Unilateral peripapillary myelinated retinal nerve fibers associated with strabismus, amblyopia, and myopia

To describe the association of unilateral peripapillary myelinated retinal nerve fibers with myopia, strabismus, and amblyopia and to propose a possible pathologic mechanism.

Four patients who have the findings associated with unilateral peripapillary myelinated nerve fibers are described and reviewed.

All patients had poor visual outcomes despite treatment with full cycloplegic refraction and appropriate patching.

Although the origin of this association is unknown, we believe that peripapillary myelinated nerve fibers in a unilateral myopic eye may be secondary to an imbalance between the process of myelination and the formation of the lamina cribrosa. Good results have been reported with amblyopic therapy; however, it is our experience that these patients are somewhat refractory to amblyopia therapy.