Disc Hemorrhages Are Associated With the Presence and Progression of Glaucomatous Central Visual Field Defects

Abstract

In this prospective cohort study, disc hemorrhages were associated with more severe central damage on 24-2 and 10-2 visual fields (VFs), and faster progression globally on 24-2 VFs and centrally on 10-2 VFs. Purpose: To study the relationship between disc hemorrhage (DH) and the presence and progression of glaucomatous central VF damage. Methods: Cross-sectional and longitudinal analyses were performed on data from the African Descent and Glaucoma Evaluation Study (ADAGES) cohort. Two masked investigators reviewed disc photographs for the presence and location of DH. 24-2 central VF damage was based on the number of test locations within the central 10 degrees of the 24-2 field pattern deviation and their mean total deviation (MTD). 10-2 central VF damage was based on pattern deviation and MTD. Main outcome measures were the association between DH and presence of central VF damage and between DH and worsening of VF. Results: DH was detected in 21 of 335 eyes (6.2%). In the crosssectional analysis, DH was significantly associated with more severe central damage on 24-2 [incidence rate ratio = 1.47; 95% confidence interval (CI) = 1.02-2.12; P = 0.035] and 10-2 VFs (incidence rate ratio = 1.81; 95% CI = 1.26-2.60; P = 0.001). In the longitudinal analysis, DH eyes progressed faster than non-DH eyes based on 24-2 global MTD rates (difference in slopes, β = −0.06; 95% CI = −0.11 to −0.01; P = 0.009) and 10-2 MTD rates (β = −0.10; 95% CI = −0.14 to −0.06; P < 0.001), but not 24-2 central MTD rates (β = −0.02; 95% CI = −0.078 to 0.026; P = 0.338). Conclusion: DH was associated with the presence and progression of central VF defects. DH identification should prompt intensive central VF monitoring and surveillance with 10-2 fields to detect progression.

Disc Hemorrhages Are Associated With Localized Three-Dimensional Neuroretinal Rim Thickness Progression in Open-Angle Glaucoma

“…3 4 However, the underlying etiology of DHs has remained elusive, and it is presently unclear if DHs are the cause or the consequence of glaucoma progression. 5,6 Prior studies investigating DHs and glaucoma progression have tended to focus on single glaucoma testing modalities (disc photographs, 7,8 visual fields, [9][10][11] or optical coherence tomography 12,13 ). A number of studies have demonstrated that presence of a DH leads to a greater probability of visual field progression and more severe central damage.…”

“…A number of studies have demonstrated that presence of a DH leads to a greater probability of visual field progression and more severe central damage. [9][10][11] Akagi and colleagues demonstrated that rates of retinal nerve fiber layer (RNFL) thinning were significantly faster in DH quadrants that non-DH quadrants and accelerated after DH occurred. 12 Similarly, ganglion cell-inner plexiform layer thinning rate was significantly more rapid in glaucomatous eyes with DH than in control eyes.…”

Investigation of progression pattern and associated risk factors in glaucoma patients with initial paracentral scotomas using Humphrey 10-2

“…We performed linear regression analysis to obtain the slope of the change of MD of the VF. We defined progression on 24-2 and 10-2 VF when the magnitude of MD slope was worse than − 1.0 dB per year with P ≤ 0.05 based on previous study 40 – 43 . Initial paracentral scotomas were classified according to their progression pattern on 10-2 VF.…”

The rates of visual field progression in glaucoma and its clinical importance

“…(42) Other studies have suggested that central visual field loss is accelerated in glaucomatous eyes with a disc hemorrhage. (43,44) An et al reported that high frequency disc hemorrhages in the same sector of the optic disc have been associated with significantly worse visual field progression compared to those patients with fewer disc hemorrhages, (45) whereas de Beaufort et al did not find difference in the rate of visual field progression in patients with a single disc hemorrhage versus those with recurrent disc hemorrhages. (46) In summary, there is good consensus that patients with ODHs are at higher risk of visual field deterioration, however, there is great variability in the rate or absolute number of patients who progress after a single or even multiple recorded episodes of ODHs.…”