WIDE RANGE OF TRAUMA RESULTS IN RETINAL NERVE FIBER LAYER (RNFL) DEFECTS

Title WIDE RANGE OF TRAUMA RESULTS IN RETINAL NERVE FIBER LAYER (RNFL) DEFECTS
Author, Co-Author Jerome Sherman, Juliana Boneta, Gulshan Karamchandani, Monica Aswani, Jeffrey Roth, Elena Laskova
Topic
Year
2006
Day
Program Number
065057
Room
Affiliation
State University of New York, College of Optometry
Abstract BACKGROUND: Although the GDx (Glaucoma Diagnosis) and HRT (Heidelberg Retina Tomograph), as well as the RNFL program of the OCT (Optical Coherence Tomograph) are often employed for glaucoma detection and monitoring, these devices often yield an abnormal RNFL in a host of non-glaucomatous optic neuropathies. Head and eye trauma often result in an abnormal RNFL in patients without evidence of glaucoma. In glaucoma suspects, an abnormal RNFL is often interpreted as evidence of glaucomatous damage, but could be due to some other optic neuropathy, such as traumatic optic neuropathy.

CASE REPORT(S): Ten cases of trauma (direct eye trauma, head trauma, body trauma, and bleeding after trauma) are presented with RNFL defects. Glaucoma as the explanation for the RNFL defect was considered and rejected in all cases. Even well documented mild trauma (being poked in the eye by an infant) sometimes results in RNFL reduction. Half of the patients presented are optometrists and these include automobile accidents, motorcycle accidents and sports related injuries. One case of mild trauma suffered in an automobile accident resulted in near immediate and profound RNFL and field loss.

CONCLUSIONS: RNFL defects, with or without corresponding field defects, occur in myriad optic neuropathies. Trauma, even relatively mild, often results in RNFL loss and should be considered in the differential diagnosis of any patient with abnormal results from functional and structural tests of the optic nerve. Unlike glaucoma, the defects due to trauma are essentially non-progressive and this is helpful in the differential diagnosis.
Affiliation of Co-Authors State University of New York, College of Optometry, Eye Institute and Laser Center, Eye Institute and Laser Center, TLC Laser Eye Centers, Nova Southeastern University, College of Optometry
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