Unilateral Myelinated Retinal Nerve Fibers

I read the photo essay titled “Unilateral Myelinated Retinal Nerve Fibers” with interest.[1] The authors reported a case of unilateral extensive myelination with amblyopia, with partial improvement after occlusion therapy. However, there was no comment about the status of the optic nerve head. Several reports have suggested that myelinated nerve fibers are associated with optic nerve dysplasia.[2] Williams proposed that retinal myelination leads to a decrease in the ganglion cells, which causes optic nerve hypoplasia, resulting in decreased visual acuity.[3] Holland and Anderson postulated that the myelinated nerve fibers induce overall disorganization of neural elements, leading to a disc anomaly, which is responsible for refractory amblyopia.