Follow‐up of glaucomatous eyes with optic disc haemorrhages: the Beijing Eye Study

Abstract

Editor, Optic disc haemorrhages play an important role in the ophthalmoscopic diagnosis of optic nerve diseases (Airaksinen et al. 1981). Previous hospital-based studies and population-based investigations have shown that disc haemorrhages are highly significantly associated with glaucoma (Airaksinen et al. 1981; Leske et al. 2003; Ramakrishnan et al. 2003; Budenz et al. 2006). The present study set out to assess how often disc haemorrhages are followed by glaucoma progression in a population-based setting. The Beijing Eye Study 2001, a population-based study on subjects aged ≥ 40 years in Greater Beijing, included 4439 of the 5324 subjects invited to participate. Glaucoma was defined by the appearance of the optic nerve head (‘optic disc glaucoma’ [ODG]) or according to the presence of additional visual field defects (‘perimetric glaucoma’ [PG]), as has recently been described in detail (Xu et al. 2007). In 2001, 221 (2.5%) eyes fulfilled the criteria for the diagnosis of ODG and 134 (1.5%) fulfilled the criteria for PG. In the same year, an optic disc haemorrhage was detected on optic disc photographs in 16 (7.2%) of the 221 eyes with ODG and in 11 (8.2%) of the 134 eyes with PG. Of the 16 eyes with ODG and an optic disc haemorrhage diagnosed in 2001, 11 (69%) returned for re-examination in 2006. Examinable photographs were obtained in nine (56%) of these eyes. In seven (78%) of these eyes, glaucoma had progressed as shown by neuroretinal rim loss and enlargement of the beta zone of peripapillary atrophy. In two (22%) eyes, optic disc appearance appeared unchanged at the 5-year follow-up. Of the 11 eyes with PG and an optic disc haemorrhage diagnosed in 2001, eight (73%) eyes returned for re-examination in 2006 and photographs were obtained in six (55%) of them. In four (66%) eyes, a change in the appearance of the optic disc indicated that glaucoma had progressed, and in two (33%) eyes the optic disc appeared to be unchanged. These results suggest that, in a population-based setting, optic disc haemorrhages in glaucomatous eyes in an adult Chinese population may be followed by a progression of glaucomatous optic nerve damage with a probability of about 70–80%. These results contrast with those of the Ocular Hypertension Treatment Study, which found that although ocular hypertensive subjects with optic disc haemorrhages during follow-up were six times more likely to experience a primary open-angle glaucoma end-point, 87% of study participants with an optic disc haemorrhage did not experience a glaucoma end-point by a median follow-up of 96 months (Budenz et al. 2006). The discrepancy in findings between the studies may reflect the facts that the majority of patients in the present study were not under treatment and that the Ocular Hypertension Treatment Study did not primarily include glaucomatous eyes. This research was supported by the National Key Laboratory Fund, Beijing, China.