Disc Hemorrhages Increase Vessel Density Loss in Glaucomatous Eyes

Scan of the Retina.
Ophthalmology office. Masked patient and doctor – Covid 19. Scan of the retina, an examination that allows you to precisely visualize the different parts of the eye. This imaging makes it possible to observe the retina in order to detect, for example, a retinal uplift with edema or a diabetic retinopathy. It is used to monitor wet AMD about every two months and complements the fundus to see if an injection of treatment is needed. OCT is also used to examine the optic nerve, and therefore screen for or monitor glaucoma. (Photo by: Pascal Bachelet/BSIP/Universal Images Group via Getty Images)
Researchers say disc hemorrhage is an independent predictor of faster vessel density loss in patients with primary open angle glaucoma.

Patients with primary open angle glaucoma (POAG) and disc hemorrhages (DH) experience faster vessel density loss vs those without DH, according to a study published in American Journal of Ophthalmology

Prior studies have reported that DH is associated with the development and swift progression of glaucoma. Researchers investigated longitudinal changes in rates of optic nerve head circumpapillary retinal nerve fiber layer (cpRNFL) thinning and vessel density decrease among POAG patients with or without history of DH. 

The investigation included 34 eyes with DH and 134 eyes without DH that had a minimum of 1.5 years of follow-up and at least 3 follow-up optical coherence tomography angiography (OCT-A) scans. The investigators utilized a linear mixed-effect model to compare rates of cpRNFL thinning and vessel density loss between DH and non-DH eyes. 

In this prospective cohort study, researchers found rates of whole image capillary density (wiCD) loss were faster in the DH group compared with the group without DH (mean difference (95% CI): -0.32 (-0.59,-0.04) %/year, P =.027). Statistically significantly faster mean rates of vessel density loss were found in the inferotemporal, inferonasal, and nasal sectors in eyes with DH vs eyes without DH (P <.05). 

No statistically significant difference in the global rate of cpRNFL thinning between the DH and no DH group was found (P =.679). A significantly higher rate of cpRNFL thinning in DH eyes compared with eyes without DH was found solely in the inferotemporal sector (mean difference (95% CI): -1.01 (-1.62,-0.40) μm/year; P =.001). 

The study reports several limitations. The study duration is relatively short and the frequency of optic disc photos may have been insufficient. Additionally, data on baseline glaucoma treatment and changes in glaucoma treatment were not collected. Lastly, the use of topical eyes drop may have been a contributing factor to the vascular differences between the study groups. 

“We find DH to be an independent predictor of faster vessel density loss in glaucoma suspects and POAG patients,” investigators report. “Our findings may help clinicians to better understand the role of OCT-A in DH eyes as a tool in monitoring glaucoma progression in these high-risk patients.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. This research was supported by multiple sources. Please see the original reference for a full list of disclosures. 


Nishida T, Moghimi S, David RCC, et al. Rates of circumpapillary retinal nerve fiber layer thinning and capillary density loss in glaucomatous eyes with disc hemorrhage. Am J Ophthalmol. Published online September 26, 2021. doi:10.1016/j.ajo.2021.09.013