This study aims to present a glaucoma case with delayed diagnosis because of myelinated retinal nerve fiber layer. On ophthalmological examination of a 58-year-old female patient with noted decrease in vision, corrected visual acuities were 0.9 in the right eye and 0.4 in the left eye, and intraocular pressures were 24 and 23 mmHg, respectively. In a slit-lamp examination, grade 1 nuclear sclerosis was observed in both the eyes. The iridocorneal angles were Grade 3 in both the eyes. On dilated fundus examination, the optical disc was bilaterally surrounded with myelinated nerve fibers, and the right one was larger than the left one. Cup/disc ratio was found to be 0.9 on the right and 0.5 on the left. On standardized Humphrey visual field test peripheral advanced deep, concentric visual field constriction and enlargement of the blind spot, which was prominent on the right side, were detected. Moreover, the patient was diagnosed with primary open-angle glaucoma. The appropriate medical treatment was initiated. In this study, we mentioned that myelinated nerve fibers can be associated with glaucoma. In patients with myelinated nerve fibers, the evaluation of the optical disk should be more detailed, and in these patients, visual field assessment should be more carefully performed.
Keywords: Myelinated nerve fibers, retina, glaucoma