Disc hemorrhage linked to progression in POAG, NTG and PACG

This large and lengthy retrospective study analyzed the clinical characteristics and prognostic significance of disc hemorrhage among primary open-angle, normal-tension and primary angle-closure glaucoma patients in Taiwan. The authors found that normal-tension glaucoma (NTG) patients had the highest incidence of disc hemorrhage. However, the clinical characteristics of hemorrhage were similar among the three types of glaucoma. The results add to previous evidence that disc hemorrhage in all major types of glaucoma is a sign of possible progression.

The authors retrospectively reviewed records of 1,134 patients with POAG, 513 with NTG and 770 with PACG. Sixty-three (5.6 percent) patients with PACG, 36 (7.0 percent) with NTG and 44 (5.7 percent) with PACG experienced disc hemorrhage over a mean of nine years of follow-up. There were no significant differences in the laterality, episodes, duration of hemorrhage and frequency of recurrent hemorrhage among the glaucoma types. IOP and cup-to-disc ratio did not differ significantly between eyes with hemorrhage and fellow eyes without hemorrhage. There was a significant association between disc hemorrhage and visual field progression [odds ratio: 2.78 (P = 0.004), 3.75 (P = 0.040) and 4.50 (P = 0.011) for POAG, NTG and PACG, respectively].

The authors conclude that the presence of disc hemorrhage is associated with the progression of glaucomatous optic neuropathy and visual field defects in patients with POAG, NTG and PACG. Unlike in previous studies, in this study disc hemorrhages were seen more commonly in the inferior-temporal area in all three subtypes of glaucoma, and recurrent disc hemorrhages tended to be in the same area of the nerve in individual cases. The authors conclude that physicians should consider treating glaucoma patients with disc hemorrhage more aggressively in order to prevent further vision loss.