Optic Disc Hemorrhage Signals Glaucoma Progression
American Journal of Ophthalmology, February 2022
In several randomized studies, optic disc hemorrhage was a strong risk factor for the development and progression of glaucoma. However, the etiology of disc hemorrhage remains unknown, and research has not determined whether it is a cause or consequence of glaucoma. Margeta et al. hypothesized that high-density minimum distance band (MDB) neuroretinal rim thinning may coincide with optic disc hemorrhage. They found that localized 3D evidence of neuroretinal rim progression preceded the occurrence of hemorrhage in many patients.
For this prospective longitudinal study, the researchers included 124 patients with open-angle glaucoma who underwent annual evaluation by disc photography, spectral-domain OCT, visual field (VF) measurements, and scans of optic nerve volume and the retinal nerve fiber layer (RNFL). All assessments took place on the same day and were repeated yearly during the five-year study period. The scans of optic nerve volume were used to calculate MDB thickness. Event-based analysis was applied to classify each patient’s status with regard to glaucoma progression.
Findings of the study showed that 19 patients (15.3%) had at least one occurrence of disc hemorrhage noted by disc photography. The presence of hemorrhage correlated with localized 3D superior progression of neuroretinal rim thickness (odds ratio, 3.96; p = .04) but not with MDB progression (global or inferior), RNFL progression (global, inferior, or superior), VF progression, or progression noted on disc photography. In 82% of patients with MDB changes, the progression was observed before or during detection of the first disc hemorrhage. Women and patients with normal tension glaucoma were more likely to be affected, as noted in earlier studies.
Only 31% of patients with superior MDB progression also exhibited hemorrhage in the same (superior) quadrant. Although inferior hemorrhage was the most common type (63% of patients), only 50% of them had inferior MDB progression. The authors explained that the discordance between the location of disc hemorrhage and the area of progression has been noted in other studies: It may relate to the transient nature of disc hemorrhage or the fact that progression is infrequently accompanied by hemorrhage and generally does not lead to glaucomatous damage. Results of this study support the theory that disc hemorrhage is an indicator of ongoing glaucoma progression rather than a cause of it.
The original article can be found here.