Recurrent disc hemorrhage does not increase the rate of visual field progression

Beaufort, Heather C. de; Moraes, Carlos Gustavo V. De; Teng, Christopher C.; Prata, Tiago S.; Tello, Celso; Ritch, Robert; Liebmann, Jeffrey M.

doi:10.1007/s00417-010-1306-0

Cited by 43 publications

(34 citation statements)

References 26 publications

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“…18 In our study, 47.6% of all DH cases were recurrent, which is similar to results from previous studies that had a follow-up period more than 4 to 5 years. 14,15 Disc hemorrhage is a significant risk factor for the development and progression of glaucoma. 5,19 However, some controversy surrounds the clinical significance of recurrent DH.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Significance of the Location of Recurrent Optic Disc Hemorrhage in Glaucoma

Kim

2015

Invest. Ophthalmol. Vis. Sci.

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PURPOSE.To compare clinical characteristics and visual field (VF) progression between glaucomatous eyes with disc hemorrhage (DH) recurring at the same or different locations in relation to the initial DH location. METHODS.One hundred forty-seven open-angle glaucoma patients with DH who were observed for more than 4 years and had more than six VF tests were included. Disc hemorrhage that recurred at the same location as the initial DH was defined as a DH at the same location, and DH that recurred at a different location was defined as a DH at a different location. Overall rate of VF change using the mean deviation (MD) was compared between groups using a linear mixed model, and Kaplan-Meier survival analysis was performed.RESULTS. Seventy-seven (52.4%) eyes had nonrecurrent DH, and 70 (47.6%) eyes had recurrent DH detected during the follow-up period. Recurrent DH at the same location (À0.32 dB/y) was not significantly different from the nonrecurrent DH group in terms of the rate of VF change (P ¼ 0.116). However, the recurrent DH group at different locations (À1.07 dB/y) had a significantly different rate of VF change compared to the recurrent DH group at the same location (P ¼ 0.014). By Kaplan-Meier analysis, eyes with recurrent DH at different locations showed the fastest time to VF progression compared to other groups (log rank test, P < 0.001).CONCLUSIONS. Eyes with recurrent DH recurring at different locations from initial DH sites had more pronounced VF progression.

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Section: Discussionmentioning

confidence: 99%

“…13 However, other studies have shown that eyes with recurrent DH do not have greater glaucoma progression than those with a nonrecurrent DH. 14,15 The clinical significance of recurrent DH remains controversial.…”

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confidence: 99%

Clinical Significance of the Location of Recurrent Optic Disc Hemorrhage in Glaucoma

Kim

2015

Invest. Ophthalmol. Vis. Sci.

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“…Several studies reported no additional risk of VF progression [2, 3, 6, 7] while another study demonstrated that recurrent DH led to accelerated VF deterioration [4]. This discrepancy may be partially due to different types of glaucoma included in those studies.…”

Section: Discussionmentioning

confidence: 79%

“…A relationship between DH and progression of VF defects was shown in many studies in both primary open angle glaucoma [2, 3] and NTG [4, 5]. The comparative effect of frequency of DH on the progression of glaucoma has been studied between groups with single detected DH and recurrent DH [2, 6, 7]. These previous studies reported either no significant difference of VF progression between the groups or that the frequency of DH was not related to VF progression.…”

Section: Introductionmentioning

confidence: 99%

Association between the Frequency of Optic Disk Hemorrhage and Progression of NTG Related with the Initial Location of RNFL Defect

2018

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Purpose: This study aimed to investigate the association of the frequency of optic disk hemorrhage (DH) and progression of normal tension glaucoma (NTG) between each group based on the location of the initial retinal nerve fiber layer (RNFL) defect. Methods: In this retrospective, observational cohort study, 142 NTG patients who underwent more than 5 reliable visual field tests with initial superior hemifield (group 2, n = 51), inferior hemifield (group 1, n = 44), or both hemifield (group 3, n = 47) defects were included. The number of DHs was inspected in serial optic disk photographs by 2 different ophthalmologists. Progression rates, which are the slope of mean thresholds from the 52 points, were calculated using a linear mixed effect model. Results: The mean follow-up period was 8.19 ± 3.30 years. DHs related with the initial RNFL defect occurred significantly more frequently in group 2 (35 in inferior hemifield) than in group 1 (6 in superior hemifield) (p = 0.009) or group 3 (6 in inferior hemifield) (p = 0.006). The progression rate in group 2 was significantly faster than in group 1 (p = 0.019) or the superior hemifield of group 3 (p = 0.001). The progression rate of subjects showing recurrent DH was significantly faster than those showing single DH from all groups (–0.5460 vs. –0.2867 dB/year, p = 0.0053). Conclusions: More careful examination and caution are required when NTG patients show recurrent DH in the inferior hemifield related to the initial RNFL defect.

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We would like to clarify several points raised by Dr. Laemmer et al There are significant differences in methodologies between our two studies.

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confidence: 99%

Response to: “Morphologic and functional glaucomatous change after occurrence of single or recurrent optic disc haemorrhages”

Beaufort

Moraes

Teng

et al. 2010

Graefes Arch Clin Exp Ophthalmol

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Dear Editor:We read with interest the comments by Dr. Laemmer and colleagues regarding our recent article "Recurrent optic disc hemorrhage does not increase the rate of visual field progression" [1]. It is gratifying to know that their study confirmed our results, and that they could not detect any difference in the rate of visual field progression between eyes with a single detected disc hemorrhage and eyes with recurrent disc hemorrhage.We would like to clarify several points raised by Dr. Laemmer et al. There are significant differences in methodologies between our two studies. We used a trend-based approach to investigate visual field progression to provide an objective measure of the velocity of progression, rather than the binary categorization into stable versus progressive eyes that is determined when using an event-based approach. Trend-analysis may be a more significant and useful tool for differentiating rapidly from slowly progressing eyes [2,3], which may help tailor clinical management more objectively and, therefore, effectively.We look forward to learning more about their study after peer review and publication. The sample size described in their letter is relatively small (n=60) and may not have sufficient statistical power to confirm or refute any differences between groups. Additional important missing information includes the precise methodology for disc assessment and masking of examiners to disc and field results. The number of patients remaining in each group at each year of follow-up will greatly impact the survival curves and whether they are, in fact, statistically different.

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Recurrent disc hemorrhage does not increase the rate of visual field progression

Abstract: Recurrent DH does not result in a faster rate of VF progression compared to a single detected DH. Eyes with single or recurrent DH have similar risks for future disease progression.

Cited by 43 publications

References 26 publications

Clinical Significance of the Location of Recurrent Optic Disc Hemorrhage in Glaucoma

Clinical Significance of the Location of Recurrent Optic Disc Hemorrhage in Glaucoma

Association between the Frequency of Optic Disk Hemorrhage and Progression of NTG Related with the Initial Location of RNFL Defect

Response to: “Morphologic and functional glaucomatous change after occurrence of single or recurrent optic disc haemorrhages”

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