Volume 52 · Issue 05 · 2016

This issue focuses on the research progress in the diagnosis and treatment of fundus diseases. Professor Li Xiaoxin is the responsible editorial committee responsible for the planning, composition and review of the key contents of this issue.

Anti-vascular endothelial growth factor (VEGF) therapy as an effective therapeutic method has been a standard treatment strategy in retinal neovascular disease, contributing to restore vision and reduce the prevalence of blindness. With the research on the pathogenesis of retinal neovascular disease and implementation of clinical trials, anti-VEGF therapy is continuously optimized. Meanwhile, the complications after the use of anti-angiogenetic drugs are exposed. The present article summarizes the update and challenge of anti-VEGF therapy in retinal neovascular disease. (Chin J Ophthalmol, 2016, 52: 321-324)

orthokeratology is a reversible non-surgical physical orthopedic treatment method that wears a series of specially designed rigid gas permeable contact lenses (RGPCL) with geometric shapes opposite to the anterior surface of the cornea. The central area of the lens is flat and the paracentral area is steep, so as to reshape the shape of the cornea, so that the curvature of the central area of the cornea changes flat and regularly within a certain range, thus temporarily reducing the diopter of myopia and improving the naked eye vision. At the same time, it can obtain the clinical effect of significantly slowing down the development of myopia. orthokeratology lenses belong to Class III medical devices recognized by the State Food and Drug Administration. With the assistance of the Optometry Committee of Chinese Women Physicians Association, China Asia Branch of International Orthokeratology Society conducted a domestic investigation and research. According to the domestic development status and foreign experience, on the basis of the Expert Consensus on Clinical Fitting of Rigid Air-permeable Contact Lenses put forward by the Optometry Group of Ophthalmology Branch of Chinese Medical Association in 2012, a new expert consensus was formed after full discussion, aiming at providing further guiding suggestions for clinical fitting and management of orthokeratology lenses, so as to further promote the healthy development of orthokeratology technology in China.

To evaluate long-term efficacy of half-dose photodynamic therapy on chronic central serous chorioretinopathy using optical coherence tomography.

A retrospective, interventional case series. Thirty-five eyes of 32 patients (35 eyes) with chronic central serous chorioretinopathy were included, with CSC durations from 6 to 60 months. Patients treated with half-dose verteporfin (3 mg/m²) PDT were followed up for 24 months. Best-corrected visual acuity (BCVA), fluorescein angiography (FA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT) pre and post-treatment were all examined to observe the anatomic and functional changes. OCT findings highlighted the alterations of the ellipsoid zone (EZ), the interdigitation zone (IZ) and the central neural retina thickness (CNT) from 3 month to 24 month post-treatment. Regression analysis was applied to determine the correlation between the visual function (BCVA) and structure status (EZ, IZ, CNT).

Thirty-five eyes of 32 patients with chronic CSC were treated with half-dose PDT. The logMAR BCVA was 0.53±0.36 at baseline, 0.49±0.39 at 3 months and 0.15±0.38 at 24 months post-PDT. There was no statistical significance between baseline and 3 month BCVA (t=1.952, P>0.05). There existed statistical significance between baseline and 24 month BCVA(t=10.761, P<0.01) as well as 3month and 24 month BCVA(t=8.930, P<0.01). OCT demonstrated the recovery of EZ and IZ. Statistical differences of EZ and IZ integrity degree were found between the 3 month and 24 month (Z=-3.419, -4.082, P<0.01). The mean CNT was (126.8±34.9) μm at baseline. And it kept constant at 3 month [(125.6±34.3)μm] and the 24 month visit [(124.8±35.1)μm]. No statistical significance was found between any two values ( t=-1.830, -1.569, 0.793, P>0.05). At baseline, 3 month and 24 month, there was negative correlation between logMAR BCVA and CNT (β=-0.604, -0.634, -0.685,P<0.01). At 3 month and 24 month, negative correlation between logMAR BCVA and EZ as well as logMAR BCVA and IZ were also found(β=-0.376, -0.394, -0.628, -0.496,P<0.05). A complete resolution of subretinal fluid was noted in 94.3% eyes at 3 month, further increased to 100% eyes at 24 month. The mean session of PDT was 1.03±0.17.

Half-dose PDT was safe and effective for chronic CSC both functionally and morphologically in the long term. Visual benefits may not appear in a short run, yet became remarkable in a long run. Visual benefits might be attributed to recovery of EZ and IZ. (Chin J Ophthalmol, 2016, 52: 328-334)

To evaluate patterns of macular retinal ganglion cell complex thickness (mRGCCT) in patients with two types of neurologic lesions in optic chiasm region.

Retrospective case review study. Visual field test was conducted with automated perimetry (HAAG-STREIT OCTOPUS101 V6.07g Seven-in-One and 2010(HFA Ⅱ750-40220-5.1.1/5.1.1) Carl Zeiss Meditec), and visual field in the central 30 degree region was measured. Three types of thickness mapping including macular retinal thickness (MRT), macular ganglion cell complex thickness (mGCCT) and peripapillary retinal nerve fiber layer (pRNFL) were recorded with TOPCON 3D-OCT 2000 spectral domain OCT. The results of OCT were compared with visual field.

Sixteen cases were included in this study, male 10 cases, female 6 cases. Age 5 to 77 years (average 48.2). Neurologic lesions including pituitary tumor (9 cases), craniopharyngioma (3 cases), optic canal dysplasia in optic chiasm region (1 case), meningioma (1 case), hemangioma (1 case) and aneurysm (1 case). 14 cases have chronic, progressive, long course of disease, OCT showed characteristic perpendicular bisector delimitation, bilateral nasal mGCCT atrophy and corresponding temporal hemianopsia. 2 cases (both were pituitary tumor ) have a chronic, short duration, accelerated attack, visual acuity and visual field rapidly declined, mGCCT is swelling or approach high limit of normal range. In pRNFL thickness map, atrophy of mRNFL in temporal peripapillary and nasal macular region could be observed.

Chronic, progressive, long course of disease, combined with characteristic perpendicular bisector delimitation, bilateral nasal mGCCT atrophy and corresponding temporal hemianopsia is helpful to predict lesion of disease. mGCCT map is of equal importance with visual field test for diagnosis of lesion within optic chiasm. In cases with a chronic, short disease course, and accelerated attack, mGCCT could be swelling, but pRNFL could be thinner in temporal peripapillary and nasal macular region of single or both eyes, and visual field test is thus necessary in these cases. (Chin J Ophthalmol, 2016, 52:335-342)

To investigate the result of vitrectomy with epiretinal membrane (ERM) peeling for idiopathic macular epiretinal membrane (IMEM).

Clinical data of 51 patients (51 eyes) of IMEM who underwent vitrectomy with ERM peeling were retrospectively investigated. All the patients were examined by visual acuity, slit lamp, fundus under mydriasis, optical coherence tomography (OCT) before and after the surgery. The 3-18 months follow-up were included, mean (5.8±3.2) months. All the macular ERM were removed successfully. Paired-sample t test was used to study the visual acuity and macular foveal thickness before and after surgery. The Pearson correlation analysis was used to study the correlation between visual acuity and macular foveal thickness.

In the 51 patients, the best visual acuity improved from 4.25±0.34 to 4.65±0.23 postoperatively. The difference was statistically significant (t=-9.012, P=0.000), and the mean foveomacular thickness decreased from (432.7 ± 91.7) to (333.3 ± 66.1)μm postoperatively, the difference was statistically significant (t=10.565, P=0.000). There was negative correlation between visual acuity and mean foveomacular thickness (r=- 0.452, P=0.001), and it was obvious postoperatively (r=-0.602, P=0.000). The increase of visual acuity was strongly correlated with the decline of mean foveomacular thickness (r=0.382, P=0.006). Twelve eyes have developed cataract in 3 to 6 months after vitrectomy which affect the visual acuity. All of them went phacoemulsification and intraocular lenses(IOL) implantation and visual acuity after surgery had an obviously improvement.

Vitrectomy with ERM peeling can improve visual acuity and ease macular edema. And it is a safe and effective therapy to treat patients of IMEM. (Chin J Ophthalmol, 2016, 52:343-347)

To investigate the characteristics of bilateral rhegmatogenous retinal detachment (RRD) in a hospital-based population.

Six hundred and three patients diagnosed with bilateral RRD in the Beijing Tongren Hospital between January 2000 and January 2014 were identified and included into the study. The clinical features including the age when retinal detachment occurrence, time interval between the occurrence of the bilateral RRDs, predisposing characteristics such as myopia, trauma, et al. were recorded by a chart review.

Out of 8 283 patients treated for primary RRD in the study period, (7.30±2.45)%(603 patients) developed a RRD in the contralateral eye, with a mean age of (30.76 ± 15.31)years (range: 2-68) when the first RRD occurred. 4.8% of the patients primarily presented with a simultaneous bilateral RRD. Most RRD occurred firstly in the left eye (52.90%). Compared with the follow eye, the first RRD occurred with more macula detachment (P=0.03, OR: 1.59, 95%CI: 1.04-2.45) and retinal proliferation (P=0.04, OR: 1.57, 95% CI: 1.02-2.42), the visual outcome was more worse. Mean interval between the bilateral RRDs was (3.73±7.05) years (mean±standard deviation, range: 0-56 years) The younger, more severe symptoms of the firstly occurred RRD, the shorter interval between the bilateral RRD. Time interval between the bilateral RRD was shorter in those RRD firstly occurred with macula detachment, giant tears, horse-shoe tear, located in the temporal superior region, or with retinal degeneration. Compared with highly myopic eyes, the interval between the bilateral RRD were shorter in moderately myopic eyes.

For patients newly diagnosed with RRD, regardless of age, are required to a lifelong follow-up for the contralateral eye, especially within one year. Patients who were young, with heavier symptoms, low to moderate myopia or present with retinal degeneration, should be closely followed up in a short time after the first RRD occurred. (Chin J Ophthalmol, 2016, 52:348-353)

To evaluate the effects of intravitreal injection of sterile air followed by scleral cryotherapy on simple rhegmatogenous retinal detachment (RRD).

Retrospective study. Thirty-five cases (thirty-five eyes) with RRD were collected from Oct 2013 to Mar 2014. Among them, macular detachment was observed in 31cases, all accompanied with obvious synchesis. All retinal breaks were horseshoe shaped and holes located above 9 o'clock to 3 o'clock position, with size ranged from 0.5 to 1.5 PD. Subretinal fluid was drained by scleral puncture, after that 0.5-2.0 ml sterile air was injected into the vitreous cavity. Cryotherapy was done under binocular indirect ophthalmoscope followed by scleral buckling.

Retina reattachment was seen in 32 cases at the first day after operation. A small amount of subretinal fluid was found in 2 cases, which absorbed completely in one week after the surgery. Vitrectomy was done in 1 case because of aggravation of vitreous opacity and failure of retinal reattachment. The success rate of single operation and final operation was 97.1% and 100.0%, respectively. Visual improvement was observed in 33 cases. Ocular hypertension was seen in 6 cases and was controlled by topical antiglaucomatous eyedrops. No recurrence of RRD was found in all cases during the 5-10 months follow-up visit.

Gas tamponade followed by scleral cryotherapy can improve the success rate of operation for simple rhegmatogenous retinal detachment with obvious synchesis and retinal holes located at the upper quadrant. (Chin J Ophthalmol, 2016, 52:354-357)

To explore the influence factors of retinal vascular changes in diabetes patients.

Case control study. One hundred and fifty-five type 2 diabetes patients were divided into NDR group (n=80) and DR group (n=70) according to the presence of diabetic retinopathy. Fundus photographs were taken after pupil dilated, the diameter of retinal arterioles and venules were measured between 1.0 PD and 1.5 PD. To analyze the relationship between retinal artery diameter, vein diameter and hypertension, diabetes duration, and DR stage. With retinal artery and vein diameter as the dependent variable, DR stage, hypertension, diabetes duration, insulin using time and age as independent variables, using step method, multiple linear regression was undergoing.

The diameter of retinal vein in DR group and NDR group were (90.37+7.95) and (83.45±7.80) μm, the difference was statistically significant ( t=5.446, P=0.000). Retinal vein diameter was positively correlated with DR stage and diabetes duration (r=0.377, 0.250; P=0.000, 0.002). DR stage (b=2.382, P=0.000) had a linear relationship with retinal vein diameter (R²=0.142, F=25.285). The regression equation was: retinal vein diameter =84.269+ 2.382 · DR stage. Retinal artery diameter was negatively correlated with DR stage, diabetes duration, and hypertension duration (r=-0.453, -0.343, -0.199. P=0.000, 0.000, 0.013). DR stage (b=-2.091, P=0.000) and age (b=-0.182, P=0.000) has a linear relationship with retinal artery diameter (R²=0.290, F=31.088). The regression equation was: retinal artery diameter =64.011-2.091·DR stage -0.182·age.

With DR developed, retinal vein diameter increases, retinal artery diameter decreases in diabetic patients. The duration of diabetes mellitus and hypertension were not related to the diameter of retinal artery and vein. (Chin J Ophthalmol, 2016, 52:358-361)

To observe the manifestations of RetCam Ⅱ and color Doppler imaging (CDI) in a retrospective case series of persistent hyperplastic primary vitreous (PHPV).

Retrospective study. The medical records of 9 eyes/9 patients with PHPV went through RetCamⅡ and CDI from 2009 to 2014.

There were 6 young boys and 3 young girl in this study, age from 2 months to 5 years. All the patients were born at full term. 9 eyes had complication (cataract). The manifestations of RetCam Ⅱ: There were pale in optic disc. There were white fibre rod connected with optic disc, then prolonged to vitreous cavity, connected with posterior lens capsule. CDI showed arterial blood stream signal in band-shaped echogenic structure within vitreous cavity, prolonged to lens from the optic disc, or showed funnel-shaped echogenic mass at the posterior surface of lens and anterior of vitreous body, adhered to ciliary body, lens and the optic disc.

PHPV is congenital ocular anomalies because of a failure of primary vitreous and the hyaloids vascular system to regress. It manifests as unilateral and boys. We diagnosis PHPV by RetCamⅡ and CDI. (Chin J Ophthalmol, 2016, 52: 362-365)

To observe the efficacy of indocyanine green-assisted vitrectomy combined with internal limiting membrane peeling for treatment of idiopathic macular epiretinal membranes(IMEM).

Retrospectively studied 60 patients with IMEM who all underwent the surgery of vitrectomy combined with internal limiting membrane peeling from 2011 to 2013. Best corrected visual acuity (BCVA), intraocular pressure(NCT), slit-lamp examination, fundus photography, optical coherence tomography (OCT) were committed. Patients were followed for 6 months. They were divided into two groups according to whether indocyanine green(ICG) was used or not with 32 members in ICG group and 28 members in none ICG group. They were divided into two groups according to the intergrity or disruption of the ellipsoid zone (EZ band) with 26 members in EZ band intergrity group and 34 members in EZ band disruption group.

Age ranged from 28 to 79 years and the average age was 60.3 ± 10.9. Twenty-five males and 35 females were included. Twenty-five left eyes and 35 right eyes were incorporate. Among the 60 patients, 38 cases (63.33%) underwent visual acuity improvement after operation(BCVA improved at least 2 rows) and 21 (35%)patients' vision remained the same(BCVA changes less than 2 rows), while only one patient(1.67%) experienced decreased visual acuity(BCVA decline at least 2 rows). Average best corrected visual acuity (BCVA) (LogMar)and central retina thickness(CRT) (μm)of all patients preoperationwere 0.85 ± 0.44 and 578.45±144.61 respectively, which were 0.57±0.40 , 466.31±87.80 for one month and 0.54±0.42, 442.33± 98.92 three and six months postoperation(P<0.05). Compared to group of disruption EZ band, the BCVA of group of integral EZ band was better(P<0.05). 15 of 26 members in group of integral EZ band came up with EZ band cells loss in one month after operation and recovered by three or six months later. There was no statistical significance in BCVA and CRT between ICG group and none ICG group(P<0.05).

Indocyanine green-assisted vitrectomy combined with internal limiting membrane peeling in the treatment of IMEM is safe and effective. The symptoms of decreased vision, metamorphopsia were greatly ameliorated. Besides, retinal organization structures showed a certain extent of improvement. The transient occurrence of EZ band disruption postoperation could recovery 3 to 6 months later. And internal limiting membrane peeling assisted with ICG is a promising approach to the accomplishment of surgery without obvious toxicity. (Chin J Ophthalmol, 2016, 52:366-372)

To observe the effect of tert-butylhydroquinone (tBHQ) on the islets function and expression of HO-1 and VEGF in retina of type 2 diabetic rats.

Experimental study. Forty healthy male Sprague-Dawley rats with 6 weeks old were given high-fat and high-sugar diet for 4 weeks and then intraperitoneal injection with streptozotocin(STZ) 30mg/kg to induce diabetic model. Model group were further randomly divided into normal group and model group. Ten age matched health rats were chosen as control group. 4 and 12 weeks later, weight of rats , fasting blood glucose (FBG), fasting serum insulin (FINS), the levels of serum liqids were measured. The HO-1 and vascular endothelial growth factor (VEGF) expression in retina were determined by immunohistochmistry and quantitative real-time PCR. The differences of the mean values among the three groups were analyzed by one-factor analysis of variance. The multiple comparisons of the mean values among the three groups were analyzed by LSD-t analysis.

Type 2 diabetic model was successfully established in 32 rats, the success rate was 80.0%. Compared with normal gourp, plasma triglyceride (TG), plasma total cholesterol (TC) and plasma low density lipoprotein (LDL-C) of diabetic rats increased dramatically, and plasma high density lipoprotein (HDL-C) decreased. FBG was significant different between all groups(χ²_4w=10.631, P_4W=0.005; χ ²_12w=15.053, P_12w=0.001), and was significantly increased in tBHQ intervention group than that in diabetic group at the end of 12 week. The levels of FINS and homeostasis model assessment for insulin resistance (HOMA-IR) were significantly higher , and insulin sensitivity index (ISI) was significantly lower in diabetic and tBHQ intervention group compared with normal group(P<0.05), but there is no significantly difference between diabetic and tBHQ intervention group(P>0.05). The immunohistochemistry staining results showed the protein leveI of retinal HO-1 (F_4w=689.535, P_4w=0.000; F_12w=287.988, P_12w=0.000)and VEGF(F_4w=1084.956, P_4w=0.000; F_12w= 1107.553, P_12w=0.000) was significant different beteween all groups. The expression of HO-1 mRNA increased significantly in diabetic group(t_4w=10.21, t_12w=9.95)and tBHQ intervention group(t_4w=14.01, t_12w= 25.64)than that in normal group(P<0.05). The expression of HO-1 mRNA increased significantly in tBHQ intervention group(t_4w=6.04, t_12w=19.00)than that in diabetic group(P<0.05). The expression of VEGF mRNA increased significantly in diabetic group(t_4w=11.92, t_12w=29.27)and tBHQ intervention group(t_4w=12.50, t_12w= 11.24)than that in normal group(P<0.05). The expression of VEGF mRNA increased significantly in tBHQ intervention group(t_4w=-6.36, t_12w=-20.22)than that in diabetic group(P<0.05).

tBHQ can promote the secretion of insulin in diabetic rats, lowered glucose levels, also induce the expression of HO-1 and suppress the expression of VEGF in retina to confer protection to islets function and retina of type 2 diabtic rats. (Chin J Ophthalmol, 2016, 52:373-381)

The patient was a male, 1 year and 4 months old. Due to 8 months of developmental regression, he went to the Department of Neurology, Beijing Children's Hospital affiliated to Capital Medical University in April 2015. There was no abnormal development in the first 6 months after birth, but then gradually developed behind, crawling at 14 months, easily startled after sound stimulation, easily choking and coughing when eating, clumsy hands, gradually straightening limbs, unable to stand, unsteady sitting alone, and poor chasing objects. The child was the first birth, first birth, full-term, natural delivery. Examination: clarity, timidity, ringing throat, high muscle tone in both lower limbs, bilateral knee tendon hyperreflexia, positive Pap sign, delayed myelination on head MRI, and video EEG showing limiting bilateral anterior head suspected epileptic discharge. Ocular examination: reflecting light in the right position, alternating coverage without movement, no abnormality in the movement of both eyes, transparent corneas in both eyes, round pupils, 3 mm in diameter, direct and indirect reaction to light, fundus: optic nerve boundary is clear, the color is pale, and cherry red spots in the macular area are visible (Figure 1）。 It is recommended to improve the visual evoked potential and electroretinogram examination, but the child's family members refused. Diagnosis: Tay-sachs disease.

The patient was a 74-year-old male. On May 10, 2015, the left eye was accidentally stabbed by a steel wire while working in farmland, and the left cornea was debrided and sutured in the local hospital. After 1 week of postoperative treatment, he was discharged from hospital after improvement (the specific ocular condition and medication were unknown). One week after discharge, the patient developed eye pain and obvious decrease in visual acuity. He went to the local hospital again for treatment for one week, but it was ineffective. He was transferred to Hefei Celebrity Eye Hospital on May 27, 2015. Eye examination at admission: visual acuity of right eye with naked eye 1.0, IOP 16.8 mmHg (1 mmHg =0.133 K Pa); No abnormalities were observed in the anterior and posterior segments of the right eye; The visual acuity of the left eye was light sensing, which could not be corrected, the light localization was normal, and the intraocular pressure was 24.3 mmHg; The conjunctiva of the left eyeball was congested (+ + +), and a pannus of about 2 mm ×3 mm was visible in the center of the cornea. A regular wound of about 3 mm extended from the limbus of the cornea to the center of the cornea at 2 o'clock. It was sutured and the wound was well aligned. The anterior chamber was full of viscous yellow-white pus, and the rest of the situation was invisible. B-ultrasound showed cotton wool-like opacity of the vitreous body in the left eye (Figure 1,Figure 2）。 The patient had a history of athlete's hands and feet for many years, denied diabetes, denied drug sensitivity and other medical history. The outpatient diagnosis was left eye endophthalmitis, left eye corneal perforation injury after operation. Auxiliary examination before hospitalization: pulmonary X-ray examination showed no abnormality; Blood routine WBC: 6×10⁹Piece/L; The percentage of neutrophils was 83.1%, and there was no abnormality in the rest; Blood biochemical tests showed no abnormalities.

The patient was a 34-year-old male. Because of poor vision since childhood, he went to the Department of Ophthalmology, the First Hospital of Jilin University. Eye examination: the visual acuity is 0.1 in the right eye and 0.3 in the left eye, which cannot be corrected; No obvious abnormalities were observed in the anterior segment of both eyes; The fundus of both eyes showed clear borders of the optic papilla, light red color, muslin-like changes in the local retina in the middle and peripheral part, coral-like changes in blood vessels, and internal retinal foramen on the temporal side of the left eye (Quintessence Picture 1）。 Electroretinogram examination showed negative B-wave waveforms in both eyes. Clinical diagnosis: congenital retinoschisis in both eyes.

The patient was a 27-year-old female. A full body physical examination was conducted in Beijing Aier Yingzhi Eye Hospital. Ocular examination: corrected visual acuity was 0.8 (-5.75 DS) in the right eye and 1.0 (-5.25 DS) in the left eye; The intraocular pressure was 12 mmHg (1 mmHg =0.133 kPa) in the right eye and 13 mmHg in the left eye; no abnormalities were seen in the anterior segment of both eyes; the fundus of the right eye was normal, and a round black mass covering the optic head was seen in the fundus of the left eye (Quintessence Picture 1）。 B-ultrasound examination: Parenchymal lesion on the surface of the optic papilla of the left eye, followed by dark area of optic nerve (Quintessence Picture 2）。 Visual field examination: Left eye nasal side visual field ladder combined with physiological blind spot enlargement. Clinical diagnosis: melanocytoma of the left eye optic papilla.

Age-related macular degeneration (AMD) is one of the major causes of visual impairment in the elder population. Recent studies have revealed that retinal microgliacytes may play an important role in the pathogenesis of AMD, and the activation of retinal microglia could regulate the progress of AMD. The immunomodulatory role of retinal microglial cells is reviewed in this article, so as to investigate the mechanism and provide new insight for prevention and treatment of AMD.(Chin J Ophthalmol, 2016, 52: 386-390)

Autophagy is an intracellular degradative process used by eukaryotes that delivers cellular constituents to lysosomal degradation, such as damaged, degenerated or long-lived proteins, and excessive or defective organelles. Dysfunction of autophagy is involved in many human diseases, such as cancers, ageing, infectious and neurodegenerative diseases. A number of studies have shown that autophagy-related proteins are constitutively expressed in the eye, and abnormal autophagy is an important pathological feature of some ocular diseases. This article reviews recent advances in understanding the role of autophagy in the pathogenesis of ocular diseases, including cataract. (Chin J Ophthalmol, 2016, 52: 391-395)

Recently, the distribution characteristics of retinal nerve fiber layer thickness in myopic population have raised scholars' attention. The retinal nerve fiber layer thickness is varied with different refractive statuses, and is correlated to many factors like age, eye elongation, and fundus changes. Further exploration of the relationship between myopia and retinal structure and function will promote our understanding and knowledge of the pathogenesis of myopia. The article reviews the structure characteristics of the retinal nerve fiber layer, its associations with demographic characteristics, its characteristics in myopia, and the structural-functional relationship.(Chin J Ophthalmol, 2016, 52: 396-400)