• Influence of Disc Hemorrhage on Central VF Damage

    By Lynda Seminara
    Selected By: Prem S. Subramanian, MD, PhD

    Journal Highlights

    Journal of Glaucoma
    Published online April 13, 2020

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    Previous studies have indicated a relationship between disc hemorrhage (DH) and early central visual field (VF) damage. Shukla et al. set out to determine the effects of DH on the central VF and to further elucidate this relationship. They found a strong link between DH and the presence and progression of central VF defects.

    For this study, the authors hypoth­esized that in addition to having more damage to the central VF, patients with DH would have faster central or global VF loss than would patients without DH. Cross-sectional and longitudinal analyses were performed on data from the African Descent and Glaucoma Evaluation Study cohort. Disc photo­graphs were examined for the presence and specific location of DH, and VF damage was characterized by location within the central 10 degrees of the 24-2 field pattern. Pattern deviation and mean total deviation (MTD) were measured. Main outcomes were asso­ciations between DH and the presence of central VF damage and between DH and worsening VF.

    In the cross-sectional analysis, DH was detected in 6.2% of the 355 eyes; it correlated with more severe central damage in the 24-2 field pattern (inci­dence rate ratio [IRR], 1.47) and in the 10-2 pattern (IRR, 1.81).

    Results of the longitudinal analysis showed that eyes with DH progressed more rapidly than those without it, based on 24-2 global and 10-2 MTD rates (p = .009 and p < .001, respective­ly) but not according to 24-2 central MTD rates (p = .338).

    Given the link between DH and the presence and progression of central VF damage, identification of DH “should prompt intensive central VF monitor­ing and surveillance with 10-2 fields to detect progression,” said the authors. They added that heightened awareness of this link should enable appropriate risk stratification and treatment escala­tion. Their suggestions for future work include more extensive measurements in 10-2 fields, particularly because research has shown that damage to this region may occur earlier. Frequent testing of more locations within the 10-2 and 24-2 grids may expedite the identification of VF decline.

    The original article can be found here.