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    Retinal Nerve Fiber Layer Protrusion Associated with Tilted Optic Discs

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    Author
    Chiang, J; Yapp, M; Ly, A; Hennessy, MP; Kalloniatis, M; Zangerl, B
    Date
    2018-03-01
    Source Title
    Optometry and Vision Science
    Publisher
    LIPPINCOTT WILLIAMS & WILKINS
    University of Melbourne Author/s
    Kalloniatis, Michael
    Affiliation
    Anatomy and Neuroscience
    Metadata
    Show full item record
    Document Type
    Journal Article
    Citations
    Chiang, J., Yapp, M., Ly, A., Hennessy, M. P., Kalloniatis, M. & Zangerl, B. (2018). Retinal Nerve Fiber Layer Protrusion Associated with Tilted Optic Discs. OPTOMETRY AND VISION SCIENCE, 95 (3), pp.239-246. https://doi.org/10.1097/OPX.0000000000001179.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/256237
    DOI
    10.1097/OPX.0000000000001179
    Abstract
    SIGNIFICANCE: This study resulted in the identification of an optic nerve head (ONH) feature associated with tilted optic discs, which might potentially contribute to ONH pathologies. Knowledge of such findings will enhance clinical insights and drive future opportunities to understand disease processes related to tilted optic discs. PURPOSE: The aim of this study was to identify novel retinal nerve fiber layer (RNFL) anomalies by evaluating tilted optic discs using optical coherence tomography. An observed retinal nerve fiber protrusion was further investigated for association with other morphological or functional parameters. METHODS: A retrospective review of 400 randomly selected adult patients with ONH examinations was conducted in a referral-only, diagnostic imaging center. After excluding other ONH pathologies, 215 patients were enrolled and evaluated for optic disc tilt and/or torsion. Gross anatomical ONH features, including size and rim or parapapillary region elevation, were assessed with stereoscopic fundus photography. Optical coherence tomography provided detailed morphological information of individual retinal layers. Statistical analysis was applied to identify significant changes between individual patient cohorts. RESULTS: A dome-shaped hyperreflective RNFL bulge, protruding into the neurosensory retina at the optic disc margins, was identified in 17 eyes with tilted optic discs. Available follow-up data were inconclusive regarding natural changes with this ONH feature. This RNFL herniation was significantly correlated with smaller than average optic disc size (P = .005), congenital disc tilt (P < .0001), and areas of rim or parapapillary elevation (P < .0001). CONCLUSIONS: This study reports an RNFL protrusion associated with tilted optic discs, which has not previously been assessed as an independent ONH structure. The feature is predominantly related to congenital crowded, small optic discs and variable between patients. This study is an important first step to elucidate diagnostic capabilities of tilted disc morphological changes and understanding associated functional deficits.

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