My patient has an optic disc hemorrhage (ODH): What does it mean? What do I do now? (Dr Dale Heuer)
/Presented 0855hrs 10Jun2011 in the Current Concepts I session: Canadian Ophthalmological Society 74th Annual Meeting, Vancouver, BC by Dr Dale Heuer.
Like coals to newcastle given home of Stephen Drance. What do we do now, so what, and who cares? Are disc heme’s glaucoma’s HgB A1C? You are only checking your patient’s 1/10,000 of the time even if you see your patient every 3 months. So only a fraction of their time. Does ODH predict damage in the future?
Patient with ODH 9x more likely to have glaucoma than one without an ODH. From OHTS, about 4x more likely to develop gaucoma if developed an ODH DURING the study…bearing in mind underestimate since ODH at entry was exclusion criteria. Same for NTG and EMGT studies…ODH increased risk developing glaucoma.
We need to revisit what an ODH is and tune ourselves up to identifying them as OHTS study showed only 1/6 identified by clinician and rest by photo. Flame shaped most common and infratemp and supratemp also more likely around existing thinning of the rim.
Is ODH cause, effect, statistical correlated finding, or none of the above? Is it vascular or shearing? More importantly, does it change your management? Do you change how you follow them, work with them on compliance, aim for lower IOP?
Rasker et al Arch Ophth 1997 115:1257 looked at ODH in NPG, POAG, and OHT patients. Also Bengtsson (Acta Ophthalmol 1990:68:450)
“Danger Will Robinson, danger!” when sees an ODH:
Danger Will Robinson
- step things up a notch
- increase monitoring
DISCUSSION:
Are other diseses in the differential like diabetes? How do you differentiate DM or HBP from glaucomatous? In some patients this can indeed be a challenge but if purely an ISOLATED heme, unlikely systemic disease. Also bear in mind a PVD can produce a disc heme.
4-12 weeks duration has been reported.