OCT shows promise for early detection of glaucoma progression after first disc hemorrhage

This retrospective study used time-domain OCT (Stratus) to evaluate glaucoma progression after first-detected disc hemorrhage (DH) and found that the retinal nerve fiber layer (RNFL) demonstrated rapid, spatially compatible, localized thinning. The results clearly demonstrate that a DH is a harbinger for nerve fiber layer thinning in eyes with glaucoma. Published in the August issue of the Journal of Glaucoma, the study reiterates the need for treatment, or advancement of treatment, of patients with disc hemorrhages, and also demonstrates the value of OCT to monitor progression.

The authors reviewed the charts of 44 patients (44 eyes) with a unilateral DH and 44 fellow eyes without DH, and compared the groups in terms of OCT-derived glaucoma progression after the first-detected DH.

After a median follow-up of 38 months, 72.7 percent of eyes in the DH group showed progression on a clock-hour basis, compared with 27.3 percent of fellow eyes (P < 0.0001). Eyes in the DH group also showed more rapid and greater falls in clock-hour-based progression (P < 0.0001), with 90.6 percent showing progression within one clock hour of locating the DH.

The authors conclude that rapid, localized thinning of the RNFL determined after first-detected DH was successfully detected by both event-based and trend-based analyses. In addition, locations of thinning were found to coincide with those of DH. This suggests that Stratus OCT might be a sensitive tool for the early detection of glaucoma progression after DH is first detected.