Elsevier

Survey of Ophthalmology

Volume 40, Issue 5, March–April 1996, Pages 369-378
Survey of Ophthalmology

Evaluation of the retinal nerve fiber layer

https://doi.org/10.1016/S0039-6257(96)80065-8Get rights and content

Abstract

In normal eyes, the retinal nerve fiber layer (RNFL) is usually best visible in the inferior temporal part of the fundus, followed by the superior temporal region, the nasal superior region and the nasal inferior region. This distribution correlates with the configuration of the neuroretinal rim, the diameter of the retinal arterioles, the location of the foveola, and the lamina cribrosa morphology. With increasing age, the RNFL visibility decreases diffusely without preferring special fundus regions and without the development of localized defects. With all optic nerve diseases, the visibility of the RNFL is decreased in addition to the age-related loss, in a diffuse and/or a localized manner. The localized defects are wedge-shaped and not spindle-like defects, running toward or touching the optic disk border. Typically occurring in about 20% of all glaucoma eyes, they can be found also in other ocular diseases, such as optic disk drusen, toxoplasmotic retinochoroidal scars, longstanding papilledema or optic neuritis due to multiple sclerosis. Since they are not present in normal eyes, they almost always signify an abnormality. RNFL evaluation is especially helpful for early glaucoma diagnosis and in glaucoma eyes with small optic disks. In advanced optic nerve atrophy, other examination techniques, such as perimetry, may be more helpful for following optic nerve damage. Considering its great importance in the assessment of optic nerve anomalies and diseases and taking into account the feasibility of its ophthalmoscopic evaluation using green light, the retinal nerve fiber layer should be examined during any routine ophthalmoscopy.

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      Citation Excerpt :

      The rim shape in its sequence inferior – superior – nasal-temporal corresponds with: the thickness of the peripapillary retinal nerve fiber layer (RNFL) which usually is thickest temporal inferiorly, followed by the temporal superior region, and which often is the thinnest in the temporal region in the so called papillo-macular bundle (Dichtl et al., 1999; Jonas et al., 1989c, 1999; Jonas and Dichtl, 1996; Jonas and Schiro, 1993; Varma et al., 1996). Correspondingly, the mean ratio of temporal-superior RNFL thickness peak to the temporal-inferior RNFL thickness peak was 1.08 in a sample of 667 healthy Chinese eyes (unpublished data); - the ophthalmoscopical visibility of the RNFL in the sequence of temporal inferior, temporal superior, nasal superior, nasal inferior, and eventually temporal (Jonas et al., 1989c; Jonas and Schiro 1993); - the diameter of the retinal arterioles which are widest in the inferior temporal arcade, followed by the superior temporal arcade, the nasal superior arcade, and finally the nasal inferior arcade (Jonas et al., 1989d); - the location of the foveola about 0.5 ± 0.3 mm inferior to a horizontal line drawn though the disc center (Jonas et al., 1989c); - the anatomy of the lamina cribrosa with the largest lamina cribrosa pores and the least amount of inter-pore connective tissue in the inferior and superior regions as compared to the temporal and nasal sectors (Dandona et al., 1990; Jonas et al., 1991a); and

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