Retinal nerve fiber layer (RNFL) defects are a defining feature of optic neuropathies and have been implicated in a few neurodegenerative disorders, including multiple sclerosis,1 Alzheimer disease,2 and Parkinson disease.3 Ashina et al4 conducted a prospective study observing 1406 children recruited from the Cophenhagen Child Cohort over 10 years. They showed that children of mothers with a history of smoking during pregnancy had a mean reduction in average circumpapillary RNFL thickness of 5.7 μm, adjusting for axial length, birth weight, and other covariates, compared with children without such history. Smoking during pregnancy has a detrimental effect on fetal development, including a higher risk of birth defects, low birth weight, and development of cognitive and behavioral problems.5 Although a difference of 5 to 6 μm in average circumpapillary RNFL thickness is unlikely to translate into a detectable difference in visual function in children aged 12 to 13 years, the risk of subsequent development of visual impairment should not be overlooked.
Leung CK. Evaluation of Retinal Nerve Fiber Layer Thinning With Fourier-Domain Optical Coherence Tomography. JAMA Ophthalmol. 2017;135(4):337–338. doi:10.1001/jamaophthalmol.2017.0056
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