ASSESSMENT OF the retinal nerve fiber layer (RNFL) in clinical practice has been an attractive but elusive goal. Despite the promise of more accurate diagnosis and better monitoring of glaucoma, standard clinical techniques for assessment have disappointed most practitioners. Perhaps RNFL evaluation with newly available instruments will be more useful and more widely implemented into clinical practice than evaluation with some of the earlier techniques. In this issue, Trible et al1 have evaluated one of these instruments, the scanning laser polarimeter, to determine its diagnostic accuracy. By comparing the independent diagnostic judgments of 3 ophthalmologists with several algorithms that assess the polarimetric results, they conclude that the instrument can help to differentiate normal subjects from those with glaucoma, but that further study is needed before it can be used for screening. When considering these results, or the results with any other new instrument, it is reasonable for one to question whether RNFL assessment should be part of the diagnostic evaluation for glaucoma and whether it can be employed to make clinical decisions.
Weinreb RN. Evaluating the Retinal Nerve Fiber Layer in Glaucoma With Scanning Laser Polarimetry. Arch Ophthalmol. 1999;117(10):1403-1406. doi:10.1001/archopht.117.10.1403