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59 EW GLAUCOMA July 2016 Contact information Budenz: 919-966-5296 Piltz-Seymour: Jody.Piltz@outlook.com documented disc hemorrhages were missed on examination. Only 17% of those identified on photographs were spotted on examination." She explained that disc hem- orrhages were relatively common, and their full incidence was hard to nail down because of their transient nature, coming and going within a matter of weeks. Their incidence seems to be higher in women, in- creased with age, and more promi- nent in people with vascular spastic issues like migraine headache. Females with regular migraines tend to have glaucoma at lower pressures, and they are more prone to disc hemorrhages, she said. Disc hemorrhages form nerve fiber layer defects, according to Dr. Piltz-Seymour. "At the spot where you see a disc hemorrhage, there may be no change at first. Later on, though, you may find a notch or an extension of a notch where the disc hemorrhage was. Disc hemorrhages don't form in notches, they form at the edge of notches—you have to have rim tissue for the disc hemor- rhage to form. You'll see that if the disc hemorrhage was at the edge of a notch, the notch is now wider— the nerve fiber layer defect is wider. There may also be some increase in beta peripapillary atrophy." Telling the patient Disc hemorrhages are very predictive of future progression in patients with glaucoma, causing visual field worsening, increased cupping, decreased nerve fiber layer, increased beta peripapillary atrophy, and an increased risk of changing from glaucoma suspect to manifest glau- coma. Patients therefore need to be informed about the relevance of disc hemorrhage, but without unneces- sarily alarming them. Informing patients is a balanc- ing act that Dr. Piltz-Seymour thinks is best done with tact. "The minute you use the word 'hemorrhage,' patients think of something big and massive. So I explain that there is a small marker, a little droplet of blood on their optic disc, which although tiny is a warning flag that everything may not be rock stable. I explain the need to follow them a bit more closely and maybe be a little bit more aggressive, if we can be." EW Reference 1. Budenz DL, et al. Detection and prognostic significance of optic disc hemorrhages during the Ocular Hypertension Treatment Study. Ophthalmology. 2006;113:2137–2143. Editors' note: Drs. Budenz and Piltz-Seymour have no financial interests related to their comments. Watch for our weekly emails every Saturday, broadcasting recorded live cornea presentations All content is archived for future reference Learn from the experts @http://VideoEd.CorneaSociety.org Copyright ©2016 Cornea Society. All rights reserved. Now online: Cornea Day 2016 The Cornea Society new VideoEd portal features cornea presentations and expert interviews from educational events throughout the year VideoEd.CorneaSociety.org Watch, Learn and Share! Available on mobile devices, tablets, and desktops

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