The relationship between intraocular pressure reduction and rates of progressive visual field loss in eyes with optic disc hemorrhage.
OBJECTIVE
To evaluate rates of visual field progression in eyes with optic disc hemorrhages and the effect of intraocular pressure (IOP) reduction on these rates.


METHODS
Observational cohort study.


METHODS
The study included 510 eyes of 348 patients with glaucoma who were recruited from the Diagnostic Innovations in Glaucoma Study (DIGS) and followed for an average of 8.2 years.


METHODS
Eyes were followed annually with clinical examination, standard automated perimetry visual fields, and optic disc stereophotographs. The presence of optic disc hemorrhages was determined on the basis of masked evaluation of optic disc stereophotographs. Evaluation of rates of visual field change during follow-up was performed using the visual field index (VFI).


METHODS
The evaluation of the effect of optic disc hemorrhages on rates of visual field progression was performed using random coefficient models. Estimates of rates of change for individual eyes were obtained by best linear unbiased prediction (BLUP).


RESULTS
During follow-up, 97 (19%) of the eyes had at least 1 episode of disc hemorrhage. The overall rate of VFI change in eyes with hemorrhages was significantly faster than in eyes without hemorrhages (-0.88%/year vs. -0.38%/year, respectively, P<0.001). The difference in rates of visual field loss pre- and post-hemorrhage was significantly related to the reduction of IOP in the post-hemorrhage period compared with the pre-hemorrhage period (r = -0.61; P<0.001). Each 1 mmHg of IOP reduction was associated with a difference of 0.31%/year in the rate of VFI change.


CONCLUSIONS
There was a beneficial effect of treatment in slowing rates of progressive visual field loss in eyes with optic disc hemorrhage. Further research should elucidate the reasons why some patients with hemorrhages respond well to IOP reduction and others seem to continue to progress despite a significant reduction in IOP levels.


BACKGROUND
Proprietary or commercial disclosure may be found after the references.
Medeiros
Felipe A
FA
Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego. fmedeiros@eyecenter.ucsd.edu
Alencar
Luciana M
LM
Sample
Pamela A
PA
Zangwill
Linda M
LM
Susanna
Remo
R
Weinreb
Robert N
RN
D000465:Algorithms; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000175:diagnosis / Q000503:physiopathology*; D006068:Gonioscopy; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009898:Optic Disk / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000175:diagnosis / Q000503:physiopathology*; D011446:Prospective Studies; D012166:Retinal Hemorrhage / Q000175:diagnosis / Q000503:physiopathology*; D012307:Risk Factors; D014786:Vision Disorders / Q000503:physiopathology*; D014794:Visual Fields