The retinal nerve fiber layer (RNFL) or nerve fiber layer, stratum opticum, is part of the

anatomy Anatomy () is the branch of morphology concerned with the study of the internal structure of organisms and their parts. Anatomy is a branch of natural science that deals with the structural organization of living things. It is an old scien ...

of the

eye An eye is a sensory organ that allows an organism to perceive visual information. It detects light and converts it into electro-chemical impulses in neurons (neurones). It is part of an organism's visual system. In higher organisms, the ey ...

Physical structure

The RNFL formed by the expansion of the fibers of the

optic nerve 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 system, visual information from the retina to the brain. In humans, the optic nerve i ...

; it is thickest near the

optic disc 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. The ganglion cell axons form t ...

, gradually diminishing toward the

ora serrata The ora serrata is the serrated junction between the choroid and the ciliary body. This junction marks the transition from the simple, non-photosensitive area of the ciliary body to the complex, multi-layered, photosensitive region of the retina. ...

. As the nerve fibers pass through the

lamina cribrosa sclerae 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 scle ...

they lose their

medullary sheath Myelin Sheath ( ) is a lipid-rich material that in most vertebrates surrounds the axons of neurons to insulate them and increase the rate at which electrical impulses (called action potentials) pass along the axon. The myelinated axon can be lik ...

s and are continued onward through the

choroid The choroid, also known as the choroidea or choroid coat, is a part of the uvea, the vascular layer of the eye. It contains connective tissues, and lies between the retina and the sclera. The human choroid is thickest at the far extreme rear o ...

and

retina The retina (; or retinas) is the innermost, photosensitivity, light-sensitive layer of tissue (biology), tissue of the eye of most vertebrates and some Mollusca, molluscs. The optics of the eye create a focus (optics), focused two-dimensional ...

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 In anatomy, a plexus (from the Latin term for 'braid') is a branching network of blood vessels, lymphatic vessels, or nerves. The nerves are typically axons outside the central nervous system. The standard plural form in English is plexuses. Al ...

. 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 Centrifugal (a key concept in rotating systems) may refer to: *Centrifugal casting (industrial), Centrifugal casting (silversmithing), and Spin casting (centrifugal rubber mold casting), forms of centrifigual casting *Centrifugal clutch *Centrifug ...

and ramify in the

inner plexiform The inner plexiform layer is an area of the retina that is made up of a dense reticulum of fibrils formed by interlaced dendrites of retinal ganglion cells and cells of the inner nuclear layer In the anatomy of the eye, the inner nuclear layer ...

and

inner nuclear layer In the anatomy of the eye, the inner nuclear layer or layer of inner granules, of the retina, is made up of a number of closely packed cells, of which there are three varieties: bipolar cells, horizontal cells, and amacrine cells. Bipolar cell ...

s, where they end in enlarged extremities.

Measurement

RNFL measurement can be made by

Optical coherence tomography Optical coherence tomography (OCT) is a high-resolution imaging technique with most of its applications in medicine and biology. OCT uses coherent near-infrared light to obtain micrometer-level depth resolved images of biological tissue or oth ...

Relation with diseases

RNFL reduction

Retinitis pigmentosa

Patients with

retinitis pigmentosa Retinitis pigmentosa (RP) is a member of a group of genetic disorders called inherited retinal dystrophy (IRD) that cause loss of vision. Symptoms include trouble seeing at night and decreasing peripheral vision (side and upper or lower visua ...

have abnormal thinning of the RNFL which correlates with the severity of the disease. However the thickness of the RNFL also decreases with age and not visual acuity. 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. A 2011 study (n=284) concluded that RNFL asymmetry exceeding 9μm may be considered statistically significant and may be indicative of early glaucomatous damage. A 2023 study of 4034 children found mean RNFL of 106μm with SD of 9.4μm.

Optic neuritis

RNFL asymmetry has been proposed as a strong indicator of

optic neuritis Optic neuritis (ON) is a debilitating condition that is defined as inflammation of cranial nerve II which results in disruption of the neurologic pathways that allow visual sensory information received by the retina to be able to be transmitted to ...

, 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." Optic neuritis is often associated with

multiple sclerosis Multiple sclerosis (MS) is an autoimmune disease resulting in damage to myelinthe insulating covers of nerve cellsin the brain and spinal cord. As a demyelinating disease, MS disrupts the nervous system's ability to Action potential, transmit ...

, and RNFL data may indicate the pace of future development of the MS.

Glaucoma

RNFL asymmetry may be produced by

glaucoma Glaucoma is a group of eye diseases that can lead to damage of the optic nerve. The optic nerve 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 ...

. 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.

Fibromyalgia

One small study found that

fibromyalgia Fibromyalgia (FM) is a functional somatic syndrome with symptoms of widespread chronic pain, accompanied by fatigue, sleep disturbance including awakening unrefreshed, and Cognitive deficit, cognitive symptoms. Other symptoms can include he ...

patients had decreased RNFL thickness but another found no difference.

Correlation with ethnicity

RNFL may vary with ethnicity.

Other factors affecting RNFL

Some processes can excite RNFL

apoptosis Apoptosis (from ) is a form of programmed cell death that occurs in multicellular organisms and in some eukaryotic, single-celled microorganisms such as yeast. Biochemistry, Biochemical events lead to characteristic cell changes (Morphology (biol ...

. 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 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 ...

. 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. Pattern of Retinal Nerve Fibers

References

External links

* {{Authority control Human eye anatomy