Retinal nerve fiber layer

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Retinal nerve fiber layer
Gray881.png
Section of retina. (Stratum opticum labeled at right, second from the top.)
Gray882.png
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.

Contents

Physical structure

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.

Measurement

RNFL measurement can be made by Optical coherence tomography. [1]

Relation with diseases

RNFL reduction

Retinitis pigmentosa

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.

Asymmetric RNFL

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]

Optic neuritis

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]

Glaucoma

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]

Fibromyalgia

One small study found that fibromyalgia patients had decreased RNFL thickness [16] but another found no difference. [17]

Correlation with ethnicity

RNFL may vary with ethnicity. [18] [19]

Other factors affecting RNFL

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. [20] 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. [21]

Pattern of retinal nerve fibers Pattern of Retinal Nerve Fibers.jpg
Pattern of retinal nerve fibers

See also

References

  1. ↑ "Optic Nerve and Retinal Nerve Fiber Imaging - EyeWiki". eyewiki.org.[ unreliable medical source? ]
  2. 1 2 Desissaire S, Pollreisz A, Sedova A, Hajdu D, Datlinger F, Steiner S, et al. (October 2020). "Analysis of retinal nerve fiber layer birefringence in patients with glaucoma and diabetic retinopathy by polarization sensitive OCT". Biomedical Optics Express. 11 (10): 5488. doi: 10.1364/BOE.402475 . PMC   7587266 . PMID   33149966.
  3. ↑ Oishi A, Otani A, Sasahara M, Kurimoto M, Nakamura H, Kojima H, et al. (March 2009). "Retinal nerve fiber layer thickness in patients with retinitis pigmentosa". Eye. 23 (3): 561–6. doi:10.1038/eye.2008.63. PMID   18344951.
  4. ↑ Budenz DL (2008). "Symmetry Between the Right and Left Eyes of the Normal Retinal Nerve Fiber Layer Measured with Optical Coherence Tomography (An AOS Thesis)". Transactions of the American Ophthalmological Society. 106: 252–275. PMC   2646446 . PMID   19277241.
  5. ↑ Mwanza JC, Durbin MK, Budenz DL (March 2011). "Interocular Symmetry in Peripapillary Retinal Nerve Fiber Layer Thickness Measured With the Cirrus HD-OCT in Healthy Eyes". American Journal of Ophthalmology. 151 (3): 514–521.e1. doi:10.1016/j.ajo.2010.09.015. PMC   5457794 . PMID   21236402.
  6. ↑ Zhang XJ, Wang YM, Jue Z, Chan HN, Lau YH, Zhang W, et al. (2023). "Interocular Symmetry in Retinal Nerve Fiber Layer Thickness in Children: The Hong Kong Children Eye Study". Ophthalmology and Therapy. 12 (6): 3373–3382. doi:10.1007/s40123-023-00825-7. PMC   10640485 . PMID   37851163.
  7. ↑ Jiang H, Delgado S, Wang J (2021). "Advances in ophthalmic structural and functional measures in multiple sclerosis: do the potential ocular biomarkers meet the unmet needs?". Current Opinion in Neurology. 34 (1): 97–107. doi:10.1097/WCO.0000000000000897. PMC   7856092 . PMID   33278142.
  8. ↑ Nij Bijvank J, Uitdehaag BM, Petzold A (2021). "Short report: Retinal inter-eye difference and atrophy progression in multiple sclerosis diagnostics". Journal of Neurology, Neurosurgery, and Psychiatry. 93 (2): 216–219. doi:10.1136/jnnp-2021-327468. PMC   8785044 . PMID   34764152.
  9. ↑ Nolan RC, Galetta SL, Frohman TC, Frohman EM, Calabresi PA, Castrillo-Viguera C, et al. (December 2018). "Optimal Intereye Difference Thresholds in Retinal Nerve Fiber Layer Thickness for Predicting a Unilateral Optic Nerve Lesion in Multiple Sclerosis". Journal of Neuro-Ophthalmology. 38 (4): 451–458. doi:10.1097/WNO.0000000000000629. PMC   8845082 . PMID   29384802.
  10. ↑ Bsteh G, Hegen H, Altmann P, Auer M, Berek K, Pauli FD, et al. (October 19, 2020). "Retinal layer thinning is reflecting disability progression independent of relapse activity in multiple sclerosis". Multiple Sclerosis Journal: Experimental, Translational and Clinical. 6 (4): 2055217320966344. doi:10.1177/2055217320966344. PMC   7604994 . PMID   33194221.
  11. ↑ Martinez-Lapiscina EH, Arnow S, Wilson JA, Saidha S, Preiningerova JL, Oberwahrenbrock T, et al. (May 2016). "Retinal thickness measured with optical coherence tomography and risk of disability worsening in multiple sclerosis: a cohort study". The Lancet. Neurology. 15 (6): 574–584. doi:10.1016/S1474-4422(16)00068-5. PMID   27011339.
  12. ↑ Rodríguez-Robles F, Verdú-Monedero R, Berenguer-Vidal R, Morales-Sánchez J, Sellés-Navarro I (14 May 2023). "Analysis of the Asymmetry between Both Eyes in Early Diagnosis of Glaucoma Combining Features Extracted from Retinal Images and OCTs into Classification Models". Sensors. 23 (10): 4737. Bibcode:2023Senso..23.4737R. doi: 10.3390/s23104737 . PMC   10220946 . PMID   37430650.
  13. ↑ Choplin NT, Craven ER, Reus NJ, Lemij HG, Barnebey H (2015). "Retinal Nerve Fiber Layer (RNFL) Photography and Computer Analysis". Glaucoma. pp. 244–260. doi:10.1016/B978-0-7020-5193-7.00021-2. ISBN   978-0-7020-5193-7.
  14. ↑ Berenguer-Vidal R, Verdú-Monedero R, Morales-Sánchez J, Sellés-Navarro I, Kovalyk O (2022). "Analysis of the Asymmetry in RNFL Thickness Using Spectralis OCT Measurements in Healthy and Glaucoma Patients". Artificial Intelligence in Neuroscience: Affective Analysis and Health Applications. Lecture Notes in Computer Science. Vol. 13258. pp. 507–515. doi:10.1007/978-3-031-06242-1_50. ISBN   978-3-031-06241-4.
  15. ↑ "RNFL Analysis in the Diagnosis of Glaucoma". Glaucoma Today.
  16. ↑ Garcia-Martin E, Tello A, Vilades E, Perez-Velilla J, Cordon B, Fernandez-Velasco D, et al. (February 26, 2022). "Diagnostic Ability and Capacity of Optical Coherence Tomography-Angiography to Detect Retinal and Vascular Changes in Patients with Fibromyalgia". Journal of Ophthalmology. 2022 (1): 3946017. doi: 10.1155/2022/3946017 . PMC   9440831 . PMID   36065284.
  17. ↑ Talu Erten P, Bilgin S (June 2024). "Assessment of ophthalmic vascular changes in fibromyalgia patients using optical coherence tomography angiography: is there a real pathology?". JFO Open Ophthalmology. 6: 100057. doi:10.1016/j.jfop.2023.100057.
  18. ↑ Nousome D, McKean-Cowdin R, Richter GM, Burkemper B, Torres M, Varma R, et al. (2020). "Retinal Nerve Fiber Layer Thickness in Healthy Eyes of African, Chinese, and Latino Americans: A Population-based Multiethnic Study". Ophthalmology. 128 (7): 1005–1015. doi:10.1016/j.ophtha.2020.11.015. PMC   8128930 . PMID   33217471.
  19. ↑ Heidary F, Gharebaghi R, Wan Hitam WH, Shatriah I (September 2010). "Nerve fiber layer thickness". Ophthalmology. 117 (9): 1861–1862. doi:10.1016/j.ophtha.2010.05.024. PMID   20816254.
  20. ↑ Pardianto G (2009). "Mastering phacoemulsification in Mimbar Ilmiah". Oftalmologi Indonesia. 10: 26.
  21. ↑ Pardianto G, Moeloek N, Reveny J, Wage S, Satari I, Sembiring R, et al. (2013). "Retinal thickness changes after phacoemulsification". Clinical Ophthalmology. 7. Auckland, N.Z.: 2207–14. doi: 10.2147/OPTH.S53223 . PMC   3821754 . PMID   24235812.

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