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We thank Dr Chen for taking an interest in our study,1Akagi T. Zangwill L.M. Saunders L.J. et al.Rates of local retinal nerve fiber layer thinning before and after disc hemorrhage in glaucoma.Ophthalmology. 2017; 124: 1403-1411Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar and for providing the opportunity to address these questions. First, although treatment intensification, intraocular pressure reduction, and visual field mean deviation are significantly associated with changes in global retinal nerve fiber layer (RNFL) slopes by stepwise multiple linear regression analysis, we did not present the results of multiple linear regression analysis in disc hemorrhage (DH) and non-DH quadrants in our paper.1Akagi T. Zangwill L.M. Saunders L.J. et al.Rates of local retinal nerve fiber layer thinning before and after disc hemorrhage in glaucoma.Ophthalmology. 2017; 124: 1403-1411Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar Stepwise multiple linear regression analyses showed that only treatment intensification was significantly associated with changes in RNFL slopes in the DH quadrant (β, 1.473; 95% confidence interval, 0.390–2.557; P = 0.009), and treatment intensification (β, 2.715; 95% confidence interval, 1.667–3.762; P < 0.001) and visual field mean deviation (β, 0.170; 95% confidence interval, 0.067–0.272; P = 0.002) were associated with changes in RNFL slopes in the non-DH quadrant. These results support our conclusion that treatment intensification significantly slows RNFL thinning in global and sectoral RNFL, even after being adjusted for various potential confounding factors. Second, the rates of RNFL thinning before DH were not different between DH and non-DH quadrants (unchanged treatment group, DH quadrant -1.38 μm per year, non-DH quadrant -0.93 μm per year [P = 0.14]; intensified treatment group, DH quadrant -2.64 μm per year, non-DH quadrant -2.89 μm per year [P = 0.57]). Thus, DH does not appear at the location that had faster rates of RNFL thinning. Third, our data do not suggest that DH has a protective effect on the rates of RNFL thinning. Rather, the appearance of DH resulted in the intensification of treatment in many eyes. As shown in Table 4 (in the original article), our results suggest the intensification of treatment after the appearance of DH led to a slowing of RNFL thinning. Finally, we agree that visual field change is very important when evaluating glaucoma progression. Further study using visual field testing is needed to confirm this issue. Re: Akagi et al.: Rates of local retinal nerve fiber layer thinning before and after disc hemorrhage in glaucoma (Ophthalmology. 2017;124:1403-1411)OphthalmologyVol. 125Issue 3PreviewWe read with great interest the article by Akagi et al1 exploring the effects of disc hemorrhage (DH) on the progression of retinal nerve fiber layer (RNFL) thinning in glaucoma. They found that the rates of RNFL thinning were faster in DH quadrants after DH, and that intensification treatment has a beneficial effect.1 However, we have some questions. First, in this study, the authors found that the treatment intensification, visual field mean deviation, and difference in intraocular pressure before and after DH will have an effect on the global RNFL slope values. Full-Text PDF