| Retinal nerve fiber layer | |
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 Section of retina. (Stratum opticum labeled at right, second from the top.) | |
 Plan of retinal neurons. (Stratum opticum labeled at left, second from the top.) | |
| Details | |
| Identifiers | |
| Latin | stratum neurofibrarum retinae |
| TA98 | A15.2.04.017 |
| FMA | 58688 |
| Anatomical terminology | |
The retinal nerve fiber layer (RNFL) or nerve fiber layer, stratum opticum, is part of the anatomy of the eye.
The RNFL formed by the expansion of the fibers of the optic nerve; it is thickest near the optic disc, gradually diminishing toward the ora serrata.
As the nerve fibers pass through the lamina cribrosa sclerae they lose their medullary sheaths and are continued onward through the choroid and retina as simple axis-cylinders.
When they reach the internal surface of the retina they radiate from their point of entrance over this surface grouped in bundles, and in many places arranged in plexuses.
Most of the fibers are centripetal, and are the direct continuations of the axis-cylinder processes of the cells of the ganglionic layer, but a few of them are centrifugal and ramify in the inner plexiform and inner nuclear layers, where they end in enlarged extremities.
RNFL measurement can be made by Optical coherence tomography. [1]
Patients with retinitis pigmentosa have abnormal thinning of the RNFL which correlates with the severity of the disease. [2] However the thickness of the RNFL also decreases with age and not visual acuity. [3] The sparing of this layer is important in the treatment of the disease as it is the basis for connecting retinal prostheses to the optic nerve, or implanting stem cells that could regenerate the lost photoreceptors.
RNFL asymmetry is the difference between the RNFL of the left and right eyes. In healthy patients, one study (2008, n=109) found asymmetry to be typically between 0-8μm, but occasionally higher, with average asymmetry of c.3μm at age 25 rising to 5μm at age 60. [4] A 2011 study (n=284) concluded that RNFL asymmetry exceeding 9μm may be considered statistically significant and may be indicative of early glaucomatous damage. [5] A 2023 study of 4034 children found mean RNFL of 106μm with SD of 9.4μm. [6]
RNFL asymmetry has been proposed as a strong indicator of optic neuritis, [7] [8] with one small study proposing that asymmetry of 5–6μm was "a robust structural threshold for identifying the presence of a unilateral optic nerve lesion in MS." [9] Optic neuritis is often associated with multiple sclerosis, and RNFL data may indicate the pace of future development of the MS. [10] [11]
RNFL asymmetry may be produced by glaucoma. [12] [13] [14] [15] Glaucoma is a lead cause of irreversible blindness. Resesrch in RNFL and optic nerve head (ONH) abnormalities may enable early detection and diagnosis of glaucoma. [2]
Some processes can excite RNFL apoptosis. Harmful situations which can damage RNFL include high intraocular pressure, high fluctuation on phase of intraocular pressure, inflammation, vascular disease and any kind of hypoxia. Gede Pardianto (2009) reported 6 cases of RNFL thickness change after the procedures of phacoemulsification. [18] Sudden intraocular fluctuation in any kind of intraocular surgeries maybe harmful to RNFL in accordance with mechanical stress on sudden compression and also ischemic effect of micro emboly as the result of the sudden decompression that may generate micro bubble that can clog micro vessels. [19]
Optic neuritis describes any condition that causes inflammation of the optic nerve; it may be associated with demyelinating diseases, or infectious or inflammatory processes.
Glaucoma is a group of eye diseases that lead to damage of the optic nerve, which transmits visual information from the eye to the brain. Glaucoma may cause vision loss if left untreated. It has been called the "silent thief of sight" because the loss of vision usually occurs slowly over a long period of time. A major risk factor for glaucoma is increased pressure within the eye, known as intraocular pressure (IOP). It is associated with old age, a family history of glaucoma, and certain medical conditions or medications. The word glaucoma comes from the Ancient Greek word γλαυκός, meaning 'gleaming, blue-green, gray'.
In neuroanatomy, the optic nerve, also known as the second cranial nerve, cranial nerve II, or simply CN II, is a paired cranial nerve that transmits visual information from the retina to the brain. In humans, the optic nerve is derived from optic stalks during the seventh week of development and is composed of retinal ganglion cell axons and glial cells; it extends from the optic disc to the optic chiasma and continues as the optic tract to the lateral geniculate nucleus, pretectal nuclei, and superior colliculus.
Optical coherence tomography (OCT) is an imaging technique that uses interferometry with short-coherence-length light to obtain micrometer-level depth resolution and uses transverse scanning of the light beam to form two- and three-dimensional images from light reflected from within biological tissue or other scattering media. Short-coherence-length light can be obtained using a superluminescent diode (SLD) with a broad spectral bandwidth or a broadly tunable laser with narrow linewidth. The first demonstration of OCT imaging was published by a team from MIT and Harvard Medical School in a 1991 article in the journal Science. The article introduced the term "OCT" to credit its derivation from optical coherence-domain reflectometry, in which the axial resolution is based on temporal coherence. The first demonstrations of in vivo OCT imaging quickly followed.
Phacoemulsification is a cataract surgery method in which the internal lens of the eye which has developed a cataract is emulsified with the tip of an ultrasonic handpiece and aspirated from the eye. Aspirated fluids are replaced with irrigation of balanced salt solution to maintain the volume of the anterior chamber during the procedure. This procedure minimises the incision size and reduces the recovery time and risk of surgery-induced astigmatism.
The optic disc or optic nerve head is the point of exit for ganglion cell axons leaving the eye. Because there are no rods or cones overlying the optic disc, it corresponds to a small blind spot in each eye.
Intraocular pressure (IOP) is the fluid pressure inside the eye. Tonometry is the method eye care professionals use to determine this. IOP is an important aspect in the evaluation of patients at risk of glaucoma. Most tonometers are calibrated to measure pressure in millimeters of mercury (mmHg).
Leber's hereditary optic neuropathy (LHON) is a mitochondrially inherited degeneration of retinal ganglion cells (RGCs) and their axons that leads to an acute or subacute loss of central vision; it predominantly affects young adult males. LHON is transmitted only through the mother, as it is primarily due to mutations in the mitochondrial genome, and only the egg contributes mitochondria to the embryo. Men cannot pass on the disease to their offspring. LHON is usually due to one of three pathogenic mitochondrial DNA (mtDNA) point mutations. These mutations are at nucleotide positions 11778 G to A, 3460 G to A and 14484 T to C, respectively in the ND4, ND1 and ND6 subunit genes of complex I of the oxidative phosphorylation chain in mitochondria.
A retinal implant is a visual prosthesis for restoration of sight to patients blinded by retinal degeneration. The system is meant to partially restore useful vision to those who have lost their photoreceptors due to retinal diseases such as retinitis pigmentosa (RP) or age-related macular degeneration (AMD). Retinal implants are being developed by a number of private companies and research institutions, and three types are in clinical trials: epiretinal, subretinal, and suprachoroidal. The implants introduce visual information into the retina by electrically stimulating the surviving retinal neurons. So far, elicited percepts had rather low resolution, and may be suitable for light perception and recognition of simple objects.
Dominant optic atrophy (DOA), or autosomal dominant optic atrophy (ADOA), (Kjer's type) is an autosomally inherited disease that affects the optic nerves, causing reduced visual acuity and blindness beginning in childhood. However, the disease can seem to re-present a second time with further vision loss due to the early onset of presbyopia symptoms (i.e., difficulty in viewing objects up close). DOA is characterized as affecting neurons called retinal ganglion cells (RGCs). This condition is due to mitochondrial dysfunction mediating the death of optic nerve fibers. The RGCs axons form the optic nerve. Therefore, the disease can be considered of the central nervous system. Dominant optic atrophy was first described clinically by Batten in 1896 and named Kjer’s optic neuropathy in 1959 after Danish ophthalmologist Poul Kjer, who studied 19 families with the disease. Although dominant optic atrophy is the most common autosomally inherited optic neuropathy (i.e., disease of the optic nerves), it is often misdiagnosed.
Optic neuropathy is damage to the optic nerve from any cause. The optic nerve is a bundle of millions of fibers in the retina that sends visual signals to the brain.
Optic disc drusen (ODD) are globules of mucoproteins and mucopolysaccharides that progressively calcify in the optic disc. They are thought to be the remnants of the axonal transport system of degenerated retinal ganglion cells. ODD have also been referred to as congenitally elevated or anomalous discs, pseudopapilledema, pseudoneuritis, buried disc drusen, and disc hyaline bodies.
Optic pit, optic nerve pit, or optic disc pit (ODP) is rare a congenital excavation (or regional depression) of the optic disc (also optic nerve head), resulting from a malformation during development of the eye. The incidence of ODP is 1 in 10,000 people with no predilection for either gender. There is currently no known risk factors for their development. Optic pits are important because they are associated with posterior vitreous detachments (PVD) and even serous retinal detachments.
The signs and symptoms of multiple sclerosis (MS) encompass a wide range of neurological and physical manifestations, including vision problems, muscle weakness, coordination difficulties, and cognitive impairment, varying significantly in severity and progression among individuals.
The nerve fibers forming the optic nerve exit the eye posteriorly through a hole in the sclera that is occupied by a mesh-like structure called the lamina cribrosa. It is formed by a multilayered network of collagen fibers that extend from the scleral canal wall. The nerve fibers that comprise the optic nerve run through pores formed by these collagen beams. In humans, a central retinal artery is located slightly off-center in the nasal direction.
Helen Victoria Danesh-Meyer is a New Zealand ophthalmology academic, and as of 2008 is a full professor at the University of Auckland.
Optical coherence tomography angiography (OCTA) is a non-invasive imaging technique based on optical coherence tomography (OCT) developed to visualize vascular networks in the human retina, choroid, skin and various animal models. OCTA may make use of speckle variance optical coherence tomography.
Hypotony maculopathy is maculopathy due to very low intraocular pressure known as ocular hypotony. Maculopathy occurs either due to increased outflow of aqueous humor through angle of anterior chamber or less commonly, due to decreased aqueous humor secretion by ciliary body.
Megalopapilla is a non-progressive human eye condition in which the optic nerve head has an enlarged diameter, exceeding 2.1 mm with no other morphological abnormalities.
The Heidelberg Retinal Tomography is a diagnostic procedure used in ophthalmology. The Heidelberg Retina Tomograph (HRT) is an ophthalmological confocal point scanning laser ophthalmoscope for examining the cornea and certain areas of the retina using different diagnostic modules. However, the most widely used area of application for HRT is the inspection of the optic nerve head (papilla) for early detection and follow-up of glaucoma. The procedure has established itself as an integral part of routine glaucoma diagnostics alongside the visual field examination (perimetry), the chamber angle examination (gonioscopy) and the measurement of intraocular pressure (tonometry). The HRT is the most widely used application of confocal scanning laser ophthalmoscopy.
This article incorporates text in the public domain from page 1015 of the 20th edition of Gray's Anatomy (1918)
| Fibrous tunic (outer) |
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| Uvea / vascular tunic (middle) |
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| Retina (inner) |
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| Anatomical regions of the eye |
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