Localized retinal nerve fiber layer defects associated with cotton wool spots

To introduce four cases of localized retinal nerve fiber layer (RNFL) defects after emergence of retinal cotton wool spots (CWSs). Four patients were evaluated for localized RNFL defects after the appearance of CWSs. Depending on the patient, they were followed up from the beginning of treatment to up to 19 years after the initial events. Fundus photos and other glaucoma examinations, including Stratus optical coherence tomography (OCT) and visual field examinations, were performed during the follow-up visits. The localized RNFL defects remained stable without any progression for as long as 19 years. Nonprogressive RNFL defects may occur after the appearance of CWSs, which the examiner may not be able to detect. Clinicians may need to consider not only visual field results and OCT findings but also disc configuration, RNFL defects, and fundus findings to decide on the proper diagnosis and treatment of patients suspected to have glaucoma.