Central Visual Field Loss in Glaucoma Worse After Optic Disc Hemorrhage

Compared with eyes without disc hemorrhage, progressive central visual field loss is approximately 3-fold faster in eyes with disc hemorrhage, suggesting that disc hemorrhaging may be an important risk factor for the progression of glaucoma, according to study results published in the American Journal of Ophthalmology.

Although optic disc hemorrhages are strongly linked to the development and progression of glaucomatous damage, its pathophysiology is unclear. While the central visual field was generally thought to be persevered until advanced stages of disease, recent studies suggest that defects in the paracentral visual field are frequent in early glaucoma. Clinicians often use the 10-2 visual field test to evaluate central vision; however, its benefit in patients who are not at high risk for central visual field progression has been debated, according to the study.

A team of investigators conducted a prospective cohort study to determine the characteristics, rates, and relations between central visual field loss and the location of disc hemorrhage compared with eyes without disc hemorrhage. The researchers also tested the rapidity of peripheral and central visual field loss in eyes with and without disc hemorrhage as measured by entire 24-2 and 10-2 visual field test patterns. 

A total of 343 eyes from 220 patients (mean age, 71.1 years) were included in the analysis; 39 eyes had disc hemorrhaging and 304 eyes did not. During the mean follow-up of 5.2 years, eyes with disc hemorrhage had 3 times the rate of 10-2 mean deviation loss than eyes without disc hemorrhage (P <.001). 

In a univariable analysis, history of disc hemorrhage (OR, 3.65; P =.002), worse baseline 10-2 visual field mean deviation (OR, 1.04; P =.096), and worse baseline 24-2 visual field mean deviation (OR, 1.06; P =.004) were linked to 10-2 visual field progression. 

Multivariable models suggested a significant link between disc hemorrhage and visual field progression when adjusting for 24-2 visual field mean deviation (OR, 3.78; P =.003) and 10-2 visual field mean deviation (OR, 3.51; P =.004).

Central visual field progression was observed in 30.8% of eyes with disc hemorrhage and in 10.9% of eyes without disc hemorrhage. A larger proportion of glaucomatous eyes had central visual field progression as opposed to peripheral visual field progression in eyes with and without disc hemorrhage. The rate of 10-2 mean deviation loss in early glaucoma was 5.5 times faster in eyes with disc hemorrhage compared with eyes without disc hemorrhage (P <.001). 

“This information should help clinicians better understand the role of 10-2 [visual field] as a supplement test to 24-2 [visual field] in eyes with [disc hemorrhage] and provides clinical clues in monitoring glaucoma progression in these high-risk patients,” according to the study. 

Disclosure: Multiple study authors declared affiliations with the biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.  

Reference 

David RCC, Moghimi S, Do JL, et al. Characteristics of central visual field progression in eyes with optic disc hemorrhage. Am J Ophthalmol. Published online June 6, 2021. doi:10.1016/j.ajo.2021.05.026