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In a prospective study of 57 patients with clinically definite, probable, or possible multiple sclerosis (MS), one-half of whom had a history of optic neuritis, retinal nerve fiber layer (RNFL) defects and the neuroretinal rim (NRR) area were quantitatively determined and compared with the visual evoked potential (VEP). There were abnormal VEP latencies in 63% of all patients (definite and probable = 68%, possible = 50%); local or diffuse RNFL defects in 54%, (definite and probable = 54%, possible = 50%); and an abnormally small NRR area in 30% (definite and probable = 32%, possible = 25%). Abnormalities in one or more of the VEP, RNFL, or NRR area occurred in 86% of all patients (definite and probable = 90%, possible = 75%), thus considerably increasing the yield of optic nerve abnormalities over that of the VEP alone. The predominance and extent of the diffuse RNFL defects, which are axonal abnormalities, suggest a more diffuse optic nerve pathology in MS than can be accounted for by a "plaque" pathology and indicate that extensive axonal loss commonly occurs in the optic nerves of MS.

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In 61 eyes of 61 patients with glaucoma, semiquantitative assessment of retinal nerve-fiber-layer (RNFL) loss and neuroretinal rim measurement of the optic nerve head by means of the Optic Nerve Head Analyzer were correlated to the outcomes of automated light-sense, flicker and resolution perimetry and the Farnsworth-Munsell (FM) 100-Hue test. A significant influence of age on total RNFL and total diffuse RNFL scores was found, but there was no measurable effect of age on neuroretinal rim area. Total RNFL and total diffuse RNFL scores showed a good correlation to the various visual field indices: total RNFL score vs mean flicker frequency as determined by flicker perimetry, r = -0.606, P less than 0.0001; total RNFL score vs mean sensitivity as determined by light-sense perimetry, r = -0.385, P = 0.002; and total RNFL score vs mean ring score as determined by resolution perimetry, r = 0.341, P = 0.007. There was no significant correlation between RNFL scores and the FM 100-Hue score. Correlation between the neuroretinal rim area and the various psychophysical indices was poor and mostly not statistically significant. The high correlation of flicker scores with RNFL loss provides interest for future applications of this perimetric technique.