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Purpose: To compare the rates of detection of optic disc hemorrhages by clinical examination and by review of optic disc photographs at the Optic Disc Reading Center (ODRC), to assess the incidence of and the predictive factors for disc hemorrhages in the annual disc photographs of the Ocular Hypertension Treatment Study (OHTS), and to determine whether optic disc hemorrhages predict the development of primary open-angle glaucoma (POAG) in the OHTS.Design: Cohort study.Participants: 3,236 eyes of 1,618 participants. Methods:Both eyes of participants were examined for optic disc hemorrhages every 6 months by clinical examination, with dilated fundus examinations every 12 months, and by annual review of stereoscopic disc photographs at the ODRC. Main Outcome Measures:Incidence of optic disc hemorrhages and POAG endpoints.Results: Median follow-up was 96.3 months. Stereophotograph-confirmed glaucomatous optic disc hemorrhages were detected in 128 eyes of 123 participants prior to POAG. Twenty one (16%) were detected by both clinical examination and review of photographs and 107 (84%) only by review of photographs (P <0.0001). Baseline factors associated with disc hemorrhages were older age, thinner corneas, larger vertical cup/disc ratio, larger PSD index on perimetry, family history of glaucoma, and smoking. The occurrence of a disc hemorrhage increased the risk of developing POAG 6-fold in a univariate analysis, (p<0.001; 95% confidence interval 3.6 -10.1), and 3.7-fold in a multivariate analysis that included baseline factors predictive of POAG (p<0.001; 95% confidence interval 2.1 -6.6). The 96-month cumulative incidence of POAG in the eyes without optic disc hemorrhage was 5.2% compared to 13.6% in the eyes with optic disc hemorrhage. In eyes with a disc hemorrhage that developed a POAG endpoint, the median time between the two events was 13 months.Corresponding Author: Donald L. Budenz, MD, MPH, Bascom Palmer Eye Institute, 900 NW 17th St, Miami, FL 33136. Telephone 305−326−6384. FAX 305−326−6337. E-mail: dbudenz@med.miami.edu Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conclusion: Review of stereo photographs was more sensitive at detecting optic disc hemorrhage than clinical examination. The occurrence of an optic disc hemorrhage was associated with an increased risk of developing a POAG endpoint in participants in the OHTS. However, the majority of eyes (86.7%) that developed a disc hemorrhage have not developed a POAG endpoint to date.

Objective-To test the validity and generalizability of the Ocular Hypertension Treatment Study (OHTS) prediction model for the development of primary open angle glaucoma (POAG) in a large independent sample of untreated ocular hypertensive individuals. To develop a quantitative calculator to estimate the 5-year risk that an individual with ocular hypertension will develop POAG.Design-A prediction model was developed from the observation group of the OHTS and then tested on the placebo group of the European Glaucoma Prevention Study (EGPS) using a z-statistic to compare hazard ratios, a c-statistic for discrimination and a calibration chi-square for systematic over/under estimation of predicted risk. The two study samples were pooled to increase precision and generalizability of a 5-year predictive model for developing POAG.Participants-The OHTS observation group (n=819, 6.6 years median follow-up) and the EGPS placebo group (n=500, 4.8 years median follow-up).Testing-Data were collected on demographic characteristics, medical history, ocular examination visual fields and optic disc photographs.Main Outcome Measures-Development of reproducible visual field abnormality or optic disc progression as determined by masked readers and attributed to POAG by a masked endpoint committee.Results-The same predictors for the development of POAG were independently identified in both the OHTS observation group and the EGPS placebo group -baseline age, intraocular pressure (IOP), central corneal thickness, vertical cup/disc ratio, and Humphrey visual field pattern standard deviation. The pooled multivariate model for the development of POAG had good discrimination (cstatistic 0.74) and accurate estimation of POAG risk (calibration chi-square 7.05). Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptOphthalmology. Author manuscript; available in PMC 2008 January 1. Conclusions-The OHTS prediction model was validated in the EGPS placebo group. A calculator to estimate the 5-year risk of developing POAG, based on the pooled OHTS-EGPS predictive model, has high precision and will be useful to clinicians and patients in deciding the frequency of tests and examinations during follow-up and the advisability of initiating preventive treatment.

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