Evidence-based understanding of disc hemorrhage in glaucoma

Lee, Eun Jung; Kee, Hyun Joo; Han, Jong Chul; Kee, Changwon

doi:10.1016/j.survophthal.2020.09.001

Cited by 13 publications

(14 citation statements)

References 132 publications

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“…37 Taken all together, our data support the hypothesis that DHs represent indicators of ongoing glaucoma progression rather than being discrete events that cause subsequent progression. 5 Current theories on the underlying pathophysiology of DHs fall into two camps: the vascular theory and the mechanical theory. 5,6 According to the vascular theory, the primary cause of a DH is a microinfarction within the optic nerve head, whereby primary vascular dysregulation leads an increase in circulating levels of endothelin-1 and matrix metalloproteinase-9 and loss of the barrier function of the endothelial cells, resulting in extravasation of red blood cells and a DH.…”

Section: Discussionmentioning

confidence: 99%

“… 5 Current theories on the underlying pathophysiology of DHs fall into 2 camps: the vascular theory and the mechanical theory. 5 , 6 According to the vascular theory, the primary cause of a DH is a microinfarction within the optic nerve head, whereby primary vascular dysregulation leads an increase in circulating levels of endothelin-1 and matrix metalloproteinase-9 and loss of the barrier function of the endothelial cells, resulting in extravasation of red blood cells and a DH. 5 , 6 According to this theory, the primary cause of a DH is the underlying vascular insufficiency.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

“… 3 , 4 However, the underlying etiology of DHs has remained elusive, and it is presently unclear whether DHs are the cause or the consequence of glaucoma progression. 5 , 6 …”

mentioning

confidence: 99%

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

Margeta¹,

Ratanawongphaibul²,

Tsikata³

et al. 2022

American Journal of Ophthalmology

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. 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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“… 3 , 4 However, the underlying etiology of DHs has remained elusive, and it is presently unclear whether DHs are the cause or the consequence of glaucoma progression. 5 , 6 …”

mentioning

confidence: 99%

See 2 more Smart Citations

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

Margeta¹,

Ratanawongphaibul²,

Tsikata³

et al. 2022

American Journal of Ophthalmology

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“…A beanpot description of the optic nerve refers to a deep appearance of the optic nerve cup in which the lamina cribrosa is posteriorly displaced and the neuroretinal rim is undermined, and has been described in eyes with high myopia as well as eyes with ocular hypertension [28,29]. Disc hemorrhages and disc notching are both features that have well-established associations with glaucoma progression [30][31][32][33][34]. The absence of these characteristics in patients harboring the GC genotype further suggests a potential protective or less severe manifestation of POAG.…”

Section: Discussionmentioning

confidence: 99%

LMX1B Locus Associated with Low-Risk Baseline Glaucomatous Features in the POAAGG Study

Meer

Qin

Gudiseva

et al. 2021

Genes

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Primary open-angle glaucoma (POAG) is the leading cause of irreversible blindness worldwide and has been associated with multiple genetic risk factors. The LMX1B gene is a genetic susceptibility factor for POAG, and several single-nucleotide polymorphisms (SNPs) were shown to be associated with POAG in our own prior Primary Open-Angle African American Glaucoma Genetics (POAAGG) study genome-wide association study (GWAS). This study evaluated the association of the LMX1B locus with baseline optic disc and clinical phenotypic characteristics of glaucoma patients from our African American cohort. Compared to the GG genotype in SNP rs187699205, the GC genotype in this SNP was found to be significantly associated with a smaller cup-to-disc ratio (CDR) and increased (better) visual field mean deviation (MD) in glaucoma cases. None of the glaucoma cases with the GC genotype had disc hemorrhages, disc notching, or beanpot disc appearance. In conclusion, glaucoma phenotypes differed significantly by LMX1B variant in African American patients with POAG, and a SNP variant was associated with certain disease features considered lower risk.

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Deep Ocular Phenotyping Across Primary Open-Angle Glaucoma Genetic Burden

Sekimitsu,

Xiang,

Smith

et al. 2023

JAMA Ophthalmol

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ImportanceBetter understanding of primary open-angle glaucoma (POAG) genetics could enable timely screening and promote individualized disease risk prognostication.ObjectiveTo evaluate phenotypic features across genetic burden for POAG.Design, Setting, and ParticipantsThis was a cross-sectional, population-based study conducted from 2006 to 2010. Included participants were individuals from the UK Biobank aged 40 to 69 years. Individuals with non-POAG forms of glaucoma were excluded from the analysis. Data were statistically analyzed from October 2022 to January 2023.Main Outcomes and MeasuresPOAG prevalence based on structural coding, self-reports, and glaucoma-related traits.ResultsAmong 407 667 participants (mean [SD] age, 56.3 [8.1] years; 219 183 majority sex [53.8%]) were 14 171 POAG cases. Area under receiver operating characteristic curve for POAG detection was 0.748 in a model including polygenic risk score (PRS), age, sex, and ancestry. POAG prevalence in the highest decile of PRS was 7.4% (3005 of 40 644) vs 1.3% (544 of 40 795) in lowest decile (P &lt; .001). A 1-SD increase in PRS was associated with 1.74 times higher odds of POAG (95% CI, 1.71-1.77), a 0.61-mm Hg increase in corneal-compensated intraocular pressure (IOP; 95% CI, 0.59-0.64), a −0.09-mm Hg decrease in corneal hysteresis (95% CI, −0.10 to −0.08), a 0.08-mm Hg increase in corneal resistance factor (95% CI, 0.06-0.09), and a −0.08-diopter decrease in spherical equivalent (95% CI, −0.11 to −0.07; P &lt; .001 for all). A 1-SD increase in PRS was associated with a thinning of the macula-region retinal nerve fiber layer (mRNFL) of 0.14 μm and macular ganglion cell complex (GCC) of 0.26 μm (P &lt; .001 for both). In the subset of individuals with fundus photographs, a 1-SD increase in PRS was associated with 1.42 times higher odds of suspicious optic disc features (95% CI, 1.19-1.69) and a 0.013 increase in cup-disc ratio (CDR; 95% CI, 0.012-0.014; P &lt; .001 for both). A total of 22 of 5193 fundus photographs (0.4%) in decile 10 had disc hemorrhages, and 27 of 5257 (0.5%) had suspicious optic disc features compared with 9 of 5158 (0.2%) and 10 of 5219 (0.2%), respectively, in decile 1 (P &lt; .001 for both). CDR in decile 10 was 0.46 compared with 0.41 in decile 1 (P &lt; .001).Conclusion and RelevanceResults suggest that PRS identified a group of individuals at substantially higher risk for POAG. Higher genetic risk was associated with more advanced disease, namely higher CDR and corneal-compensated IOP, thinner mRNFL, and thinner GCC. Associations with POAG PRS and corneal hysteresis and greater prevalence of disc hemorrhages were identified. These results suggest that genetic risk is an increasingly important parameter for risk stratification to consider in clinical practice.

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Evidence-based understanding of disc hemorrhage in glaucoma

Cited by 13 publications

References 132 publications

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

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

LMX1B Locus Associated with Low-Risk Baseline Glaucomatous Features in the POAAGG Study

Deep Ocular Phenotyping Across Primary Open-Angle Glaucoma Genetic Burden

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