A Japanese family has members with Leber's hereditary optic neuropathy resulting from the heteroplasmic 11778 mutation and the homoplasmic 4216 mutation. Quantitative determination of heteroplasmy was performed by a combination of polymerase chain reaction and single-strand conformation polymorphism analysis. The association between heteroplasmy and clinical features was determined. Eleven people from the maternal side of the family, including four affected and seven unaffected members, showed heteroplasmy of the mtDNA mutation ranging from 5% to more than 95%. Four possibly affected patients had more than 90% of the mutant mtDNA. Seven unaffected people had mutant mtDNA ranging from 5% to 77%. A recovery episode of visual acuity was noted in the history of three of the four patients. Heteroplasmy is likely to be a factor in the expression of disease in this family.