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Correspondence: Address to Angelo P. Tanna, MD, Department of Ophthalmology, Northwestern University Feinberg School of Medicine, 645 N Michigan Ave, Ste 440, Chicago, IL 60611.
The axons of the retinal ganglion cells compose the retinal nerve fiber layer, located in the inner (closest to the vitreous) retina. These axons coalesce at the optic disc and traverse the scleral canal to become the optic nerve. Posterior to the globe, the axons of the optic nerve become myelinated by supporting oligodendrocytes. Within the retina, however, myelination of these axons is present in only about 0.5% of autopsy eyes and has the appearance of a feathery, white opacity in the inner retina.
In one-third of cases, the area of myelination is contiguous with the optic disc, as shown in this case in an asymptomatic 58-year-old man (Figure). Myelination of the retinal nerve fiber layer interferes with transmission of light to the underlying photoreceptors, reducing visual sensitivity in the corresponding areas of the visual field. If the area of myelination is extensive, this condition can sometimes be associated with myopia, amblyopia, and strabismus.
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