Non-glaucomatous RNFL loss with Cerebellar Atrophy – Page 25 of 31

Comments and Conclusions

• This patient has diffuse retinal thinning which appears to be related to diffuse loss of cortical tissue.
• Substantial loss of cerebellar tissue may occur prior to neurological symptoms.
• Specifically, loss of much of the cerebellum can occur prior to balance and coordination problems as this case demonstrates.
• Similarly, loss of RNFL in glaucoma and in the non-glaucomatous optic neuropathies can occur prior to both visual symptoms and measurable visual field loss.
• Most patients with Parkinson’s Disease¹ and no evidence of glaucoma have loss of the GCC (as measured with the Optovue) in the early stage of the disease.
• Although the VA, central fields, mf ERGs and the PIL all suggest that the photoreceptors are normal or near normal, segmentation of the outer retina indicates that the outer retina is thinner than normal. Hence, both the outer retina and inner retina are both thin.
• Thinning of the RNFL or thinning of both the inner and outer retina may occur in neurodegenerative disorders.
• Spectral Domain OCT may prove to be very useful in the diagnosis of diffuse brain disorders. Serial thickness measurements may eventually be used to determine whether treatment changes the course of various progressive neurological diseases.