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vitreous detachment and optic nerve damage

 
 
gudrun17
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      06-09-2005, 06:07 PM
When a vitreous detachment occurs and a Weiss ring floater appears,
this is tissue that has been pulled away from the optic nerve head,
correct? From what I have read, this event may occasionally be
accompanied by optic disk hemorrhage. Would this ever cause damage to
the optic nerve? Although I realize it is likely just coincidence, I
have always wondered why I began to notice the beginnings of diminished
peripheral vision, later diagnosed as normal tension glaucoma, at the
same time an acute posterior vitreous detachment occurred. If the
vitreous can sometimes pull hard enough on the optic nerve to cause
bleeding, could there be any actual damage?
-Gudrun

 
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Dr. Leukoma
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      06-09-2005, 07:16 PM
I believe you may be correct. This was my suspicion when you first
started posting about this problem some months ago.

DrG

 
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drfrank21@gmail.com
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      06-10-2005, 12:19 AM


gudrun17 wrote:
> When a vitreous detachment occurs and a Weiss ring floater appears,
> this is tissue that has been pulled away from the optic nerve head,
> correct? From what I have read, this event may occasionally be
> accompanied by optic disk hemorrhage. Would this ever cause damage to
> the optic nerve? Although I realize it is likely just coincidence, I
> have always wondered why I began to notice the beginnings of diminished
> peripheral vision, later diagnosed as normal tension glaucoma, at the
> same time an acute posterior vitreous detachment occurred. If the
> vitreous can sometimes pull hard enough on the optic nerve to cause
> bleeding, could there be any actual damage?
> -Gudrun


I've never seen any "actual" permanent optic nerve head damage
from a pvs especially something like glaucoma (my own opinion,
these are 2 unrelated events).

frank

 
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Dr. Leukoma
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      06-10-2005, 12:15 PM
....nor have I, and I am going far afield with this speculation.

I have rarely seen a disc hemorrhage following a PVD, and even more
rarely have I taken visual fields following one. I do know that
retinal hemorrhages are not uncommon following PVD's, but those tend to
be peripherally located. There is very little published information
about field loss following a PVD, but there are a few articles about
field loss following vitrectomies and vitreous peels. Focal damage
does occur following a splinter hemorrhage in glaucoma, so why not
following a PVD?

A couple of additional points: splinter hemorrhages of the optic nerve
have been associated with NTG. Migraine has also been associated with
NTG. Migraine has also been associated with arcuate field loss.

DrG

 
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gudrun17
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      06-10-2005, 03:49 PM
Dr. Leukoma wrote:
> ...nor have I, and I am going far afield with this speculation.
>
> I have rarely seen a disc hemorrhage following a PVD, and even more
> rarely have I taken visual fields following one. I do know that
> retinal hemorrhages are not uncommon following PVD's, but those tend to
> be peripherally located. There is very little published information
> about field loss following a PVD, but there are a few articles about
> field loss following vitrectomies and vitreous peels. Focal damage
> does occur following a splinter hemorrhage in glaucoma, so why not
> following a PVD?
>
> A couple of additional points: splinter hemorrhages of the optic nerve
> have been associated with NTG. Migraine has also been associated with
> NTG. Migraine has also been associated with arcuate field loss.
>
> DrG


Thank you for your reply, Dr.G. That is exactly what I was wondering,
ever since one doctor told me that disc hemorrhages can sometimes occur
with an acute PVD although they are not uncommon in glaucoma patients.
Since as you say, splinter hemorrhages are associated with visual field
defects in glaucoma, why would the same not be possible after a PVD?
None of my doctors ever reported any sign of hemmorhage after my PVD
but I'm not sure that's something the ophthalmologist would be looking
for, and anyway, my understanding is they are transient and sometimes
hard to detect. I was just curious as to whether logically it's
possible for something like that to happen.

Oh, and I'm flattered you remember my case. It is still difficult--none
of the eyedrops have lowered pressure in that eye but the visual field
defects have beome less dense although a little more widespread.
-Gudrun

 
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Dr. Leukoma
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      06-11-2005, 10:54 PM
I remember your case because I have had similar cases, and I always try
to learn.

DrG

 
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gudrun17
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      06-13-2005, 03:08 PM


Dr. Leukoma wrote:
> I remember your case because I have had similar cases, and I always try
> to learn.
>
> DrG


May I ask how your patients with similar cases have fared? I am still
worried since so far the various eyedrops I have been prescribed--five
different meds by now--have not lowered IOP.
-Gudrun

 
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Dr. Leukoma
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      06-13-2005, 03:46 PM
How sure are you of the diagnosis of NTG? It seems to me that your
visual field loss was unusually fast, and now you say that it has
changed again, more diffuse as in a generalized depression.

I meant to say that I have had a few suspects whom I have followed with
suspicious discs, suspicious and variable visual fields, but were
stable without any treatment whatsoever. Most of those were patients
who suffered from migraine, either classical or ophthalmic. I always
have the more suspicous cases seen by a glaucoma specialist.

DrG

 
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gudrun17
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      06-13-2005, 08:38 PM


Dr. Leukoma wrote:
> How sure are you of the diagnosis of NTG? It seems to me that your
> visual field loss was unusually fast, and now you say that it has
> changed again, more diffuse as in a generalized depression.
>
> I meant to say that I have had a few suspects whom I have followed with
> suspicious discs, suspicious and variable visual fields, but were
> stable without any treatment whatsoever. Most of those were patients
> who suffered from migraine, either classical or ophthalmic. I always
> have the more suspicous cases seen by a glaucoma specialist.
>
> DrG


That was the diagnosis, but the first GS was not 100 percent sure
because as you note, the visual field defect isn't entirely typical of
glauoma. The one I am seeing now seems pretty sure, but just in case, I
am getting another opinion from someone with a special interest in NTG.
Yes, the visual fields have actually been steadily improving in terms
of mean deviation and PSD but while the damaged areas have become less
dense, it has spread over a little more of the upper field. No damage
yet in the lower half of the field or in the other eye. Maybe after six
visual field tests I'm just getting a lot better at taking them.
-Gudrun

 
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