Prevalence of optic disc hemorrhages in rural central India. The Central Indian Eye and Medical Study

To determine the frequency of optic disc hemorrhages in a rural Indian population.

The population-based Central Indian Eye and Medical Study included 4711 subjects. Mean age was 48.5±12.9 years (range: 30-100 years). Color optic disc photographs were examined.

Optic disc photographs were available for 4570 (97.0%) subjects. Prevalence of disc hemorrhages was 17/8869 (0.19%; 95%CI:0.10,0.28) per eye and 16/4570 (0.35±0.09%; 95%CI:0.18,0.52) per subject. Prevalence of disc hemorrhages increased from 0.05% (95%CI:0.00,0.13) in the age group of 30-39 years to 0.25% (95CI:0.00,0.49) in the age group of 60-69 years and to 0.91% (95%CI:0.24,1.58) in the age group of 70+ years. After adjusting for older age, higher systolic blood pressure, diabetes mellitus, myopic refractive error, smaller neuroretinal rim area and thinner retinal nerve fiber layer, occurrence of disc hemorrhages was associated only with glaucomatous optic nerve damage (P<0.001; Odds ratio: 87; 95%CI:32,239). Eleven of the 17 (65%; 95%CI:39,90) disc hemorrhages were found in glaucomatous eyes. Out of 193 glaucomatous eyes, 11 eyes (5.7%; 95%CI:2.4,9.0) showed a disc hemorrhage. Out of the 8676 non-glaucomatous eyes, 6 eyes (0.07%; 95%CI:0.01,0.12) had an optic disc hemorrhage.

Prevalence of disc hemorrhages (0.2% per eye; 0.4% per subject) in Indians aged 30+ years was strongly associated with glaucoma after adjustment for age, blood pressure and diabetes mellitus. A disc hemorrhage suggested glaucomatous optic nerve damage with a positive predictive value of 65%. About 6% of glaucomatous eyes showed a disc hemorrhage at the time of clinical examination highlighting the importance of optic disc hemorrhages for the diagnosis of glaucoma.