• Written By: Gail F. Schwartz, MD

    The results of this offshoot analysis from the Ocular Hypertension Treatment Study (OHTS) appear intuitive: The rate of visual field (VF) progression was more than twice as rapid with the presence of a disc hemorrhage (DH).

    One could argue that some glaucomatous eyes were enrolled in OHTS but met criteria due to pre-perimetric defect status. This is a large-scale study chock-full of data, corroborating the importance of more frequent fields and follow-up, as well as further IOP-lowering, after a DH is detected.

    The study included 2,607 eyes (1,378 participants) with a minimum of 10 reliable VF tests followed for at least five years. There were a mean number of 23.7 VF tests per eye spanning a mean of 12.2 years.

    At least one DH was detected in 187 eyes (7.2 percent), of which 52 eyes had recurrent DH. Mean deviation rate of change was significantly worse in eyes with DH compared with non-DH eyes (P < 0.01). Significant pointwise linear regression (PLR) progression occurred more frequently in eyes with DH (P < 0.01), which increased when two or more DHs were present (P = 0.01). Eyes initially randomized to treatment were less likely to have a DH during follow-up.

    The authors conclude that eyes with DH had more rapid VF deterioration when assessed by global (regression of mean deviation; MDR) or local (PLR) trend analysis than eyes without DH. Eyes with recurrent DH had similar rates of global VF change (MDR) when compared with eyes with a single DH but reached criteria for rapid PLR change more often.

    They conclude that the presence of DH in ocular hypertensive eyes affects clinical outcomes, and such patients should be monitored closely and may need more aggressive therapy.

    They point out that having a DH during follow-up in this study had as deleterious an effect on MDR as (1) being 10.5 years older than average at baseline; (2) having an 11.4-mm Hg higher baseline IOP than average; (3) having a 23.1-µm thinner cornea than average; (4) having a 1.3-dB worse baseline pattern standard deviation than average; or (5) having a 0.1-unit worse baseline vertical cup-disc ratio than average. They advise clinicians to be aware of these comparisons when assessing the risk of glaucoma conversion among ocular hypertension patients.