Optic disc hemorrhages may indicate ongoing glaucoma progression but do not appear to cause it, according to authors of a prospective multicenter cohort study published in the American Journal of Ophthalmology. 

Results of several randomized prospective glaucoma trials have established optic disc hemorrhages as important risk factors for development and progression of the disease. As the authors of the current study note, however, “the underlying etiology of [disc hemorrhages] has remained elusive, and it is presently unclear if [they] are the cause of the consequence of glaucoma progression.”

Therefore, the aim of their investigation was to evaluate the link between the occurrence of optic disc hemorrhages and the progression of glaucoma.


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The researchers evaluated images from 124 patients with open-angle glaucoma who had yearly disc photography (DP), visual fields (VFs), spectral-domain optical coherence tomography (SD-OCT) retinal nerve fiber layer (RNFL) thickness scans, and optic nerve volume scans performed on the same day spanning a period of 5 years. Of the 124 patients, 19 (15.3%) had one or more disc hemorrhages on yearly DPs. The presence of a disc hemorrhage was associated with localized 3D neuroretinal rim thickness progression (superior minimum distance band [MDB] progression; OR 3.96, P =.04), but not with global or inferior MDB progression (P =.14 and P =.81, respectively); DP progression (P =.08); VF progression (P =.45); or RNFL global, inferior, or superior progression (P =.17, P =.26, and P =.76, respectively). In most patients with MDB progression (14/17, or 82%), the progression was noted before or concurrently with the first instance of disc hemorrhage.

These findings suggest that detection of disc hemorrhages requires heightened clinical scrutiny but not necessarily immediate treatment intensification, according to researchers.

The investigators believe their study is “the first … comparing glaucoma progression in patients with and without [disc hemorrhages] using multiple commonly used clinical modalities … and the novel high-density 3D OCT neuroretinal rim parameter, MDB thickness.” 

An advantage of the study is that it “was longitudinal and examined the natural history of [disc hemorrhages] in an unbiased sample,” given that patients were not recruited based on presence of a disc hemorrhage, therefore their treatment was not modified solely based on detection of this condition, according to researchers.

Researchers note limitations of their work: for example, not all of the disc hemorrhages that occurred in patients may have been captured and the study design did not include a repeat test within a few weeks to confirm disease progression. They added that repeat confirmation testing is important given that it “may help to reduce the rate of false positives and false negatives, because false positives have been known to occur in the clinical setting and can lead to an initial overestimation of glaucoma progression.”

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

Reference

Margeta MA, Ratanawongphaibul K, Tsikata E, et al. Disc hemorrhages are associated with localized three-dimensional neuroretinal rim thickness progression in open-angle glaucoma. Am J Ophthalmol. Published online June 29, 2021. doi:10.1016/j.ajo.2021.06.021

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