The Nerve Fiber Layer Its Value In The Diagnosis And Management Of Glaucoma.

In the past six months, many of the faculty and also my fellow students have inquired about the subject of my senior research. When I answered that I was doing a literature search on nerve fiber layer (NFL) defects and their involvement in glaucoma, more often than not my answer was met with a blank stare. I guess this reaction really does not surprise me . After all, I knew very little about the evaluation of the NFL before my experience with glaucoma patients at the Topeka Veterans Administration Medical center. Yet the idea of using retinal NFL evaluation in the diagnosis and management of glaucoma is hardly a new concept. Vogt first used a red-free light source to examine and describe the NFL as long ago as 1913. Of course, the knowledge and instrumentation that is available to us today is far superior to what was available at that time. I am not exactly sure why clinicians today are not more willing and able to add the evaluation of the NFL to their arsenal of diagnostic procedures for glaucoma. In 1973, Hoyt and associates reported that red-free fundus photographs of the NFL could show glaucomatous abnormalities as subtle losses of nerve fibers in the presence of normal optic discs and visual fields. This has subsequently been confirmed by other investigators who have used red-free photographs of NFL to help diagnose glaucoma. The purpose of my literature search is to define NFL dropout, describe how it can be applied in clinic, and investigate its usefulness in glaucoma management.