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Daiyan Xin, Danilo B. Fernandes, Matthew Nguyen, Christine L. Talamini, Gustavo V. De Moraes, Jeffrey G. Odel, Jeffrey M. Liebmann, Robert Ritch, Donald C. Hood; Hypodense Regions ("Holes") Are Seen in the Retinal Nerve Fiber Layer of the Frequency-Domain OCT Scans of Eyes with Glaucoma, but not Eyes with MS or ION. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3914.
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To see if eyes with ischemic optic neuropathy (ION) or optic neuritis/multiple sclerosis (ON/MS) exhibit hypodense regions ("holes") in the retinal nerve fiber layer (RNFL) of frequency-domain optic coherence tomography (fdOCT) scans, as previously reported for glaucoma patients (GL) and glaucoma suspects (GLS).
Peripapillary circle (1.7 mm radius) and 3D optic disc fdOCT scans (Topcon 3D OCT 2000) were obtained on 63 eyes of 34 patients (39.6 ± 12.8 yrs) with ON/MS; 25 eyes of 15 patients (58.4 ± 10.5 yrs) with ION; 119 eyes of 63 patients (56.8 ± 14.5 yrs) with glaucomatous optic neuropathy (GON) and visual field mean deviations better than -6 dB. Patients were excluded if they did not have good quality scans and reliable 24-2 visual fields (Zeiss Meditec). Holes in the RNFL on circle scans were identified independently by 2 observers. The presence of holes also was verified on successive slices of 3D disc scans.
A total of 60 holes were found in 16 of the eyes of the GL/GLS patients, with 12 eyes showing more than one location with a hole. Conversely, none of the 25 ION eyes and only one eye with ON/MS had a hole. That is, one or more holes were found in 13.4% of the GL/GLS eyes, 0% of the ION eyes, and 1.6% of the ON/MS eyes. Severity of visual field loss as measured by mean deviations (MD) or thinning of the RNFL did not explain the differences among the groups.
As previously reported for a different group of GL/GLS patients, holes are seen in the RNFL of patients with GON, even in eyes of glaucoma suspects with normal visual fields. These holes, which are likely due to a local loss of retinal nerve fibers, are not seen in healthy controls  and seldom seen in patients with damage to the optic nerve secondary to ION or ON/MS.1. Xin et al, IOVS, 2011, 9, 7180.
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