Reconciling visual field defects and retinal nerve fibre layer asymmetric patterns in retrograde degeneration: an extended case series

Abstract

Background

Accurate diagnosis in patients presenting with lesions at various locations within the visual pathway is challenging. This study investigated functional and structural changes secondary to such lesions to identify patterns useful to guide early and effective management.

Methods

Over 10,000 records from patients referred for optic nerve head assessment were reviewed and 31 patients with a final diagnosis of likely neuropathic lesions posterior to the eye were included in the current study. Fundus photographs, optic coherence tomography images and visual field tests were evaluated for changes with respect to retinal nerve fibre layer topography and prediction of structure‐function paradigms. Emerging clinical patterns were examined for their consistency with the likely anatomical origin of the underlying insult in the presence of varying diagnoses.

Results

Data from patients with lesions along the visual system allowed identification of retinal nerve fibre layer asymmetry correlated with visual field defects and ganglion cell analysis. Bilateral discordance in retinal nerve fibre loss easily discernible from an altered pattern of the temporal‐superior‐nasal‐inferior‐temporal curve was characteristic for post‐chiasmal lesions. These sometimes‐subtle changes supported diagnosis in cases with multiple aetiologies or with ambiguous visual field analysis and/or ganglion cell loss.

Conclusion

Intricate knowledge of the retinal architecture and projections allows coherent predictions of functional and structural deficits following various lesions affecting the visual pathway. The integration of adjunct imaging and retinal nerve fibre layer thinning will assist clinicians to guide clinical investigations toward a likely diagnosis in the light of significant individual variations. The case series presented in this study aids in differential diagnosis of retrograde optic neuropathies by using retinal nerve fibre layer asymmetric patterns as an important clinical marker.

Key words:

• ganglion cells
• optic nerve head
• optical coherence tomography
• retinal nerve fibre layer
• retrograde degeneration

Author included posthumously

Author included posthumously

ACKNOWLEDGEMENTS

The authors extend particular thanks to the clinicians at CFEH, without whose exceptional expertise and efforts patient data collection and reviews would have been impossible.

This work was supported, in part, by a grant from the National Health and Medical Research Council (NHMRC) of Australia (1033224). Guide Dogs NSW/ACT is also a partner on the NHMRC grant and supplemented a PhD scholarship to Agnes Choi, who holds an Australian Postgraduate Award. Dr Zangerl holds a Faculty Research Grant awarded by the School of Optometry and Vision Science, University of New South Wales, Australia. Dr Kim was supported by an Australian Research Council (ARC) Future Fellowship (FT140100535).

Additional supporting information may be found in the online version of this article at the publisher’s website:

Figure S1. Variations of clinical findings with glaucoma.

Table S1. Glaucoma patients’ characteristics. All lesions were located in the optic nerve head.

Notes

Author included posthumously

Additional information

Funding

National Health and Medical Research Council (NHMRC)

University of New South Wales

Australian Research Council (ARC)