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Spatial and Temporal Relationship between Structural Progression and Disc Hemorrhage in Glaucoma in a 3-Year
Tomomi Higashide1, Shinji Ohkubo1, Sachiko Udagawa1
1Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
Ophthalmology. Glaucoma
|August 25, 2020
Summary
Disc hemorrhage (DH) in primary open-angle glaucoma (POAG) patients is linked to structural progression. More frequent DH at a site predicts faster glaucoma progression, indicating vulnerability.
Area of Science:
- Ophthalmology
- Glaucoma Research
- Optic Nerve Head Imaging
Background:
- Primary open-angle glaucoma (POAG) is a leading cause of irreversible blindness.
- Disc hemorrhage (DH) is a transient finding on the optic nerve head, often associated with glaucoma progression.
- Understanding the relationship between DH and structural changes is crucial for predicting glaucoma severity.
Purpose of the Study:
- To investigate the spatial and temporal relationship between disc hemorrhage (DH) and structural progression in patients with primary open-angle glaucoma (POAG).
- To determine if DH predicts structural deterioration at specific locations on the optic nerve head.
- To analyze the association between DH occurrence and the rate of glaucoma progression over a 3-year period.
Main Methods:
- A prospective cohort study involving patients with POAG and controlled intraocular pressure.
- Fundus photography performed every 3 months for 3 years to detect disc hemorrhage and structural progression.
- Independent detection of DH and structural progression (retinal nerve fiber layer defects widening) using flicker chronoscopy.
- Statistical analysis using mixed-effects models to account for intra-eye and inter-eye correlations.
Main Results:
- Disc hemorrhage (DH) occurred in 33.3% of eyes, most frequently at the 7 o'clock location.
- Structural progression, primarily RNFLD widening, occurred in 26.7% of eyes, with no significant difference between superior and inferior hemidiscs.
- Eyes with DH showed a significantly higher risk of progression (HR, 3.72).
- Recurrence and increased frequency of DH at a progression site were associated with shorter time to progression.
Conclusions:
- Disc hemorrhage (DH) and retinal nerve fiber layer defect (RNFLD) progression patterns vary by optic disc location in Japanese POAG patients.
- The presence and frequency of DH at a specific site are associated with an increased risk and faster rate of structural progression.
- DH may serve as an indicator of localized optic nerve vulnerability in POAG.
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