Dear Editor, With much interest we have read the recent paper from de Beaufort et al. about the impact of optic disc hemorrhages (ODH) on the rate of visual field (VF) progression during a mean follow-up of 4.6 years [1]. The study covers an important topic since ODH is a considerable risk factor for occurrence and progression of glaucomatous VF defects in patients with ocular hypertension and open-angle glaucoma. Nevertheless, it seems surprising that the authors did not find a difference in the rate of VF progression between patients with single and recurrent ODH. We would like to add some of our own findings from structural and functional analysis of long-term follow-up of an ongoing cohort study (www. clinicaltrials.gov: ID: NTC00494923). Sixty patients with single or recurrent ODH were recruited from the Erlangen Glaucoma Registry to evaluate the rate of glaucomatous optic disc change and VF deterioration using an event-based approach. All patients underwent annually a complete, standardized ophthalmologic examination including standard static white-on-white perimetry and acquisition of stereographic optic disc slides, which were used for evaluation of ODH. Morphologic assessment of the optic disc was performed by simultaneous projection of optic disc slides in a masked order to determine whether progressive change of the optic disc morphology in comparison to the first date of examination took place or not. Criteria for progression were marked neuroretinal rim (NRR) loss with extension of the optic disc cup or notching accompanied by kinking of small vessels passing the NRR [2]. Morphologic changes had to be confirmed by two experienced examiners independently from each other. Visual field deterioration was defined as significant increasing cluster defects (p<0.01) evaluated with Octopus Field Analysis (Version 2.63). The first two VF tests from each patient were excluded from analysis to avoid learning effects. Subsequent perimetric results just before ODH were used as baseline values. Kaplan-Meier survival analysis and the log-rank test were used to compare the rate of NNR loss and VF deterioration in both groups. The cumulative probability of progressive glaucomatous optic disc change was significantly higher in the recurrent ODH group (p<0.01, Fig. 1). However, no significant difference was found between both groups regarding the incidence of VF progression (p=0.29, Fig. 2). Average follow-up time after the first ODH was 7.2 years for the single group and 8.1 years for the recurrent group. The duration of hemorrhages to disappear varies over a wide range and may reach from a few weeks up to several months. We defined the first observed ODH as the first hemorrhage in our patient group, even if it is not known if any previous hemorrhages occurred. Patients with single ODH may develop another ODH after the maximum followup or between the annual intervals. Indeed, it is very difficult for monitoring ODH patients with both closer time period and long-term follow-up of up to 13 years after occurring ODH. Since the examination interval was standardized and follow-up time is comparable in both groups, we do not Supported by Deutsche Forschungsgemeinschaft SFB 539 “Glaukome und Pseudoexfoliationssyndrom”