The USA release of Fred Couples' Golf mirrors the Japan release in its core gameplay but might include alterations to the visuals, course design or even game modes to cater to the American audience. Given that the Game Gear's library varied between regions, these differences would not be unusual and would explain the existence of separate releases.  Again, precise details about the differences remain largely undocumented.

Fred Couples' Golf (USA)

Frank Thomas Big Hurt Baseball (USA)