Optic Disc Hemorrhage Research Articles

Morphological characteristics of parapapillary atrophy and subsequent visual field progression in primary open-angle glaucoma

Background/AimsTo investigate the associations between the morphological characteristics of beta-zone parapapillary atrophy (β-zone PPA) and subsequent visual field (VF) progression in eyes with primary open-angle glaucoma (POAG).MethodsOne hundred and twenty-one...

Densitometric Profiles of Optic Disc Hemorrhages in the Ocular Hypertension Treatment Study

The origin of blood in glaucoma-related disc hemorrhages (DH) remains unknown. A prior clinic-based study of primary open-angle glaucoma (POAG)-related DH showed that they had grayscale pixel intensities more similar to blood from retinal macroaneurysms and adjacent retinal arterioles than to blood from retinal vein occlusions or adjacent retinal venules, suggesting an arterial source. Here we assessed the densitometric profile of DH from fundus photographs in the Ocular Hypertension Treatment Study (OHTS). Retrospective cross-sectional study of prospectively collected images. Stereo disc photographs of 161 DH events from 83 OHTS participants (mean age [standard deviation (SD)]: 65.6 [9.2] years; 46.6% female; 13.0% black race) were imported into ImageJ to measure densitometry differences (adjacent arterioles minus DH [ΔA] or venules minus DH [ΔV]). Their size as percentage of disc area, ratio of length to midpoint width, and location relative to the disc margin were also analyzed. We performed t tests to compare ΔA and ΔV, analysis of variance to compare ΔA and ΔV across DH recurrent events, and multivariable linear regression to identify determinants of ΔA and ΔV. Mean (SD) ΔA and ΔV were-2.2 (8.7) and-11.4 (9.7) pixel intensity units, respectively (P < .001). ΔA and ΔV each did not differ significantly across recurrence of DH (P ≥ .92) or between DH events with and without POAG (P ≥ .26). OHTS DH had densitometric measurements more similar in magnitude to adjacent arterioles than venules, supporting an arterial origin for DH. Vascular dysregulation may contribute to disc hemorrhage formation in ocular hypertension.

Comparison of Rate of Change between Bruch's Membrane Opening Minimum Rim Width and Retinal Nerve Fiber Layer in Eyes Showing Optic Disc Hemorrhage

To investigate and compare the longitudinal rate of change of Bruch's membrane opening minimum rim width (BMO-MRW) and peripapillary retinal nerve fiber layer (RNFL) thickness in eyes showing optic disc hemorrhage(DH). Observational case series. A total of 82 subjects(82 eyes) showing DH who had undergone more than five reliable spectral-domain optical coherence tomography (OCT) tests were included. BMO-MRW and RNFL were measured with OCT at 3-month intervals. The rates of change in global and each Garway-Heath sector were calculated with a linear mixed-effects model after adjusting for age, sex, and BMO area. The mean follow-up period was 21.57 ± 7.88months with a mean number of 7.88 ± 2.39 OCT tests. Baseline demographics were age (58.37 ± 10.65 y); 46.3% were female; and the mean deviation was-4.41 ± 5.04 dB. The global rate of change in BMO-MRW was-3.507 ± 0.675μm/y and in-1.404 ± 0.208μm/y in RNFL. The rate of change was the greatest in the inferotemporal sector, which was-9.141 ± 1.254μm/y in BMO-MRW and-4.204 ± 0.490μm/y in the RNFL. The rate of change was significantly greater in BMO-MRW than in the RNFL in all sectors, except for the nasal sector (P < .05). Percentage of reduction was significantly greater in BMO-MRW than in RNFL in the inferotemporal and superotemporal sectors (P < .05). BMO-MRW showed a significantly greater rate of change than RNFL in eyes showing DH, especially in the inferotemporal and superotemporal sectors in percentage of reduction. Thus, it may be more advantageous to detect glaucomatous progression earlier in BMO-MRW than in the RNFL in eyes showing DH that are more likely to progress.

Primary Open Angle Glaucoma and Vascular Risk Factors: A Review of Population Based Studies from 1990 to 2019.

Glaucoma is one of the leading causes of blindness worldwide, and as the proportion of those over age 40 increases, so will the prevalence of glaucoma. The pathogenesis of primary open angle glaucoma (POAG) is unclear and multiple ocular risk factors have been proposed, including intraocular pressure, ocular perfusion pressure, ocular blood flow, myopia, central corneal thickness, and optic disc hemorrhages. The purpose of this review was to analyze the association between systemic vascular risk factors (including hypertension, diabetes, age, and migraine) and POAG, based on major epidemiological studies. Reports presenting the association between POAG and systemic vascular risk factors included a total of over 50,000 patients. Several epidemiological studies confirmed the importance of vascular risk factors, particularly hypertension and blood pressure dipping, in the pathogenesis and progression of glaucomatous optic neuropathy. We found that diabetes mellitus is associated with elevated intraocular pressure, but has no clear association with POAG. No significant correlation between migraine and POAG was found, however, the definition of migraine varied between studies.

Ten Years and Beyond Longitudinal Change of ß-Zone Parapapillary Atrophy: Comparison of Primary Open-Angle Glaucoma with Normal Eyes

To investigate the difference in longitudinal change of ß-zone parapapillary atrophy (PPA) between eyes with primary open-angle glaucoma (POAG) and normal eyes. Longitudinal, observation study. A total of 153 eyes with POAG and 105 normal eyes. Participants were followed for 10 years or more, with disc photography performed every year. The topographic parameters of ß-zone PPA (area, maximal radial extent, angular extent around disc) were measured. The factors associated with the enlargement of ß-zone PPA parameters were assessed by odds ratio (OR) using multivariable logistic regression. Enlargement of ß-zone PPA parameters and associated factors. Over the course of the average 11.6±1.3-year follow-up period, enlargement of β-zone PPA was detected in 66.7% of POAG eyes and in 26.7% of normal eyes. Increment of all PPA parameters was significantly more common in cases of POAG than in normal eyes (all P < 0.001). The spatial distribution of maximal radial extent at baseline and final examination was significantly different between the 2 groups: POAG eyes; inferotemporal versus normal eyes; temporal (chi-square= 26.549, P < 0.001, chi-square= 19.320, P= 0.004, respectively). The widening of radial extent was significantly associated with older age (OR, 1.036; P= 0.010) and the presence of glaucoma (OR, 2.599; P= 0.002). The increment of angular extent was associated with the presence of glaucoma (OR, 12.167; P= 0.017) and optic disc hemorrhage (OR, 3.266; P= 0.019). The pattern of ß-zone PPA change differed between POAG and normal eyes during a follow-up of 10 years or more. The enlargement of PPA occurred more frequently in POAG than in normal eyes. The widening of radial extent was associated with older age and glaucoma, whereas the increment of angular extent was associated with glaucomatous damage.

Relationship between optic disc hemorrhage and corneal hysteresis

ObjectiveTo determine the relationship between optic disc hemorrhage (DH) and corneal hysteresis (CH). MethodsConsecutive patients with prior or current photographic evidence of unilateral DH who had undergone CH measurement with the Ocular Response Analyzer (ORA; Reichert, Buffalo, NY) were enrolled. Eyes with a history of corneal disease, refractive surgery, or bilateral DH were excluded. Central corneal thickness (CCT), visual field data, 5 consecutive previous intraocular pressures (IOPs), and maximum documented peak IOP were obtained by chart review. Vertical cup-to-disc ratio (VCDR), the presence of neuroretinal rim notching, number of clock hours of beta zone parapapillary atrophy (ßPPA), and eye with greater ßPPA width were determined from photographs by 2 masked expert examiners. ResultsWe identified and analyzed 49 patients with photographically documented unilateral DH. Compared to fellow non-DH eyes, eyes with DH had lower CH (8.7 ± 1.9 vs 9.2 ± 1.7; p = 0.002), higher IOP (15.6 ± 3.6 vs 14.3 ± 4.1; p = 0.017), and greater VCDR (0.79 ± 0.13 vs 0.68 ± 0.23; p < 0.001), but were similar with respect to CCT, ßPPA extent, rim notching, peak IOP, and visual field damage (all p > 0.05). Using multivariate conditional logistic regression analysis, only CH (p = 0.012) and VCDR (p = 0.004) predicted the laterality of the DH. ConclusionsLower CH and greater VCDR are independently associated with DH. This suggests that CH may be a structural biomarker for an abnormality of the optic nerve complex that may be associated with progressive glaucoma. Eyes in which DH were detected had lower CH.

The effect of systemic blood pressure on optical coherence tomography angiography in glaucoma patients with optic disc hemorrhage

AbstractPurposeThe association between retinal microvascular structure and glaucoma has been revealed in multiple studies using optical coherence tomography angiography (OCTA). Recently, the vessel density (VD) of the macular area has been studied for various applications such as diagnosis, assessment, and estimation of visual function in glaucoma. In this study, we tried to identity the factors that affected macular VD (mVD) in glaucomatous eyes.MethodsOptical coherence tomography and OCTA images were collected in a retrospective, cross‐sectional observational study. Glaucomatous eyes were further divided into two groups according to history of disc hemorrhage (DH). Association between mVD and demographic characteristics, ganglion cell‐inner plexiform layer (GCIPL) thickness, visual field mean deviation (MD) and systemic blood pressure was analyzed in each group.ResultsNinety‐two eyes from 58 healthy subjects and 179 eyes from 103 patients with glaucoma were included. In both healthy and glaucomatous eyes, mVD was inversely associated with the age of the eyes (β = −0.035, p = 0.025; β = −0.039, p = 0.018). In the glaucomatous eyes, mVD was significantly decreased as the MD value was worse (β = 0.109, p = 0.002). In the glaucomatous eyes with DH, the mVD decreased as the blood pressure increased (β = −0.080, p = 0.002; β = −0.104, p = 0.007; β = −0.105, p = 0.003, for systolic BP, diastolic BP and mean arterial pressure, respectively) but the other factors were not significantly associated with mVD.ConclusionsReduced mVD is more common in older individuals in both healthy and glaucomatous eyes. mVD also correlates with the severity of MD value in glaucomatous eyes. In glaucomatous eyes with DH, high systemic BP is associated with a reduction in mVD. This may indicate that patients with glaucoma are more susceptible to vascular damage secondary to hypertension.

Making a Correct Diagnosis of Glaucoma: Data From the EMGT.

Précis:A correct diagnosis of glaucoma established at initial visits.Purpose:It has been suggested that a diagnosis of glaucoma cannot be certain until progression has been demonstrated. Our aim was to evaluate the correctness of a glaucoma diagnosis established after 2 initial visits.Patients and Methods:Patients included in the Early Manifest Glaucoma Trial (EMGT) who had continued follow-up for at least 15 years were included in this analysis. The patients had been recruited primarily through a population screening and were diagnosed with glaucoma if the Glaucoma Hemifield Test was outside normal limits in the same sector at two consecutive visits. A Glaucoma Hemifield Test classification of borderline was also diagnostic if corresponding optic disc findings were present. At least one of the following criteria had to be fulfilled during follow-up to confirm the initial diagnosis: (1) visual field progression in at least one eye according to the EMGT criterion; (2) development of manifest glaucoma in an initially ineligible fellow eye; (3) optic disc progression in at least one eye; (4) optic disc hemorrhages in at least 1 eye.Results:Of the 255 patients included in the EMGT, 117 were followed for at least 15 years, representing 147 eyes eligible for our study. During follow-up, 134 eyes (91%) showed visual field progression, and, of the remaining 13 eyes, only 4 (3%) did not fulfill any of the criteria to confirm the diagnosis.Conclusions:A diagnosis made applying strict criteria to 2 initial visual field tests, supported by optic disc findings if visual field findings were borderline, was almost always correct.

Ophthalmic features of HIV associated cryptococcal meningitis in Malawian Adults: an observational study

Background: Cryptococcal meningitis (CM) is the commonest neurological complication in patients with advanced HIV. Visual disturbance is a frequent presenting symptom. Papilloedema is commonly reported but other ophthalmic findings are not well described. Methods: We performed an observational study comparing severely immunocompromised HIV-infected patients with and without CM to determine the nature and prevalence of retinal pathology attributable to CM. 70 adult patients were enrolled in Blantyre Malawi, 35 with CM and 35 HIV-infected patients without CM. Results: 79% (19/24) of CM patients examined on day one had evidence of retinal abnormalities compared to 17% (6/35) of HIV-infected controls (p &lt;0.001). In the CM group, retinal whitening was the commonest abnormality (50%), followed by optic disc swelling (29%), haemorrhage (25%) and vascular abnormalities (7%). Retinal whitening was the only abnormality observed in the comparator group (17%). In CM, there was no significant difference between those with and without retinal abnormalities in fungal burden (13,550 cfu/ml vs. 9,150 cfu/ml; p = 0.65), CD4 count (28 cells/µl vs. 76 cells/µl; p = 0.79) or CSF opening pressure (21cm H20 vs. 27cm H20; p = 0.5). There was no association between presence/absence of retinal abnormalities and death (40% 10-week mortality vs. 26%; p = 0.6). Conclusions: Whether the presence of CM retinopathy could be used as a marker of disease severity warrants further investigation. The observed ophthalmic findings provide a descriptive framework for CM retinopathy to be utilised in future CM studies. Trial registration: ISRCTN (ISRCTN45035509) 19/06/2012.

Rate of three-dimensional neuroretinal rim thinning in glaucomatous eyes with optic disc haemorrhage

BackgroundTo investigate the thinning rate of three-dimensional neuroretinal rim thickness (3D-NRT) in glaucoma eyes with optic disc haemorrhage (DH) and its relationship to retinal nerve fibre layer thickness (RNFLT) progression.MethodsNinety-five...

Influence of optic nerve appearance on final visual outcome in pediatric patients with idiopathic intracranial hypertension (IIH)

In adult IIH patients, Frisén grade, but not optic disc hemorrhages (ODH) or cotton wool spots (CWS), was an independent risk factor for worse visual outcomes, allowing for early intervention. We investigated these variables in pediatric IIH (PIIH) patients.

Considerations With Regard to the Relationship Between Anticoagulant Intake and Glaucoma Prognosis in Eyes With Optic Disc Hemorrhages.

Considerations With Regard to the Relationship Between Anticoagulant Intake and Glaucoma Prognosis in Eyes With Optic Disc Hemorrhages.

Ophthalmic features of HIV associated cryptococcal meningitis in Malawian Adults: an observational study

Background: Cryptococcal meningitis (CM) is the commonest neurological complication in patients with advanced HIV. Visual disturbance is a frequent presenting symptom. Papilloedema is commonly reported but other ophthalmic findings are not well described. Methods: We performed an observational study comparing severely immunocompromised HIV-infected patients with and without CM to determine the nature and prevalence of retinal pathology attributable to CM. 70 adult patients were enrolled in Blantyre Malawi, 35 with CM and 35 HIV-infected patients without CM. Results: 79% (19/24) of CM patients examined on day one had evidence of retinal abnormalities compared to 17% (6/35) of HIV-infected controls (p &lt;0.001). In the CM group, retinal whitening was the commonest abnormality (50%), followed by optic disc swelling (29%), haemorrhage (25%) and vascular abnormalities (7%). Retinal whitening was the only abnormality observed in the comparator group (17%). In CM, there was no significant difference between those with and without retinal abnormalities in fungal burden (13,550 cfu/ml vs. 9,150 cfu/ml; p = 0.65), CD4 count (28 cells/µl vs. 76 cells/µl; p = 0.79) or CSF opening pressure (21cm H20 vs. 27cm H20; p = 0.5). There was no association between presence/absence of retinal abnormalities and death (40% 10-week mortality vs. 26%; p = 0.6). Conclusions: Whether the presence of CM retinopathy could be used as a marker of disease severity warrants further investigation. The observed ophthalmic findings provide a descriptive framework for CM retinopathy to be utilised in future CM studies. Trial registration: ISRCTN (ISRCTN45035509) 19/06/2012.

Risk factors for disease progression in low-teens normal-tension glaucoma

Background/AimsTo investigate the risk factors for disease progression of normal-tension glaucoma (NTG) with pretreatment intraocular pressure (IOP) in the low-teens.MethodsOne-hundred and two (102) eyes of 102 patients with NTG with...

Optic Disc Microhemorrhage in Primary Open-Angle Glaucoma: Clinical Implications for Visual Field Progression.

To establish the existence of minute-sized optic disc hemorrhage (DH; i.e., optic disc microhemorrhage [micro-DH]) in primary open-angle glaucoma (POAG) and to evaluate its clinical implications for glaucoma progression. Retrospective analysis of prospectively collected data. POAG patients with macro-DH who had met the following conditions were included: follow-up period 7 years or longer (at least 3 years before and at least 4 years after the date of first macro-DH), and more than nine reliable VF results. Micro-DH was defined as a less than 0.01-mm2 area DH that is undetectable on conventional stereo disc photography (SDP) but can be discriminated by enhanced SDP. SDPs were enhanced by customized image-compensation software. Each enhanced image was evaluated to determine the presence of micro-DH. VF progression was confirmed by standard automated perimetry's guided progression analysis. Among the 107 POAG eyes with macro-DH, micro-DH was detected prior to macro-DH in 39 (36.4%), the median time lag being 13.6 months. Over the course of the mean 7.1 ± 0.8-year follow-up period, 40 of 107 eyes showed VF progression: 21 (53.8%) of the 39 eyes of the micro-DH positive group and 19 (27.9%) of the 68 eyes of the micro-DH-negative group (P = 0.008). In the micro-DH-positive group, the cumulative VF-progression probability was significantly greater (P = 0.001), and the overall VF-deterioration rate was much faster (-1.01 ± 0.58 vs. -0.78 ± 0.49 dB/year, P = 0.029). Micro-DH was found prior to macro-DH detection in a significant proportion of POAG patients; micro-DH, moreover, was associated with earlier and faster VF progression.

Association between focal lamina cribrosa defects and optic disc haemorrhage in glaucoma

Background/aimsTo explore the relationship between focal lamina defect (LD) size and optic disc haemorrhages (DH) in glaucomatous eyes.MethodsRadial B-scan images at 15° intervals obtained using enhanced depth imaging (EDI) spectral-domain...

Parapapillary Deep-Layer Microvasculature Dropout and Visual Field Progression in Glaucoma

To evaluate the association between optical coherence tomography angiography (OCT-A)-derived parapapillary deep-layer microvasculature dropout and glaucomatous visual field (VF) progression. Retrospective, cohort study. A total of 138 eyes of 138 patients with primary open-angle glaucoma (mean follow-up, 5.5 years) and with ≥5 VFs prior to OCT-A imaging were included. VF progression was defined as either a Guided Progression Analysis-based "likely progression" event or a significant VF index (VFI) slope. Microvasculature dropout was defined as parapapillary deep-layer microvasculature dropout based on a qualitative analysis of OCT-A. Prevalence of dropout was compared between eyes with and without VF progression. Fifty-five eyes (39.9%) demonstrated VF progression. A higher proportion of eyes with dropout progressed than those without dropout (50/84 eyes [59.5%] vs 5/54 eyes [9.3%]; P < .001). In multivariable logistic regression analysis, mean and standard deviation intraocular pressure, optic disc hemorrhage, focal lamina cribrosa defect, and dropout were significantly associated with prior VF progression (P < .05). The VFI progression rate was significantly faster in eyes with dropout than in those without dropout (-2.23% ± 3.22%/year vs-0.05% ± 1.24%/year, respectively; P < .001), and the location of dropout and VF progression were spatially correlated. Eyes with parapapillary deep-layer microvasculature dropout detected by OCT-A had a significantly higher rate of VF progression than eyes without dropout. These findings implicate dropout as a structural parameter suggestive of past glaucomatous VF progression. Further prospective longitudinal studies are needed to elucidate the role of deep-layer microvasculature damage in thepathogenesis of glaucoma.

Optic nerve appearance as a predictor of visual outcome in patients with idiopathic intracranial hypertension

Background/aimsIt remains unclear whether the presence of optic disc haemorrhages (ODH) or cotton wool spots (CWS) at presentation in patients with papilloedema from idiopathic intracranial hypertension (IIH) has prognostic value....

Effect of Antiplatelet/Anticoagulant Use on Glaucoma Progression in Eyes With Optic Disc Hemorrhage.

To assess whether the use of antiplatelets (APs)/anticoagulants (ACs) affects glaucoma progression in eyes with optic disc hemorrhage (DH). One hundred and nineteen eyes from 119 patients with primary open-angle glaucoma in whom a DH was observed at least once during the follow-up period (mean follow-up duration: 6.2 y) were included in this retrospective observational study. Cox proportional hazard models were used to identify the association between putative factors, including AP/AC use, and glaucoma progression. Glaucoma progression was assessed on the basis of changes noted on serial optic disc and retinal nerve fiber layer photographs or changes in the visual field. Nineteen of the 119 patients took AP/AC drugs daily [AP/AC use group (AG)], while the others did not [no use group (NG)]. The follow-up period to progression was significantly different between the 2 groups (61.2±23.5 mo for the AG and 47.6±22.0 mo for the NG; P=0.016). Kaplan-Meier analysis revealed a greater cumulative probability of glaucoma progression in the NG than in the AG, with borderline statistical significance (P=0.081). Higher mean intraocular pressure during the follow-up period was a risk factor for glaucoma progression (hazard ratio, 1.107; P=0.014), while AP/AC drug use protected against glaucoma progression (hazard ratio, 0.576; P=0.046). According to our result, use of AP/AC drugs was associated with lower risk of glaucoma progression in eyes with DH.

Prevalence of optic disc haemorrhages in an elderly UK Caucasian population and possible association with reticular pseudodrusen-the Bridlington Eye Assessment Project (BEAP): a cross-sectional study (2002-2006).

To determine disc haemorrhage (DH) prevalence in an elderly UK population-the Bridlington Eye Assessment Project (BEAP). Thirty-degree fundus photographs (3549 participants ≥65 years) were graded for DH/macula changes. Glaucoma evaluation included Goldmann tonometry, 26-point suprathreshold visual-fields and mydriatic slit-lamp assessment for glaucomatous optic neuropathy. In all, 3548 participants with photographs in at least one eye. DHs were present in 53 subjects (1.49%), increasing from 1.17% (65- to 69-year age group) to 2.19% (80- to 84-year age group), p = 0.06. DH was found in 9/96 (9.38%) right eyes (RE) with open-angle glaucoma (OAG). Two of twelve RE (16.67%) with normal-tension glaucoma (NTG) had DH. Prevalence in eyes without glaucoma was lower (32/3452, [0.93%]). Reticular pseudodrusen (RPD) occurred in 170/3212 (5.29%) subjects without DH, and 8/131 subjects (6.11%) with OAG. Twenty eyes had NTG, two of whom had RPD (10%) (p = 0.264). Within a logistic regression model, DH was associated with glaucoma (OR 10.2, 95% CI 5.32-19.72) and increasing age (OR 1.05, 95% CI 1.00-1.10, p = 0.03). DH was associated with RPD (p = 0.05) with univariate analysis but this was not statistically significant in the final adjusted model. There was no significant association with gender, diabetes mellitus (DM), hypertension treatment or Age-related Macular Degeneration (AMD) grade. DH prevalence is 1.5% in those over 65 years old and significantly associated with glaucoma and increasing age. There appears to be increased RPD prevalence in eyes with DH and NTG with age acting as a confounding factor. Larger studies are required to fully assess the relationship and investigate a possible shared aetiology of choroidal ischaemia.