title: Detection and prognostic significance of optic disc hemorrhages during the Ocular Hypertension Treatment Study.
abstract: OBJECTIVE
  To compare the rates of detection of optic disc hemorrhages by clinical examination and by review of optic disc photographs at the Optic Disc Reading Center (ODRC), to assess the incidence of and the predictive factors for disc hemorrhages in the annual disc photographs of the Ocular Hypertension Treatment Study (OHTS), and to determine whether optic disc hemorrhages predict the development of primary open-angle glaucoma (POAG) in the OHTS.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Three thousand two hundred thirty-six eyes of 1618 participants.
  
  
  METHODS
  Both eyes of participants were examined for optic disc hemorrhages every 6 months by clinical examination, with dilated fundus examinations every 12 months, and by annual review of stereoscopic disc photographs at the ODRC.
  
  
  METHODS
  Incidence of optic disc hemorrhages and POAG end points.
  
  
  RESULTS
  Median follow-up was 96.3 months. Stereophotography-confirmed glaucomatous optic disc hemorrhages were detected in 128 eyes of 123 participants before the POAG end point. Twenty-one cases (16%) were detected by both clinical examination and review of photographs, and 107 cases (84%) were detected only by review of photographs (P<0.0001). Baseline factors associated with disc hemorrhages were older age, thinner corneas, larger vertical cup-to-disc ratio, larger pattern standard deviation index on perimetry, family history of glaucoma, and smoking status. The occurrence of a disc hemorrhage increased the risk of developing POAG 6-fold in a univariate analysis (P<0.001; 95% confidence interval, 3.6-10.1) and 3.7-fold in a multivariate analysis that included baseline factors predictive of POAG (P<0.001; 95% confidence interval, 2.1-6.6). The 96-month cumulative incidence of POAG in the eyes without optic disc hemorrhage was 5.2%, compared with 13.6% in the eyes with optic disc hemorrhage. In eyes with a disc hemorrhage in which a POAG end point developed, the median time between the 2 events was 13 months.
  
  
  CONCLUSIONS
  Review of stereophotographs was more sensitive at detecting optic disc hemorrhage than clinical examination. The occurrence of an optic disc hemorrhage was associated with an increased risk of developing a POAG end point in participants in the OHTS. However, most eyes (86.7%) in which a disc hemorrhage developed have not experienced a POAG end point to date.
authors.affiliation: Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida 33136, USA. dbudenz@med.miami.edu
authors.forename: Donald L
authors.initials: DL
authors.lastname: Budenz
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Anderson
authors.forename: William J
authors.initials: WJ
authors.lastname: Feuer
authors.forename: Julia A
authors.initials: JA
authors.lastname: Beiser
authors.forename: Joyce
authors.initials: J
authors.lastname: Schiffman
authors.forename: Richard K
authors.initials: RK
authors.lastname: Parrish
authors.forename: Jody R
authors.initials: JR
authors.lastname: Piltz-Seymour
authors.forename: Mae O
authors.initials: MO
authors.lastname: Gordon
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kass
mesh_terms: D015331:Cohort Studies; D003941:Diagnostic Techniques, Ophthalmological; D005260:Female; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D015994:Incidence; D007429:Intraocular Pressure; D008297:Male; D009798:Ocular Hypertension / Q000175:diagnosis / Q000188:drug therapy; D009898:Optic Disk / Q000473:pathology*; D010781:Photography; D011379:Prognosis; D012166:Retinal Hemorrhage / Q000150:complications / Q000175:diagnosis*; D012307:Risk Factors