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PurposeTo investigate the characteristics and rate of central visual field loss after optic disc hemorrhage (DH).DesignProspective cohort study.MethodsThree hundred forty-three eyes of 220 subjects who had ≥3 years of follow-up with a minimum of 5 visits with 10-2 and 24-2 visual field (VF) were recruited. Rates of 10-2 mean deviation (MD) loss in each hemifield and predefined zones were compared using linear mixed-effects models in DH and non-DH eyes. Clustered pointwise regression analysis was also used to define central VF progressors and compared with 24-2 VF loss using guided progression analysis.ResultsThirty-nine eyes with DH and 304 eyes without DH had a mean follow-up of 5.2 years. Eyes with DH had rates of 10-2 MD loss that were 3 times faster than non-DH eyes (mean difference -0.36 dB/year [95% confidence interval 0.54-0.18]; P < .001) and were 3.7 times more likely to progress (P=.002). A larger proportion of glaucomatous eyes showed central VF progression rather than peripheral VF progression in the DH group (30.8% vs. 20.5%) compared with the non-DH group (10.9% vs. 9.2%). In early glaucoma, the rate of 10-2 MD loss was 5.5 times faster in DH eyes than in non-DH eyes (P < .001). Superonasal and superotemporal central VF regions progressed more rapidly than other regions, especially in DH eyes.ConclusionCentral VF loss is accelerated in glaucoma eyes with DH and it corresponds topographically to the DH location. In patients with glaucoma with DH, one should consider supplementing 10-2 VFs with 24-2 VFS to monitor the disease.

To investigate and compare the longitudinal rate of change of Bruch's membrane opening minimum rim width (BMO-MRW) and peripapillary retinal nerve fiber layer (RNFL) thickness in eyes showing optic disc hemorrhage(DH).Observational case series.A total of 82 subjects(82 eyes) showing DH who had undergone more than five reliable spectral-domain optical coherence tomography (OCT) tests were included. BMO-MRW and RNFL were measured with OCT at 3-month intervals. The rates of change in global and each Garway-Heath sector were calculated with a linear mixed-effects model after adjusting for age, sex, and BMO area.The mean follow-up period was 21.57 ± 7.88 months with a mean number of 7.88 ± 2.39 OCT tests. Baseline demographics were age (58.37 ± 10.65 y); 46.3% were female; and the mean deviation was -4.41 ± 5.04 dB. The global rate of change in BMO-MRW was -3.507 ± 0.675 μm/y and in -1.404 ± 0.208 μm/y in RNFL. The rate of change was the greatest in the inferotemporal sector, which was -9.141 ± 1.254 μm/y in BMO-MRW and -4.204 ± 0.490 μm/y in the RNFL. The rate of change was significantly greater in BMO-MRW than in the RNFL in all sectors, except for the nasal sector (P.05). Percentage of reduction was significantly greater in BMO-MRW than in RNFL in the inferotemporal and superotemporal sectors (P.05).BMO-MRW showed a significantly greater rate of change than RNFL in eyes showing DH, especially in the inferotemporal and superotemporal sectors in percentage of reduction. Thus, it may be more advantageous to detect glaucomatous progression earlier in BMO-MRW than in the RNFL in eyes showing DH that are more likely to progress.

To determine the relationship between optic disc hemorrhage (DH) and corneal hysteresis (CH).Consecutive patients with prior or current photographic evidence of unilateral DH who had undergone CH measurement with the Ocular Response Analyzer (ORA; Reichert, Buffalo, NY) were enrolled. Eyes with a history of corneal disease, refractive surgery, or bilateral DH were excluded. Central corneal thickness (CCT), visual field data, 5 consecutive previous intraocular pressures (IOPs), and maximum documented peak IOP were obtained by chart review. Vertical cup-to-disc ratio (VCDR), the presence of neuroretinal rim notching, number of clock hours of beta zone parapapillary atrophy (ßPPA), and eye with greater ßPPA width were determined from photographs by 2 masked expert examiners.We identified and analyzed 49 patients with photographically documented unilateral DH. Compared to fellow non-DH eyes, eyes with DH had lower CH (8.7 ± 1.9 vs 9.2 ± 1.7; p = 0.002), higher IOP (15.6 ± 3.6 vs 14.3 ± 4.1; p = 0.017), and greater VCDR (0.79 ± 0.13 vs 0.68 ± 0.23; p0.001), but were similar with respect to CCT, ßPPA extent, rim notching, peak IOP, and visual field damage (all p0.05). Using multivariate conditional logistic regression analysis, only CH (p = 0.012) and VCDR (p = 0.004) predicted the laterality of the DH.Lower CH and greater VCDR are independently associated with DH. This suggests that CH may be a structural biomarker for an abnormality of the optic nerve complex that may be associated with progressive glaucoma. Eyes in which DH were detected had lower CH.

Objective To determine whether there is an increased prevalence of nailfold hemorrhages in patients with glaucoma with a current optic disc hemorrhage (ODH) compared with those without a history of ODH. Design Prospective observational study. Participants Group 1 (n = 40) consisted of patients with primary open-angle glaucoma or normal tension glaucoma (POAG/NTG) with a current ODH who met the specified inclusion/exclusion criteria. Group 2 (n = 20) consisted of age- and sex-matched patients with glaucoma without a history of ODH who met specified criteria (control group). Methods This study was performed in a clinical practice setting. Nailfold capillaroscopy was performed in each participant to determine the presence of nailfold hemorrhages and other capillary morphologic changes. Results There was no significant difference in mean age (68 ± 10 years for Group 1 vs 71 ± 12 years for Group 2; p = 0.20) or sex (62% female in Group 1 vs 59% female in Group 2; p = 0.80) between the groups. There was no significant difference in the proportion of patients with nailfold hemorrhage(s) between Group 1 (23%, 10/42) and Group 2 (26%, 11/42; p = 0.8). Subanalysis of Group 1 identified no significant difference in the prevalence of nailfold hemorrhages between patients with POAG (23%, 6/26) and NTG (25%, 4/16; p = 0.9). Conclusions We report no increase in nailfold haemorrhages in patients with glaucoma with a current ODH compared with patients with glaucoma without a history of ODH. However, the prevalence of nailfold hemorrhages in patients with glaucoma either with or without an ODH is significantly greater than that identified in normal (nonglaucoma) control subjects in other studies.

To evaluate quantitatively the structural damage of the peripapillary retinal nerve fiber layer (RNFL) in eyes with disc hemorrhage (DH).Prospective cross-sectional study.Seventy patients with DH (70 eyes; mean age +/- standard deviation, 60.0+/-11.8 years) and 100 healthy control subjects (100 eyes; mean age +/- standard deviation, 57.7+/-8.0 years) were enrolled from the Glaucoma Clinic of Seoul National University Hospital.Normal eyes without DH (group 1: normal control group) served as controls. Eyes with DH were divided into the following groups: (1) eyes with a DH, accompanied by no visible RNFL defect according to red-free fundus photography and normal visual fields (group 2: DH only group); (2) eyes with a DH and a localized RNFL defect in the same quadrant, accompanied by normal visual fields (group 3: DH-preperimetric group); and (3) eyes with a DH and a localized RNFL defect in the same quadrant, accompanied by glaucomatous visual field defect in the corresponding hemifield location (group 4: DH-perimetric group). Optical coherence tomography (OCT)-measured RNFL thicknesses were compared.Average and segmental (4 quadrants and 12 clock-hours) OCT-measured RNFL thicknesses.The number of eyes in groups 1, 2, 3, and 4 was 100, 25, 22, and 23 eyes, respectively. The OCT-measured RNFL thickness was significantly different among the 4 groups in average RNFL thickness and in inferior, superior, and nasal quadrants (P0.01, 1-way analysis of variance). On post hoc analysis, the eyes of groups 2 and 3 showed thinner average RNFL thickness than those of group 1, and the average RNFL thickness of group 4 was significantly lower than that of groups 2 and 3 (P0.001, 1-way analysis of variance and Tukey's test). The OCT-measured RNFL thickness revealed a topographic relationship with the DH location.Significant RNFL loss was already present in the DH only eyes with apparently normal RNFL configuration by red-free fundus photography, indicating that preperimetric changes of the RNFL are already present. These results suggest that OCT has the potential to detect subclinical or preperimetric RNFL loss in the eyes with DH.The authors have no proprietary or commercial interest in any of the materials discussed in this article.