Predictive Factors Within the Optic Nerve Complex for Glaucoma Progression: Disc Hemorrhage and Parapapillary Atrophy

The optic nerve complex (ONC) is a new term we have created to describe the clinically and non-clinically visible portions of the optic nerve and surrounding tissues. Recent advances in imaging technologies have created a need to provide a unified and comprehensive view of the structure and function of the components of ONC to assess various risk factors for glaucoma development and progression. Despite a great deal remaining to elucidate their underlying pathogenesis, disc hemorrhages and β-zone parapapillary atrophy have been consistently shown in different study designs to be significant risk factors for glaucoma progression. Given their easy visibility as components of the ONC, disc hemorrhage and β-zone parapapillary atrophy are widely underscored glaucoma features that should be thoroughly investigated and documented with the purpose of stratifying patients under risk categories along with other intraocular pressure-dependent and -independent factors. This review provides an update on these 2 features and their relationship to glaucoma progression.