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Medical Forum / General / Vision / June 2005vitreous detachment and optic nerve damage
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 believe you may be correct. This was my suspicion when you first started posting about this problem some months ago. DrG > When a vitreous detachment occurs and a Weiss ring floater appears, > this is tissue that has been pulled away from the optic nerve head, [quoted text clipped - 7 lines] > 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 ...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 > ...nor have I, and I am going far afield with this speculation. > [quoted text clipped - 12 lines] > > 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 I remember your case because I have had similar cases, and I always try to learn. DrG > 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 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 > 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 [quoted text clipped - 7 lines] > > 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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