Optic Disc Microhemorrhage in Primary Open-Angle Glaucoma: Clinical Implications for Visual Field Progression

Area of Science:

• Ophthalmology
• Glaucoma Research
• Optic Nerve Head Imaging

Background:

• Primary open-angle glaucoma (POAG) is a leading cause of irreversible blindness.
• Optic disc hemorrhages (DH) are associated with POAG progression.
• Minute-sized optic disc hemorrhages (micro-DH) have not been well-characterized.

Purpose of the Study:

• To establish the existence of micro-DH in POAG.
• To evaluate the clinical implications of micro-DH for glaucoma progression.

Main Methods:

• Retrospective analysis of prospectively collected data from POAG patients with macro-DH.
• Enhanced stereo disc photography (SDP) used to detect micro-DH (<0.01 mm2).
• Visual field (VF) progression assessed using standard automated perimetry's guided progression analysis over a mean 7.1-year follow-up.

Main Results:

• Micro-DH was detected prior to macro-DH in 36.4% of POAG eyes.
• Eyes with micro-DH showed significantly earlier and faster VF progression compared to those without.
• The VF-deterioration rate was significantly faster in the micro-DH positive group (-1.01 dB/year vs. -0.78 dB/year).

Conclusions:

• Micro-DH is present in a significant proportion of POAG patients before macro-DH.
• Micro-DH serves as an indicator of increased risk for earlier and more rapid glaucoma progression.