title: Estimated rates of retinal ganglion cell loss in glaucomatous eyes with and without optic disc hemorrhages.
abstract: OBJECTIVE
  To evaluate whether optic disc hemorrhages are associated with faster rates of estimated retinal ganglion cell (RGC) loss in glaucoma.
  
  
  METHODS
  A longitudinal observational cohort study of 222 eyes of 122 patients with glaucoma recruited from the Diagnostic Innovations Glaucoma Study (DIGS) followed for an average of 3.74±0.85 years. All subjects had optical coherence tomography and standard automated perimetry during follow up. Optic disc hemorrhages were detected by masked evaluation of stereophotographs. Rates of change in estimated numbers of RGCs were determined using a previously described method. A random coefficients model was used to investigate the relationship between disc hemorrhages and rates of change in estimated RGC counts over time.
  
  
  RESULTS
  19 eyes of 18 subjects had at least one disc hemorrhage during follow up. At baseline, average estimated RGC counts in eyes with and without disc hemorrhages were 677,994 cells and 682,021 cells, respectively (P = 0.929). Eyes with optic disc hemorrhages during follow-up had significantly faster rates of estimated RGC loss than eyes without disc hemorrhages (22,233 cells/year versus 10,704 cells/year, P = 0.020). The effect of disc hemorrhages on the rates of estimated RGC loss remained significant after adjusting for confounding variables.
  
  
  CONCLUSIONS
  Eyes with disc hemorrhages showed faster rates of RGC loss compared to eyes without disc hemorrhages. These results provide further evidence that disc hemorrhages should be considered as an indicator of increased risk for faster neural loss in glaucoma.
authors.affiliation: Hamilton Glaucoma Center and Department of Ophthalmology, University of California San Diego, San Diego, California, United States of America; Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo Brazil.
authors.forename: Carolina P B
authors.initials: CP
authors.lastname: Gracitelli
authors.affiliation: Hamilton Glaucoma Center and Department of Ophthalmology, University of California San Diego, San Diego, California, United States of America; Princess Alexandra Eye Pavilion and Department of Ophthalmology, University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Tatham
authors.affiliation: Hamilton Glaucoma Center and Department of Ophthalmology, University of California San Diego, San Diego, California, United States of America.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Zangwill
authors.affiliation: Hamilton Glaucoma Center and Department of Ophthalmology, University of California San Diego, San Diego, California, United States of America.
authors.forename: Robert N
authors.initials: RN
authors.lastname: Weinreb
authors.affiliation: Hamilton Glaucoma Center and Department of Ophthalmology, University of California San Diego, San Diego, California, United States of America.
authors.forename: Ting
authors.initials: T
authors.lastname: Liu
authors.affiliation: Hamilton Glaucoma Center and Department of Ophthalmology, University of California San Diego, San Diego, California, United States of America.
authors.forename: Felipe A
authors.initials: FA
authors.lastname: Medeiros
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002452:Cell Count; D005260:Female; D005901:Glaucoma / Q000150:complications* / Q000473:pathology*; D006470:Hemorrhage / Q000150:complications* / Q000473:pathology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009898:Optic Disk / Q000473:pathology; D009901:Optic Nerve Diseases / Q000150:complications* / Q000473:pathology; D012165:Retinal Ganglion Cells / Q000473:pathology*