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Impressum
Neuroretinal Rim Shape and Regional Visibility of the Retinal Nerve Fiber Layer in South Indians
1Nestel A., 2George R., 2Thomas R., 3Muliyel J. P., 1Jonas J. B.
1Department of Ophthalmology, Faculty for Clinical Medicine Mannheim of the University Heidelberg; 2Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, Indien; 3Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, Indien
Purpose: The neuroretinale rim is the intrapapillary equivalent
of the optic nerve fibers, and by that, the most important intrapapillary
parameter for the quantification of the retinal ganglion cell axons. Besides
its size, it is the shape of the neuroretional rim which is of utmost
importance for the early diagnosis of glaucomatous optic neuropathy. Since
the morphology of the optic nerve head depends on the ethnic background,
it was the purpose of the present study to evaluate the shape of the neuroretinal
rim in a South Indian population. Additionally, the ophthalmoscopic visibility
of the retinal nerve fiber layer as second parameter for the assessment
of the optic nerve should be examined.
Patients and Methods: The study included 73 ophthalmologically
unremarkable subjects living in a suburb of Vellore, Tamil Nadu, South
India. The subjects were randomly chosen and asked to participate in a
routine eye examination and in the study. All subjects were adults (age
range, 35-65 years) and were part of a population based sample that had
been investigated 5 years prior to the start of the present study. The
subjects of the present study formed a randomly selected subgroup of subjects
who were called for a follow-up examination. The study group was compared
with a control group consisting of 50 Caucasian subjects. Color stereo
optic disc photographs taken of all subjects included in the study were
evaluated.
Results: The neuroretinal rim had a characteristic configuration.
It was significantly (P<0.001) the widest at the inferior optic disc
pole, followed by the superior disc pole, the nasal optic disc region,
and it was thinnest in the temporal region of the optic disc. The shape
of the neuroretinal rim thus fulfilled the "ISN´T" rule.
The neuroretinal rim shape was independent (P>0.10) of the optic disc
size, the area of the neuroretinal rim, the optic cup depth, the presence
and size of zones alpha and beta of the parapapillary atrophy, age, right
or left eye, gender and refractive error. Corresponding to the shape of
the neuroretinal rim, the ophthalmoscopic visibility of the retinal nerve
fiber layer was significantly (P<0.01) the best in the temporal inferior
fundus region, followed by the temporal superior fundus region.
Conclusions: Thee neuroretinal rim shows in South Indians as well
as in Caucasians a characteristic shape according to the "ISN´T"
rule. This rim shape is independent of the ocular and general parameters
mentioned above. Correspondingly, the ophthalmoscopic visibility of the
retinal nerve fiber layer is better temporal inferiorly than temporal
superiorly. These findings may be of importance for the diagnosis of glaucomatous
optic nerve damage in Asiatic patients.