Optic Disc Hemorrhage Chat Highlights – April 1, 2015

Optic Disc Hemorrhage Chat Highlights – April 1, 2015

Guest Speaker – Dr. Anand Mantravadi

Lorraine Miller – Editor, Chat Topic Researcher

 

Moderator:  Welcome to this evening’s chat!  Our guest glaucoma specialist is Dr. Anand Mantravadi and the topic for tonight is Optic Disc Hemorrhage.  If everyone is ready, let’s begin!

P:   Doctor, what is an optic disc hemorrhage?

Dr. Mantravadi:    Optic disc hemorrhages are hemorrhages oriented perpendicular to the optic disc margin.   They are strongly associated with glaucoma.  The mechanisms are not clear.  There are multiple theories on why they occur.

P:   How common is a disc hemorrhage?

Dr. Mantravadi:   One-half of a percent to fifteen percent of the population is affected as shown in many population-based studies.

P:   Why do these hemorrhages occur?

Dr. Mantravadi: No one truly knows.  There are mechanical theories, vascular theories and other theories.  It is known that a strong association with glaucoma, optic nerve structural changes, and visual field progression all exist.

P:   Is it a painful condition for the patient? Does a patient know when it occurs?

Dr. Mantravadi:   No, it is not a painful condition.  An optic disc hemorrhage is often accidentally found during an eye exam.  These hemorrhages will spontaneously resolve.

P:   What treatment is provided to the patient for a disc hemorrhage?

Dr. Mantravadi:   Treatment is controversial and patient dependent.  Occasionally, a practitioner may intensify the treatment for lowering intraocular pressure (IOP).  Simply observing the condition is also acceptable if all other parameters suggest a stable disease.

P:   Is there a relationship between an optic disc hemorrhage and the stage of glaucoma?

Dr. Mantravadi:   No, there is no relationship between the two.

P:   How long does it take for a hemorrhage site to heal?

Dr. Mantravadi:   This is variable but usually several weeks.  A hemorrhage does not heal but resolves or dissipates.  In studies, a disc hemorrhage has been associated with a possibility for further disc damage and field loss.  There may or may not be some change in the optic nerve.

P:   Do disc hemorrhages decrease vision?

Dr. Mantravadi:   No, a hemorrhage does not directly decrease vision.

P:   Do disc hemorrhages occur as frequently in glaucoma patients as in people with normal eyes?

 

Dr. Mantravadi:   A disc hemorrhage occurs more frequently in glaucoma patients.

P:   Is there a type of glaucoma that is more prone to this condition, and if so, is it known why a certain form of glaucoma is more at risk than others?

Dr. Mantravadi:   Disc hemorrhages have been observed more frequently in early rather than advanced glaucoma and in patients with low tension rather than primary open angle glaucoma.  It is not known why one form of glaucoma is more susceptible than another.

P:   What theories exist to explain the link between glaucoma and a disc hemorrhage?

Dr. Mantravadi:   There are a few theories.  Mechanical stress is one.   The entry of the optic nerve in the eye and the supportive structures around it change in the mechanical theory.  An analogy would be tectonic plates in an earthquake.   These changes cause some damage to the blood vessel.  The vascular theory shows that there is some blood supply problem or problem in the blood vessels.  It is not known which is true.

P:   How difficult is it to find a disc hemorrhage in a glaucomatous eye?

Dr. Mantravadi:   It can range from very subtle to very obvious based on a number of factors.

P:   If a doctor sees a disc hemorrhage in an eye, how does it change the course of glaucoma treatment?

Dr. Mantravadi:   It may or may not depending on a number of other factors such as perceived IOP control, stage and rate of the disease, and life expectancy.

P:   Can you count how many disc hemorrhages an eye has experienced?  Do disc hemorrhages leave scar tissue?

Dr. Mantravadi:   This is impossible to know unless one has documentation over years.   Disc hemorrhages do not cause scar tissue but neural rim loss in that area may occur.

P:   What factors distinguish fast progressors of optic nerve damage and slow progressors of optic nerve damage after a disc hemorrhage?

Dr. Mantravadi:   Rapid and slow progressors are distinguished by ongoing monitoring.  The disc appears progressive if supported by clinical exam, photos, and disc imaging, and there is corresponding field loss. In contrast, very gradual changes comprise the contrasting clinical situation.  Dr. Joseph Caprioli from UCLA has noted that patients with more severe glaucomatous damage, as measured by both visual field or optic disc cupping and older age, are at highest risk for rapid worsening of the disease.

P:   Can an individual have multiple disc hemorrhages throughout their life?  If so, does each hemorrhage influence optic nerve damage and visual field degradation?

Dr. Mantravadi:   Yes, multiple disc hemorrhages can occur throughout a lifetime.  Each hemorrhage does not necessarily influence optic nerve damage or visual fields.

P:   Does a disc hemorrhage affect future eye health in any way?

Dr. Mantravadi:   A disc hemorrhage may influence the health of the eye since there is an association with glaucoma.  There are disc hemorrhages that have been noted in otherwise healthy eyes.  The significance of this is unknown and may never result in any issues.

P:   Are disc hemorrhages seen in areas of advanced cupping?  Why or why not?

Dr. Mantravadi:   I don’t think this is well established.  Usually these occur at the vertical poles of the optic nerve.  Disc hemorrhages can occur nasal or temporal.  It is more common for the hemorrhage to occur superior or inferior.  There are no clear distinctions on the implication or significance of the direction of the hemorrhage.   Overall, disc hemorrhages have been observed more frequently in early rather than late disease.

P:   Does lowering intraocular pressure (IOP) decrease the development of disc hemorrhages?

Dr. Mantravadi:   Whether or not IOP reduction lowers the frequency of disc hemorrhages has not been clearly established.

P:   What other ocular disorders have an association with disc hemorrhages?

Dr. Mantravadi:   Many other conditions have been cited to have associations such as vitreous separation, diabetes, high blood pressure, and a long list of other conditions with rare associations.

P:   How does age influence the probability of a disc hemorrhage?

Dr. Mantravadi:   The literature does not demonstrate a clear association with age.

P:   Are disc hemorrhages an inherited condition?

Dr. Mantravadi:   It is not known if this is an inherited condition.

Moderator:  Dr. Mantravadi, our time is up.  We would like to thank you for the information you shared and the time you have spent with us this evening.

 

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The Glaucoma Service Foundation’s mission is to preserve or enhance the health of all people with glaucoma and to provide a model of medical care by supporting the educational and research efforts of the physicians on the Wills Eye Institute Glaucoma Service, the largest glaucoma diagnosis and treatment center in the country.

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