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  • Courtesy of Alina K. Sinha, BA; Boonkit Purt, MD, David N. Zacks, MD, PhD.
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    Pediatric Ophth/Strabismus, Retina/Vitreous

    Fundus photography displaying extensive myelination of the retinal nerve fiber layer involving the optic nerve. Myelinated retinal nerve fiber layer (MRNFL) lesions occur in less than 1% of the population. These benign lesions are whitish gray with frayed borders and can obscure retinal vessels. They originate from oligodendrocytes abnormally continuing from the central nervous system through the lamina cribrosa of the optic nerve to retinal ganglion axons. Although patients are typically asymptomatic and incidentally diagnosed, some cases are associated with amblyopia, axial myopia, ocular trauma, colobomas, strabismus and Gorlin-Goltz syndrome. This image is of a 24-year-old male with history of myopia and was found to have a MRNFL of the optic disc in the right eye, with significant thickening of the corresponding layers on optical coherence tomography. The MRNFL resulted in an enlarged physiologic blind spot, as shown on his visual field. The patient had 20/20 vision in each eye and an otherwise normal ophthalmic examination.