This 50YO female presented with multiple bilateral patches of myelinated nerve fiber layer (NFL). The findings are beautifully imaged using both the Optos color RG and green channels.
Myelinated NFL is a relatively uncommon, unilateral or bilateral, usually isolated finding present at birth. The myelinated NFL is often connected to the optic nerve, but not necessarily as in this case. Most patients are asymptomatic, although some may have a corresponding relative scotoma. Myelination can progress in about 10% of cases and can also resolve following retinal ischemic events. Myelinated NFL occurs when retinal nerve fibers develop a myelin sheath, which usually stops posterior to the lamina cribrosa. The myelination may represent an oligodendrocytic choristoma (see Rao et al, Retina 2019;39:1125-1132).
