapy my daughter no longer gets headaches, and she no longer gets car sick. Daily tears are a thing of the past. I really can’t say enough about this clinic. It was fascinating to watch Dr. Zurcher work. For the first time, someone who knew what they were doing was intently studying my daughter, really trying to figure out all of her eye issues, and his therapist Rain is one of the most patient and lovely people that I’ve ever had the good fortune to meet. We’re finished with eye therapy—yay!—and I have switched to American Family Vision Clinic for all of my family’s other eye health needs.

Lars Wulff

Very professional, yet kind and helpful. They do what they can to make the appointment comfortable. I was running a bit late, I made sure ti call. They were able to switch me with a patient who was already there, they treated me with respect, and helped my son have confidence by getting him the eye care he needed that day. Thank you so much! Would recommend to anyone. It's a blessing that they care enough to work with people who have all different types of insurance from work to state coverage.

Justin E.

The staff is friendly. The Doc is very knowledgeable. The office is family friendly and everyone is so patient with the little ones.

Amy Fagerness
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