| Identifier |
Retinal_Nerve_Fiber_Layer_RNFL |
| Title |
Retinal Nerve Fiber Layer (RNFL) |
| Creator |
Andrew G. Lee, MD; Jessica Sheu |
| Affiliation |
(AGL) Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, Texas; Professor of Ophthalmology, Weill Cornell Medicine, New York City, New York; (JS) Class of 2021, Baylor College of Medicine, Houston, Texas |
| Subject |
Nerve Fiber; Neuro-Ophthalmology; Atrophy |
| Description |
Dr. Lee lectures medical students on retinal nerve fiber layer and the retinal nerve fiber. |
| Transcript |
So, today we're going to be talking about the retinal nerve fiber layer, and the retinal nerve fiber layer allows us to actually see central nervous system when we're looking in the eye, so it really is one of our superpowers that we can look in the eye and see the nerve fiber layer. And so if this is the optic nerve, the fovea is the center of the eye. Fibers from the temporal portion of the retina arch around the fovea, and insert into the top of the disc, and the inferior fibers also do the same thing and insert into the bottom of the disk. And because the fovea is the center of the eye and not the optic nerve, all of the fibers in the papillomacular bundle on this side of the X are actually nasal fibers. They are not temporal fibers, and all of the nasal fibers are obviously nasal fibers. And what that means is when we have retinal nerve fiber layer loss from glaucoma, normally that means we're going to have an arcuate field defect, and we're going to have nerve fiber layer loss that takes on an hourglass appearance in terms of both atrophy and cupping, because the disk is the temporal fibers are inserting in the top (superior temporal) and in the bottom (inferior temporal). These two are nasal; this nasal fiber has a special name called the papillomacula, but it's still a nasal fiber, because mostly it's nasal to this only. And what that means is normally in glaucoma, because the temporal fiber is the fiber that is more susceptible and we get cupping, it causes a vertical type of notch. And so if we see atrophy nasally like a band across or cupping like a band across the nerve, that is the nasal fiber. And the reason this is important to know this retinal nerve fiber layer is most field defects from nerve fiber layer loss are glaucoma. It's the number one cause of a nerve fiber layer loss, and the ophthalmoscopic feature is cupping, and it's going match the nerve fiber layer loss and the most common field defect is going to be nasal, like a nasal step in a temporal fiber loss. However, if we have papillomacular bundle drop out, that's going to cause a central scotoma. If we have nasal fiber loss, that's going to cause a temporal field effect. And as opposed to glaucoma and their fiber layer defects that respect the horizontal meridian, once we get close to the junction of the optic nerve chiasm, the temporal fibrous thing uncross, the nasal fibers trying to cross. And what that means is the field defect will cease to respect the horizontal Meridian, and start to respect the vertical Meridian. And so the things that you should worry about when you're looking at a field or a fundus or an OCT that suggest someone has nerve fiber layer loss in non-glaucomatous pattern: if you have temporal field effect rather than nasal; if you have vertical respect rather than horizontal respect to the meridian; if you have nasal cupping or nasal atrophy in the papillomacular bundle or the nasal fiber, which we call a band-type atrophy; if we see any combination of those nerve fiber layer problems, then you really should be thinking that it's neuroophthalmic in origin. Vertical step, temporal fiber, and band atrophy. The markers that whatever the problem is inside your head and not inside of your eye. |
| Language |
eng |
| Format |
video/mp4 |
| Type |
Image/MovingImage |
| Collection |
Neuro-Ophthalmology Virtual Education Library: Andrew G. Lee Collection: https://novel.utah.edu/Lee/ |
| Publisher |
North American Neuro-Ophthalmology Society |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E SLC, UT 84112-5890 |
| Rights Management |
Copyright 2019. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6rg182r |
| Setname |
ehsl_novel_lee |
| ID |
1561525 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6rg182r |
