Bilateral progressive myelinated retinal nerve fibres

Fig. 1: Bilateral progressive myelinated retinal nerve fibres. Full size image Fundus images of the right ( A ) and left ( B ) eye of a 5-year-old boy with myelinated retinal nerve fibre layers (MRNFLs) identified as white striated patches with poorly defined borders radiating from the optic discs [ 1 , 2 ]. These were observed by optometry prompted following persistent headache secondary to concussion. At the age of 17 years the dense, opaque white MRNFLs now obscure the underlying retinal vasculature in the peripapillary region of the right ( C ) and left ( D ) eye. Visual field testing observed barring of the blind spots. He remained asymptomatic. No other abnormalities such as decreased visual acuity or strabismus were identified on ophthalmology examination. Though MRNFLs were typically thought to be asymptomatic and nonprogressive, they can be associated with other ocular problems such as visual field deficits depending on the extent of myelination. Recent studies have highlighted they rarely can grow over time, as illustrated in this case [ 2 , 3 ].