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EDITORIAL
Year : 2015  |  Volume : 3  |  Issue : 1  |  Page : 1-2

Retinal nerve fiber layer defects


DORCS, MRCOphth, FRCOphth, FICS, FACS Professor of Ophthalmology BIJO Editor-In-Cheif, Faculty of Medicine, Al-Neelain University, Khartoum, Sudan

Date of Web Publication10-Nov-2015

Correspondence Address:
Mahgoub Saleem
DORCS, MRCOphth, FRCOphth, FICS, FACS Professor of Ophthalmology BIJO Editor-In-Cheif, Faculty of Medicine, Al-Neelain University, Khartoum
Sudan
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DOI: 10.4103/1858-6538.169307

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How to cite this article:
Saleem M. Retinal nerve fiber layer defects. Albasar Int J Ophthalmol 2015;3:1-2

How to cite this URL:
Saleem M. Retinal nerve fiber layer defects. Albasar Int J Ophthalmol [serial online] 2015 [cited 2019 May 19];3:1-2. Available from: http://www.bijojournal.org/text.asp?2015/3/1/1/169307

(This review does not purport to be comprehensive but was written to raise awareness of issues on Retinal Nerve Fiber Layer Defects.)

For years, ophthalmologists have recognized that ophthalmoscopic features of normal retinal nerve fiber layer (RNFL) could be observed by "white" and "red-free" direct ophthalmoscopy. Moreover, can be documented by a high-resolution red-free fundus photography.[1] Normal RNFL shows the fine parallel striated appearance of the arcuate bundle, especially along the vascular temporal arcades. Therefore, careful scrutiny of the RNFL should be an integral part the routine evaluation of the fundus.[2]

Diseases of the anterior visual pathway beside some systemic can produce defects in the RNFL: Optic nerve diseases, glaucoma, ocular hypertension, papilledema, toxic amblyopia, and congenital hemianopia,[2] cotton wool spots,[3] and obstructive sleep apnea syndrome.[4] Localized RNFL defects were found to be associated with cotton wool spots.[3]

Thinning of the RNFL is associated with brain atrophy in multiple sclerosis.[5],[6] Grazioli results support potential usefulness of optical coherence tomography (OCT) for MS patient monitoring.[7]

Macular RNFL imaging could protect the optic nerve from axonal loss of optic neuritis.[8]

In Leber's hereditary optic neuropathy the temporal fibers (papillomacular bundle) are the first and most severely affected; the nasal fibers seem to be partially spared in the late stage of the disease.[9]

Central retinal artery occlusion may lead to the optic disc and RNFL damage.[10] Patterns of these RNFL defects may be localized [3] or generalized attrition of RNFL. Small slit or sector-shaped defects also can be occurs.[2]

RNFL and visual field defects are uncommon (5%) in eyes with buried optic nerve Drusen (OND). Although most of the eyes with OND always have normal average RNFL thickness, very few may have clinically nonsignificant focal RNFL defects.[11]

Age-related RNFL defect is not uniform in all the quadrants, with a maximum loss in the superior quadrant, and seems to reach a maximum after the age of 50 years. Furthermore, it seems that inferior quadrant RNFL is more resistant to loss.[12]

The average superior and inferior RNFL thickness is usually inversely related to age.[13] For creating a normative database of SOCT RNFL values have to be age adjusted.[14]

The majority (86%) of the patients with retinitis pigmentosa develop well recorded RNFL damage. Some demonstrate thickening of the peripapillary RNFL (42%) in one or more quadrants whereas others (36%) show thinning of the peripapillary RNFL in one or more quadrants. Few (8%) may develop both thinning and thickening of the peripapillary RNFL thickness.[15]

Early diagnosis of glaucoma is critical to prevent permanent structural damage and irreversible vision loss. Preperimetric glaucoma.[16] can be early diagnosed by OCT assessment of the RNFL, optic nerve head, and macular thickness,[17] as a good combined parameters improve the diagnostic accuracy for early glaucoma. Nerve fiber atrophy usually precedes the onset of glaucomatous field loss.[18]

RNFL thickness decreases with the axial length and negative spherical equivalent of the eye. Highly myopic eyes have significantly lower RNFL thickness than other type of refractive error.[19]

Many factors can affect the variability of RNFL thickness measurements because of changes in signal strength:[20]

Soft contact lenses wearing at the time of examination,[21] ocular media opacity (cataract, cornal, or vitreous opacity),[22] and cataract extraction and intraocular lens implantation.[23],[24]

Reliable RNFL thickness measurement is done with:

  1. 1. OCT
  2. Time domain OCT (e.g.: Stratus; Carl Zeiss Meditec)
  3. 2. Spectral domain OCT (SD-OCT, e.g., Cirrus HD-OCT; Carl Zeiss Meditec)
  4. 3. Heidelberg retinal tomography
  5. 4. Scanning laser polarimetry
  6. Confocal scanning laser ophthalmoscopy.


 
  References Top

1.
Savino PJ. Evaluation of the retinal nerve fiber layer: Descriptive or predictive? J Neuroophthalmol 2009;29:245-9.  Back to cited text no. 1
    
2.
Newman N, Hoyt W. Ophthalmoscopic observation of retinal nerve fiber layer damage. West J Med 1975;122:238-9.  Back to cited text no. 2
    
3.
Koh JW, Park KH, Kim MS, Kim JM. Localized retinal nerve fiber layer defects associated with cotton wool spots. Jpn J Ophthalmol 2010;54:296-9.  Back to cited text no. 3
    
4.
Kargi SH, Altin R, Koksal M, Kart L, Cinar F, Ugurbas SH, et al. Retinal nerve fibre layer measurements are reduced in patients with obstructive sleep apnoea syndrome. Eye (Lond) 2005;19:575-9.  Back to cited text no. 4
    
5.
Gordon-Lipkin E, Chodkowski B, Reich DS, Smith SA, Pulicken M, Balcer LJ, et al. Retinal nerve fiber layer is associated with brain atrophy in multiple sclerosis. Neurology 2007;69:1603-9.  Back to cited text no. 5
    
6.
Waxman SG, Black JA. Retinal involvement in multiple sclerosis. Neurology 2007;69:1562-3.  Back to cited text no. 6
    
7.
Grazioli E, Zivadinov R, Weinstock-Guttman B, Lincoff N, Baier M, Wong JR, et al. Retinal nerve fiber layer thickness is associated with brain MRI outcomes in multiple sclerosis. J Neurol Sci 2008;268:12-7.  Back to cited text no. 7
    
8.
Trip SA, Schlottmann PG, Jones SJ, Altmann DR, Garway-Heath DF, Thompson AJ, et al. Retinal nerve fiber layer axonal loss and visual dysfunction in optic neuritis. Ann Neurol 2005;58:383-91.  Back to cited text no. 8
    
9.
Barboni P, Savini G, Valentino ML, Montagna P, Cortelli P, De Negri AM, et al. Retinal nerve fiber layer evaluation by optical coherence tomography in Leber's hereditary optic neuropathy. Ophthalmology 2005;112:120-6.  Back to cited text no. 9
    
10.
Hayreh SS, Jonas JB. Optic disk and retinal nerve fiber layer damage after transient central retinal artery occlusion: An experimental study in rhesus monkeys. Am J Ophthalmol 2000;129:786-95.  Back to cited text no. 10
    
11.
Katz BJ, Pomeranz HD. Visual field defects and retinal nerve fiber layer defects in eyes with buried optic nerve drusen. Am J Ophthalmol 2006;141:248-253.  Back to cited text no. 11
    
12.
Parikh RS, Parikh SR, Sekhar GC, Prabakaran S, Babu JG, Thomas R. Normal age-related decay of retinal nerve fiber layer thickness. Ophthalmology 2007;114:921-6.  Back to cited text no. 12
    
13.
Varma R, Skaf M, Barron E. Retinal nerve fiber layer thickness in normal human eyes. Ophthalmology 1996;103:2114-9.  Back to cited text no. 13
    
14.
Bendschneider D, Tornow RP, Horn FK, Laemmer R, Roessler CW, Juenemann AG, et al. Retinal nerve fiber layer thickness in normals measured by spectral domain OCT. J Glaucoma 2010;19:475-82.  Back to cited text no. 14
    
15.
Walia S, Fishman GA, Edward DP, Lindeman M. Retinal nerve fiber layer defects in RP patients. Invest Ophthalmol Vis Sci 2007;48:4748-52.  Back to cited text no. 15
    
16.
Lisboa R, Leite MT, Zangwill LM, Tafreshi A, Weinreb RN, Medeiros FA. Diagnosing preperimetric glaucoma with spectral domain optical coherence tomography. Ophthalmology 2012;119:2261-9.  Back to cited text no. 16
    
17.
Medeiros FA, Zangwill LM, Bowd C, Vessani RM, Susanna R Jr, Weinreb RN. Evaluation of retinal nerve fiber layer, optic nerve head, and macular thickness measurements for glaucoma detection using optical coherence tomography. Am J Ophthalmol 2005;139:44-55.  Back to cited text no. 17
    
18.
Sommer A, Katz J, Quigley HA, Miller NR, Robin AL, Richter RC, et al. Clinically detectable nerve fiber atrophy precedes the onset of glaucomatous field loss. Arch Ophthalmol 1991;109:77-83.  Back to cited text no. 18
    
19.
Leung CK, Mohamed S, Leung KS, Cheung CY, Chan SL, Cheng DK, et al. Retinal nerve fiber layer measurements in myopia: An optical coherence tomography study. Invest Ophthalmol Vis Sci 2006;47:5171-6.  Back to cited text no. 19
    
20.
Youm DJ, Kim H, Shim SH, Jang HJ, Kim JM, Park KH, et al. The effect of various factors on variability of retinal nerve fiber layer thickness measurements using optical coherence tomography. Korean J Ophthalmol 2012;26:104-10.  Back to cited text no. 20
    
21.
Youm DJ, Kim JM, Park KH, Choi CY. The effect of soft contact lenses during the measurement of retinal nerve fiber layer thickness using optical coherence tomography. Curr Eye Res 2009;34:78-83.  Back to cited text no. 21
    
22.
Lee DW, Kim JM, Park KH, Choi CY, Cho JG. Effect of media opacity on retinal nerve fiber layer thickness measurements by optical coherence tomography. J Ophthalmic Vis Res 2010;5:151-7.  Back to cited text no. 22
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23.
Gazzard G, Foster PJ, Devereux JG, Oen F, Chew PT, Khaw PT, et al. Effect of cataract extraction and intraocular lens implantation on nerve fibre layer thickness measurements by scanning laser polarimeter (GDx) in glaucoma patients. Eye (Lond) 2004;18:163-8.  Back to cited text no. 23
    
24.
Dada T, Behera G, Agarwal A, Kumar S, Sihota R, Panda A. Effect of cataract surgery on retinal nerve fiber layer thickness parameters using scanning laser polarimetry (GDxVCC). Indian J Ophthalmol 2010;58:389-94.  Back to cited text no. 24
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