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S.C. Anderson, R.H. Kardon; Optical Coherence Tomography (OCT) of the Retinal Nerve Fiber Layer (RNFL) in Blind Eyes Having No Light Perception . Invest. Ophthalmol. Vis. Sci. 2003;44(13):640.
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Purpose:To investigate how thin the RNFL becomes in chronically damaged eyes with complete blindness. Methods:The average RNFL thickness of 12 blind eyes (no light perception vision) were compared to 74 seeing eyes that had chronic damage from optic neuropathy and an abnormal mean deviation on automated threshold light perimetry of at least –10 decibels or worse. Blind eyes were damaged due to either trauma (n=1), tumor (n=6), ischemic optic neuropathy (n=1), or inflammatory optic neuropathy (n=4). Results:The frequency distribution of the RNFL thickness of the blind eyes was no different compared to that of the less damaged eyes. The RNFL thickness (mean microns +/- 2SD) of the blind eye group was 88 +/- 17 microns and the seeing eyes with optic neuropathy was 100 +/- 19 microns (no significant difference). Four patients with a blind eye had a normal fellow eye for comparison and showed a RNFL thickness that was 72% +/- 3% of the normal eye (average difference between normal eye and blind eye = 38 microns +/- 6). Two patients with a blind eye due to compression of the intracranial optic nerve by a large cavernous sinus meningioma coincidentally had a patch of myelinated nerve fibers in the retina, indicating presence of intact axons, despite no light perception vision. One patient with blindness due to traumatic optic neuropathy was followed over time after the acute damage and was found to have re-thickening of the RNFL after thinning due to atrophy. Conclusions:The RNFL thickness of blind eyes was not as thin as anticipated for the amount and duration of damage and may be explained by 1) gliosis, causing a thickening of the RNFL in spite of loss of axons, and/or 2) complete conduction block (and hence, blindness) of axon impulses caused by a tumor compressing the optic nerve, with intact viable ganglion cell axons in the retina.
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