vitreous detachment and optic nerve damage

Discussion in 'Optometry Archives' started by gudrun17, Jun 9, 2005.

  1. gudrun17

    gudrun17 Guest

    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?
    gudrun17, Jun 9, 2005
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  2. gudrun17

    Dr. Leukoma Guest

    I believe you may be correct. This was my suspicion when you first
    started posting about this problem some months ago.

    Dr. Leukoma, Jun 9, 2005
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  3. gudrun17

    drfrank21 Guest

    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).

    drfrank21, Jun 10, 2005
  4. gudrun17

    Dr. Leukoma Guest

    ....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.

    Dr. Leukoma, Jun 10, 2005
  5. gudrun17

    gudrun17 Guest

    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.
    gudrun17, Jun 10, 2005
  6. gudrun17

    Dr. Leukoma Guest

    I remember your case because I have had similar cases, and I always try
    to learn.

    Dr. Leukoma, Jun 11, 2005
  7. gudrun17

    gudrun17 Guest

    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.
    gudrun17, Jun 13, 2005
  8. gudrun17

    Dr. Leukoma Guest

    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.

    Dr. Leukoma, Jun 13, 2005
  9. gudrun17

    gudrun17 Guest

    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.
    gudrun17, Jun 13, 2005
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