title: Reconciling visual field defects and retinal nerve fibre layer asymmetric patterns in retrograde degeneration: an extended case series.
abstract: BACKGROUND
  Accurate diagnosis in patients presenting with lesions at various locations within the visual pathway is challenging. This study investigated functional and structural changes secondary to such lesions to identify patterns useful to guide early and effective management.
  
  
  METHODS
  Over 10,000 records from patients referred for optic nerve head assessment were reviewed and 31 patients with a final diagnosis of likely neuropathic lesions posterior to the eye were included in the current study. Fundus photographs, optic coherence tomography images and visual field tests were evaluated for changes with respect to retinal nerve fibre layer topography and prediction of structure-function paradigms. Emerging clinical patterns were examined for their consistency with the likely anatomical origin of the underlying insult in the presence of varying diagnoses.
  
  
  RESULTS
  Data from patients with lesions along the visual system allowed identification of retinal nerve fibre layer asymmetry correlated with visual field defects and ganglion cell analysis. Bilateral discordance in retinal nerve fibre loss easily discernible from an altered pattern of the temporal-superior-nasal-inferior-temporal curve was characteristic for post-chiasmal lesions. These sometimes-subtle changes supported diagnosis in cases with multiple aetiologies or with ambiguous visual field analysis and/or ganglion cell loss.
  
  
  CONCLUSIONS
  Intricate knowledge of the retinal architecture and projections allows coherent predictions of functional and structural deficits following various lesions affecting the visual pathway. The integration of adjunct imaging and retinal nerve fibre layer thinning will assist clinicians to guide clinical investigations toward a likely diagnosis in the light of significant individual variations. The case series presented in this study aids in differential diagnosis of retrograde optic neuropathies by using retinal nerve fibre layer asymmetric patterns as an important clinical marker.
authors.affiliation: Centre for Eye Health, Sydney, New South Wales, Australia.|School of Optometry and Vision Science, The University of New South Wales, Kensington, New South Wales, Australia.
authors.forename: Barbara
authors.initials: B
authors.lastname: Zangerl
authors.affiliation: Centre for Eye Health, Sydney, New South Wales, Australia.|School of Optometry and Vision Science, The University of New South Wales, Kensington, New South Wales, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Whatham
authors.affiliation: School of Optometry and Vision Science, The University of New South Wales, Kensington, New South Wales, Australia.
authors.forename: Juno
authors.initials: J
authors.lastname: Kim
authors.affiliation: Centre for Eye Health, Sydney, New South Wales, Australia.|School of Optometry and Vision Science, The University of New South Wales, Kensington, New South Wales, Australia.
authors.forename: Agnes
authors.initials: A
authors.lastname: Choi
authors.affiliation: Centre for Eye Health, Sydney, New South Wales, Australia.|Ophthalmology Department, Prince of Wales Hospital, Randwick, New South Wales, Australia.
authors.forename: Nagi N
authors.initials: NN
authors.lastname: Assaad
authors.affiliation: Centre for Eye Health, Sydney, New South Wales, Australia.|Ophthalmology Department, Prince of Wales Hospital, Randwick, New South Wales, Australia.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Hennessy
authors.affiliation: Centre for Eye Health, Sydney, New South Wales, Australia.|School of Optometry and Vision Science, The University of New South Wales, Kensington, New South Wales, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Kalloniatis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology*; D009898:Optic Disk / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D012165:Retinal Ganglion Cells / Q000473:pathology*; D012189:Retrospective Studies; D012607:Scotoma / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D041623:Tomography, Optical Coherence / Q000379:methods*; D014794:Visual Fields / Q000502:physiology*; D055815:Young Adult
keywords: ganglion cells; optic nerve head; optical coherence tomography; retinal nerve fibre layer; retrograde degeneration