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Clinical Significance of Optic Disc Hemorrhage Size in Visual Field Progression in Patients With Glaucoma
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersPURPOSE
To investigate the correlation between optic disc hemorrhage (DH) size and glaucoma progression.
DESIGN
A retrospective observational cohort study METHODS: XXXX SETTING: A single tertiary hospital in South Korea STUDY POPULATION: Two hundred and fifty (250) open-angle glaucoma (OAG) patients with DH. Participants were followed for 5 years or longer, with a minimum of 5 visual field (VF) tests.
OBSERVATION PROCEDURE
The DH area was calculated by comparing the pixel numbers of the DH area with the disc area based on optical coherence tomography (OCT). For recurrent DH cases, we calculated the average DH area. DH size was classified as large or small based on the median value. Rates of mean deviation (MD) loss were determined using Guided Progression Analysis (GPA). Univariable and multivariable regression analyses were performed to identify significant predictors of MD loss.
MAIN OUTCOME MEASURES
DH size and longitudinal VF progression RESULTS: The mean follow-up period was 11.1 ± 3.6 years. The group with large DH showed faster global MD loss relative to the group with small DH (-0.51±0.48 dB/y vs. -0.36±0.42 dB/y, p = 0.01). In the multivariable model, mean DH size, maximum DH size, and initial MD were all significantly associated with the overall rate of MD loss (all p < 0.05).
CONCLUSIONS
DH size was associated with the rate of VF deterioration. Eyes with larger DH showed more pronounced VF progression.
Additional Info
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Clinical Significance of Optic Disc Hemorrhage Size in Visual Field Progression in Glaucoma
Am J Ophthalmol 2024 Feb 21;[EPub Ahead of Print], Y Jeong, E Bak, M Jang, A Ha, YI Shin, MG Huh, YK Kim, JW Jeoung, KH ParkFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Jeong et al conducted a retrospective observational study in Seoul, Korea, which assessed the clinical significance of optic disc hemorrhage (DH) size in relation to visual field (VF) progression in patients with glaucoma. Previous studies have shown the correlation of VF progression with DH recurrence and location; however, no studies have evaluated the relationship between VF progression and actual DH size. This was a unique study wherein patients with different DH sizes were compared in terms of longitudinal VF progression rate.
The study included 250 participants with open-angle glaucoma with DH in a single tertiary hospital. Participants were followed for 5 years or longer, with a minimum of five VF tests. The authors nicely compared DH areas by pixel numbers based on optical coherence tomography. This is the first study to compare patients with different DH sizes in terms of mean deviation (MD) loss rate, as measured using Guided Progression Analysis. The mean follow-up period was 11.1 ± 3.6 years. The group with large DH showed a faster rate of MD loss globally and within the affected hemisphere relative to the group with small DH. This study articulates that patients with glaucoma who exhibit large DHs experience a more rapid deterioration of their VFs. This suggests that "if a significantly large DH is detected at any point, there may be a corresponding increase in the rate of VF deterioration."
DH remains an important glaucomatous prognostic indicator, as supported by the vascular and mechanical theories of glaucoma. The presence of an optic DH remains a reason for the progression of glaucoma. DHs may be a consequence of mechanical stress at the lamina cribrosa, and degrading erythrocytes may induce neurotoxicity, supporting the vascular theory of glaucoma progression. Overall, the dysregulation at the optic nerve head may be more pronounced in patients with large DHs, which results in a faster rate of glaucoma progression, as measured in MD on perimetry. This study eloquently highlights how the size of DH affects glaucoma progression rather than simply its presence.