Use Of NFL Atrophy In Diagnosing Glaucoma Suspects.

There has been some recent controversy among eye care professionals as to whether or not subtle changes in the retinal nerve fiber layer (NFL) can provide an early indication of
the onset of primary open-angle glaucoma. The prevalent view seems to be that just visualizing the NFL, let alone being able to make meaningful and consistent evaluations, is
prohibitively difficult. This paper presents the findings of a related literature search. An early indicator is obviously needed since practitioners face the problem of when to begin treatment of a glaucoma suspect. Should they begin treatment early, and perhaps needlessly, using expensive and potentially harmful drugs, or wait, and risk added damage? The preponderance of the liter at ure deals with the use of the conventional glaucoma
indicators (physiological cupping of the optic nerve head, increased intraocular pressure, visual field defects, etc.). Some of the literature, however, outlines procedures to be used in visualizing the NFL, describes, classifies, and assigns levels of significance to subtle changes, and states flatly that discernible changes in the NFL occur four to six years in advance of any visual field defects! If this is so, then evaluation of NFL changes represents an extremely valuable, but grossly underused, adjunct to the normal diagnostic procedures. Treatment initiated on the basis of this early indicator could significantly retard the progress of the disease and delay the onset of visual field defects.