Abstract
PurposeTo evaluate whether optic disc hemorrhages are associated with faster rates of estimated retinal ganglion cell (RGC) loss in glaucoma.MethodsA 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.Results19 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.ConclusionEyes 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.
Highlights
Glaucoma is an optic neuropathy characterized by progressive loss of retinal ganglion cells (RGCs) and associated morphological changes to the optic nerve and retinal nerve fiber layer (RNFL).[1]
There was no significant difference in standard automated perimetry (SAP) mean deviation (MD) or average RNFL thickness at baseline for those with and without disc hemorrhages during follow up
The mean estimated number of RGCs at baseline was similar in both groups with an estimated 682,0216152,455 cells in those with disc hemorrhages compared to 677,9946196,568 cells in eyes without disc hemorrhages (P = 0.929)
Summary
Glaucoma is an optic neuropathy characterized by progressive loss of retinal ganglion cells (RGCs) and associated morphological changes to the optic nerve and retinal nerve fiber layer (RNFL).[1] Visual field loss from glaucoma is irreversible and, it is paramount to identify eyes at high risk of progression. Medeiros and colleagues[8] evaluated rates of visual field progression in eyes with and without optic disc hemorrhages. Eyes with disc hemorrhages were found to have significantly faster rates of progressive visual field loss than those without disc hemorrhages, further supporting disc hemorrhages as an important risk marker for progression. De Moraes et al[9] showed that disc hemorrhages may be associated with rapid and localized visual field progression
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