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Any exudative vitreoretinopathy in which the cause of the disease is a mutation in the NDP gene.
Features include always present findings: Reduced visual acuity; and common findings: Retinal detachment and Peripheral retinal avascularization. 17 total HPO annotations.
Organ System | Phenotype Count | Example Features |
|---|---|---|
Eyes | 8 | Retinal neovascularization, Retinal detachment, Falciform retinal fold |
NDP-related ocular phenotypes typically involve bilateral and symmetric fibrovascular changes of the retina that are evident at birth and usually progress through childhood or adolescence to cause varying degrees of visual impairment. The NDP-related ocular phenotypes appear to be a continuum with considerable overlap: Norrie disease, NDP-related persistent fetal vasculature (PFV), NDP-related familial exudative vitreoretinopathy (FEVR), NDP-related advanced retinopathy of prematurity (ROP), and NDP-related Coats disease. Table 2. NDP-Related Retinopathies: Ocular Phenotypes
Phenotype | Ocular Findings / Age | Progression / Age | Vision |
|---|---|---|---|
Norrie disease | Grayish-yellow fibrovascular masses of immature retinal cells ("pseudoglioma") behind lens (i.e., retrolental), bilateral total retinal detachments (frequent)/0-3 mos | Cataract, posterior synechiae (iris-to-lens adhesions), anterior synechiae (iris-to-cornea adhesions), iris atrophy, shallowing of anterior chamber, corneal opacification, band keratopathy, shrinking of globe secondary to loss of intraocular pressure (phthisis bulbi)/3 mos to 8-10 yrs | Severely impaired or absent light perception |
NDP-related PFV1 | Fibrotic white stalk w/hyaloid vessel remnants extending from optic disc to posterior lens capsule (unilateral or bilateral)/Birth | Cataract, growth restriction of globe, vitreoretinal traction, retinal exudation, retinal detachment, secondary glaucoma, phthisis bulbi | Varying impairment; amblyopia common if left untreated |
NDP-related FEVR2 | Peripheral retinal avascularity ± congenital retinal folds, temporal macular dragging, fibrovascular scarring at ora serrata/Birth | Retinal ischemia neovascularization, retinal detachment (tractional /or exudative; may be unilateral), subretinal exudation or hemorrhage/≤20 yrs | Mild-to-severe impairment |
NDP-related advanced ROP3 | Retinal neovascularization, extraretinal fibrovascular proliferation, end-stage retrolental fibroplasia, vitreoretinal traction/Premature birth | Partial (Stage 4) or complete (Stage 5) retinal detachment | Mildly impaired-to-absent light perception |
NDP-related Coats disease4 | Unilateral retinal telangiectasia, exudation | Progressive vascular leakage, subretinal exudation fibrosis, retinal detachment (often exudative) | Normal to impaired FEVR = familial exudative vitreoretinopathy; PFV = persistent fetal vasculature; ROP = retinopathy of prematurity 1. 2. NDP pathogenic variants are commonly identified in clinically diagnosed X-linked familial exudative vitreoretinopathy . |
Source: GeneReviews — "NDP-Related Retinopathies"
NDP encodes norrin cystine knot growth factor NDP (133 aa). Activates the canonical Wnt signaling pathway through FZD4 and LRP5 coreceptor. Highest expression in Brain Cerebellar Hemisphere (40.0 TPM) and Ovary (38.9 TPM).
Exudative vitreoretinopathy 2, X-linked is associated with mutations in the NDP gene on chromosome X.
The NDP protein participates in (d)NTP + ADP (d)NDP + ATP (NME1,2,3), (d)NDP + ATP (d)NTP + ADP (NME1,2,3), and (d)NDP + ATP (d)NTP + ADP (NME4) pathways.
NDP is classified as a druggable target (Cell Surface and Druggable Genome categories) with score 0.0.
The Norrie disease ocular phenotype, especially at birth, is more severe than that of NDP-related FEVR.
NDP variants affecting the cysteine knot domain of the norrin protein result in Norrie disease ocular phenotypes and, possibly, phenotypic expression in heterozygous females .
In contrast, males with non-cysteine variants (which do not affect the tertiary structure of the protein) usually have the less severe ocular findings more consistent with NDP-related FEVR, including avascular peripheral retina, abnormal retinal vasculature, and subretinal exudation .
Source: GeneReviews — "NDP-Related Retinopathies"
An NDP-related retinopathy should be suspected in a male infant with the following ocular findings and family history. Ocular findings. The following spectrum of typically bilateral and symmetric fibrovascular changes of the retina are evident at birth and usually progress through childhood or adolescence to cause varying degrees of visual impairment:
• Norrie disease
Source: GeneReviews — "NDP-Related Retinopathies"
Table 3. Genes of Interest in the Differential Diagnosis of NDP-Related Retinopathies
Gene(s) | Disorder | MOI | Overlapping Clinical Feature(s) | Comment |
|---|---|---|---|---|
ATOH7 | Autosomal recessive PFV (OMIM 221900) | AR | PFV | To be considered in diffdx of PFV |
CAPN5 |
Genetic testing for NDP is available. Testing is considered confirmatory for diagnosis.
No approved treatments are currently available for exudative vitreoretinopathy 2, X-linked. The disease remains an area of unmet medical need.
No clinical practice guidelines for NDP-related retinopathies have been published.
To establish the extent of disease and needs in an individual diagnosed with an NDP-related retinopathy, the evaluations summarized (if not performed as part of the evaluation that led to the diagnosis) are recommended.
Table 4.
Recommended Evaluations Following Initial Diagnosis in Individuals with NDP-Related Retinopathies
System/Concern | Evaluation | Comment
| Height, weight, head circumference | Perform at time of clinic eval.
Ophthalmologic
involvement | By pediatric ophthalmologist | Assess best corrected visual acuity, abnormal ocular movement alignment (strabismus), intraocular pressure, refractive error.
By retina specialist /or ophthalmic geneticist | Usually referred by pediatric ophthalmologist if concern for retinal pathology on initial eye exam:
Perform ultrasonography to identify retinal detachment when media opacities are present.
Perform fluorescein angiography of fundus to identify areas of avascularity /or vascular abnormalities.
Assess need for intervention (e.g., surgery, laser, intravitreal injection).
Need for early educational intervention for low vision /or low vision clinic | Refer to early intervention low vision services in infancy, esp when visual impairment is severe.
| Neurologic eval | • Brain MRI
Consider EEG if seizures are a concern.
| Developmental assessment | • Motor, adaptive, cognitive, speec...
Source: GeneReviews — "NDP-Related Retinopathies"
Given the risk of hearing loss, the following are recommended:
Avoidance of exposure to loud noises
Use of hearing protection in noisy environments or when using noisy equipment
Minimal use of ear buds and other listening devices
Source: GeneReviews — "NDP-Related Retinopathies"
Search ClinicalTrials.gov in the US and EU Clinical Trials Register in Europe for access to information on clinical studies for a wide range of diseases and conditions. Note: There may not be clinical trials for this disorder.
Source: GeneReviews — "NDP-Related Retinopathies"
View trials for exudative vitreoretinopathy 2, X-linked
Table 6. Recommended Surveillance for Individuals with NDP-Related Retinopathies
System/Concern | Evaluation | Frequency |
|---|---|---|
involvement | Visual acuity, ocular alignment, measurement of intraocular pressure refractive error, dilated fundus exam | In infancy: 1x/mo per treating ophthalmologist (as frequency may be 1 or 2x/wk if concerns about imminent progression) |
Seizures | Assess response to medications /or changes in seizure type. | At each visit per family concerns |
Development | Monitor developmental progress educational needs. | At each visit Psychiatric/ |
Behavioral | Behavioral assessment for evidence of ASD, anxiety, ADHD, /or depression | At each visit per family concerns Musculoskeletal/ |
ADL | Physical medicine, OT/PT assessment of mobility, self-help skills | At each visit Sensorineural |
hearing loss | Audiogram incl assessment of speech discrimination | For those w/known hearing loss: per treating audiologist; For those w/o known hearing loss: prior to onset of language, frequent eval; thereafter, every 6 mos Peripheral |
vascular disease | Eval by primary care provider | Annually after age 16 yrs Erectile |
dysfunction | By patient history | At each visit Family/ |
Source: GeneReviews — "NDP-Related Retinopathies"
Phenotype severity distribution: 1 always present feature, 2 common features.
No clinical trials have been registered for exudative vitreoretinopathy 2, X-linked.
13 publications have been identified in PubMed for exudative vitreoretinopathy 2, X-linked. Research spans Basic Science / Preclinical (46%), Epidemiology / Natural History (31%), and Case Report / Case Series (15%).
Research Type | Count | % of Total |
|---|---|---|
Laboratory research | 6 | 46% |
Disease patterns and progression | 4 | 31% |
Patient case studies | 2 | 15% |
Research summaries | 1 | 8% |
Tao LR (2026). [PMID: 42097232](https://pubmed.ncbi.nlm.nih.gov/42097232/). *Surv Ophthalmol*. [Review / Meta-Analysis]
Sun D (2026). [PMID: 41412793](https://pubmed.ncbi.nlm.nih.gov/41412793/). *Journal of medical genetics*. [Case Report / Case Series]
Viegas Mestre N (2026). [PMID: 41803549](https://pubmed.ncbi.nlm.nih.gov/41803549/). *Eye (London, England)*. [Basic Science / Preclinical]
Yang L (2026). [PMID: 41526591](https://pubmed.ncbi.nlm.nih.gov/41526591/). *Scientific reports*. [Basic Science / Preclinical]
Naruse S (2026). [PMID: 42073993](https://pubmed.ncbi.nlm.nih.gov/42073993/). *Int J Mol Sci*. [Epidemiology / Natural History]
Qiao H (2025). [PMID: 40624078](https://pubmed.ncbi.nlm.nih.gov/40624078/). *Nature communications*. [Basic Science / Preclinical]
van der Ende S (2025). [PMID: 39918476](https://pubmed.ncbi.nlm.nih.gov/39918476/). *Investigative ophthalmology & visual science*. [Case Report / Case Series]
Liu S (2025). [PMID: 41174744](https://pubmed.ncbi.nlm.nih.gov/41174744/). *Orphanet journal of rare diseases*. [Basic Science / Preclinical]
Yaylacioglu Tuncay F (2025). [PMID: 39903177](https://pubmed.ncbi.nlm.nih.gov/39903177/). *Investigative ophthalmology & visual science*. [Epidemiology / Natural History]
Okamoto M (2025). [PMID: 39197492](https://pubmed.ncbi.nlm.nih.gov/39197492/). *Ophthalmology. Retina*. [Epidemiology / Natural History]
Data assembled from 6 of 12 sources · Last updated Sep 19, 2026, 2:56 PM UTC
Online Mendelian Inheritance in Man
Genetic and Rare Diseases Info Center
Autosomal dominant neovascular inflammatory vitreoretinopathy (ADNIV) (OMIM 193235)
AD |
Cataract, synechiae, retinal neovascularization, vitreoretinal traction, fibrovascular proliferation, vitreous hemorrhage, tractional retinal detachment, phthisis, loss of light perception in late stages |
Significant uveitis is a hallmark finding in ADNIV (not seen in ND). There are no findings at birth in ADNIV: early signs can be detected in adolescents, but most persons w/ADNIV present as adults. |
CTNNB1 | CTNNB1-related neurodevelopmental disorder (NDD)1 | AD | Assoc w/exudative vitreoretinopathy in some persons | CTNNB1-related NDD is assoc w/mild-to-profound cognitive impairment in all persons. Other common findings: truncal hypotonia, peripheral spasticity, dystonia, behavioral issues, microcephaly, refractive errors strabismus. CTNNB1 FZD4 LRP5 TSPAN12 |
ZNF408 | Nonsyndromic FEVR (OMIM PS133780) | ADAR2 | FEVR, retinal detachment, retinal vascular abnormalities | Genes should be incl in targeted panel for FEVR. |
KIF11 | Microcephaly-lymphedema-chorioretinopathy (OMIM 152950) | AD | FEVR | KIF11 pathogenic variants can cause nonsyndromic ocular findings or be assoc w/microcephaly, peripheral lymphedema, DD, brain anomalies. |
LRP5 | Osteoporosis pseudoglioma syndrome (OMIM 259770) | AR | Pseudoglioma, FEVR; common to have severe exudative vitreoretinopathy congenital blindness | Low bone density fractures are not typical in ND. |
RB1 | Retinoblastoma (RB) | AD | Leukocoria, pseudoglioma, cataract, strabismus | RB must be considered in diffdx of ND, esp in setting of unilateral pseudoglioma. Fundoscopic exam by retina specialist /or ocular oncologist can distinguish between RB ND. Ultrasonography head CT imaging show highly reflective foci in RB, consistent w/calcium deposits. |
Source: GeneReviews — "NDP-Related Retinopathies"
AI-curated news mentioning exudative vitreoretinopathy 2, X-linked
Updated Apr 3, 2026
A recent study highlights the challenges in diagnosing and managing complex retinal detachment in adults with familial exudative vitreoretinopathy. This research underscores the need for improved clinical strategies in handling this rare condition.