There is mounting evidence that retinal nerve fiber layer (RNFL) loss precedes detectable visual field loss in early glaucomatous optic neuropathy. However, examination and photography of the RNFL is a difficult technique in many patients, is subjective, qualitative, variably reproducible, time consuming, operator dependent, and has limited sensitivity and specificity. Scanning laser polarimetry provides automated, objective, and quantitative measurements of the RNFL. Such assessments are highly reproducible and show good agreement with clinical estimates of optic nerve head structure and visual function. This report will review the historical development, technological principles, reproducibility, sensitivity and specificity, capacity to detect glaucomatous progression, strengths, and limitations of this technology.
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