We repel there the clinical, genetic, and molecular characterization of three Chinese families with Leber's hereditary optic neuropathy (LHON). There were variable severity and age of onset in visual impairment among these families. Strikingly, there were extremely low penetrances of visual impairment in these Chinese families. Sequence analysis of complete mitochondrial genomes in these pedigrees showed the homoplasmic T14502C (158V) mutation, which localized at a highly conserved isoleucine at position 58 of ND6, and distinct sets of mtDNA polymorphisms belonging to haplogroups M10a, F1a1, and H2. The Occurrence of T14502C mutation in these several genetically unrelated Subjects affected by visual impairment Strongly indicates that this mutation is involved in the pathogenesis of visual impairment. Here mtDNA variants 1187T in the ND1, A122V in CO1. S99A in the A6, and V2541 in CO3 exhibited an, indicating a potential modifying role in the development of visual impairment evolutionary conservation, associated with T14502C mutation in those families. Furthermore, nuclear modifier gene(s) OF environmental factor(s) may play a role in the phenotypic manifestation of the LHON-associated T14502C mutation in these Chinese families. (C) 2009 Elsevier Inc. All rights reserved