Optic Disc Hemorrhage Research Articles

The primary vascular dysregulation syndrome: implications for eye diseases

Vascular dysregulation refers to the regulation of blood flow that is not adapted to the needs of the respective tissue. We distinguish primary vascular dysregulation (PVD, formerly called vasospastic syndrome) and secondary vascular dysregulation (SVD). Subjects with PVD tend to have cold extremities, low blood pressure, reduced feeling of thirst, altered drug sensitivity, increased pain sensitivity, prolonged sleep onset time, altered gene expression in the lymphocytes, signs of oxidative stress, slightly increased endothelin-1 plasma level, low body mass index and often diffuse and fluctuating visual field defects. Coldness, emotional or mechanical stress and starving can provoke symptoms. Virtually all organs, particularly the eye, can be involved. In subjects with PVD, retinal vessels are stiffer and more irregular, and both neurovascular coupling and autoregulation capacity are reduced while retinal venous pressure is often increased. Subjects with PVD have increased risk for normal-tension glaucoma, optic nerve compartment syndrome, central serous choroidopathy, Susac syndrome, retinal artery and vein occlusions and anterior ischaemic neuropathy without atherosclerosis. Further characteristics are their weaker blood–brain and blood-retinal barriers and the higher prevalence of optic disc haemorrhages and activated astrocytes. Subjects with PVD tend to suffer more often from tinnitus, muscle cramps, migraine with aura and silent myocardial ischaemic and are at greater risk for altitude sickness. While the main cause of vascular dysregulation is vascular endotheliopathy, dysfunction of the autonomic nervous system is also involved. In contrast, SVD occurs in the context of other diseases such as multiple sclerosis, retrobulbar neuritis, rheumatoid arthritis, fibromyalgia and giant cell arteritis. Taking into consideration the high prevalence of PVD in the population and potentially linked pathologies, in the current article, the authors provide recommendations on how to effectively promote the field in order to create innovative diagnostic tools to predict the pathology and develop more efficient treatment approaches tailored to the person.

Optic disc progression and rates of visual field change in treated glaucoma

To investigate the relationship between optic disc progression and rates of visual field (VF) change in patients with treated glaucoma. Glaucoma patients with repeatable VF loss, ≥8 SITA-Standard 24-2 VF tests and good quality optic disc stereophotographs evaluated over a 10-year period were included. Optic disc photographs were reviewed for signs of glaucoma progression (neuroretinal rim change, widening of retinal nerve fibre layer defect, disc haemorrhage and enlargement of beta-zone parapapillary atrophy) by two glaucoma specialists masked to their temporal sequence. Disagreements were adjudicated by a third grader. VF progression was evaluated using automated pointwise linear regression (PLR) and defined as at least two adjacent test points progressing >1.0 dB/year at p < 0.01. VF progression outcomes were compared with photograph review results. Three-hundred and eighty nine eyes (389 patients; mean age 64.9 ± 13.0 years; mean baseline MD, -7.1 ± 5.1 dB) were included. Most patients had primary open angle glaucoma (54%). Eighty-two eyes (21%) had confirmed optic disc progression and 115 eyes (29%) met the VF PLR criteria. Eyes with documented optic disc progression had more rapid rates of VF change (-0.66 ± 0.7 versus -0.36 ± 0.7 dB/year, p < 0.01) and met the VF PLR endpoint more often (univariate OR = 1.85, p = 0.02; multivariate OR = 1.78, p = 0.03) than eyes without optic disc progression. There was moderate spatial consistency between the location of the optic disc progression and the hemifield with more rapid progression (81%, kappa = 0.40). Treated glaucomatous eyes with documented optic disc progression are at increased risk of diminished visual function over time and may require more aggressive therapy to prevent future vision loss. Among the indicators of structural progression, disc haemorrhage was the single most significant predictor for VF deterioration.

Neovascularization of the optic disk and vitreous hemorrhage after immune recovery and treatment of cytomegalovirus retinitis in an HIV-positive patient.

To report a case of neovascularization of the disk and vitreous hemorrhage associated with cytomegalovirus retinitis in an HIV-positive man on highly active antiretroviral therapy. Clinical examination by fellowship-trained retina specialist, including fundus photography and fluorescein angiography. A 44-year-old HIV-positive man with known history of cytomegalovirus retinitis subsequently developed neovascularization of the disk and vitreous hemorrhage after the initial treatment. This was treated with panretinal photocoagulation and responded well to treatment. Neovascularization of the disk and vitreous hemorrhage are rare but important sequelae of cytomegalovirus retinitis in the HIV-positive population.

Rate of Visual Field Progression in Eyes With Optic Disc Hemorrhages in the Ocular Hypertension Treatment Study

Objective To compare rates of visual field (VF) change in ocular hypertensive eyes with and without optic disc hemorrhage (DH). Methods Ocular Hypertension Treatment Study subjects (minimum 10 reliable VF tests, followed up ≥5 years) were included. Trend analyses of VF sequences over time of DH and non-DH eyes were assessed by regression of mean deviation (MDR) and pointwise linear regression (PLR). The main outcome measures were rates of VF change in DH and non-DH eyes. Results Two thousand six hundred seven eyes (1378 participants) were included. The mean (SD) number of VF tests per eye was 23.7 (4.9) spanning a mean (SD) of 12.2 (2.0) years. At least 1 DH was detected in 187 eyes (7.2%), of which 52 eyes had recurrent DH. Mean deviation rate of change was significantly worse in DH compared with non-DH eyes (mean [SD], −0.17 [0.27] vs −0.07 [0.19] dB/y; P Conclusions Eyes with DH had more rapid VF deterioration when assessed by global (MDR) or local (PLR) trend analysis than eyes without DH. Eyes with recurrent DH had similar rates of global VF change (MDR) when compared with eyes with a single DH but reached criteria for rapid PLR change more often. Intraocular pressure reduction in ocular hypertension reduces the risk of developing a DH. Ocular hypertensive eyes with DH should be monitored closely and may need more aggressive therapy. Trial Registration clinicaltrials.gov Identifier: NC0125

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To compare rates of visual field (VF) change in ocular hypertensive eyes with and without optic dischemorrhage (DH). Ocular Hypertension Treatment Study subjects(minimum 10 reliable VF tests, followed up 5 years) were included. Trend analyses of VF sequences over time of DH and non-DH eyes were assessed by regression of mean deviation (MDR) and pointwise linear regression (PLR). The main outcome measures were rates of VF change in DH and non-DH eyes. Two thousand six hundred seven eyes (1378 participants) were included. The mean (SD) number of VF tests per eye was 23.7 (4.9) spanning a mean (SD) of 12.2 (2.0) years. At least 1 DH was detected in 187 eyes(7.2%), of which 52 eyes had recurrent DH. Mean deviation rate of change was significantly worse in DH compared with non-DH eyes (mean [SD], −0.17 [0.27] vs−0.07 [0.19] dB/y; P<.01). Significant PLR progression occurred more frequently in eyes with DH (odds ratio,3.6; P<.01), which increased when 2 or more DHs were present (odds ratio, 4.2; P=.01). Eyes initially randomized to treatment were less likely to have a DH during follow-up. Eyes with DH had more rapid VF deterioration when assessed by global (MDR) or local (PLR)trend analysis than eyes without DH. Eyes with recurrent DH had similar rates of global VF change (MDR)when compared with eyes with a single DH but reached criteria for rapid PLR change more often. Intraocular pressure reduction in ocular hypertension reduces the risk of developing a DH. Ocular hypertensive eyes with DH should be monitored closely and may need more aggressive therapy. clinicaltrials.gov Identifier: NCT00000125

The Glaucoma Guidelines of the Swedish Ophthalmological Society

The Glaucoma Guidelines of the Swedish Ophthalmological Society

The Role of Optical Coherence Tomography Raster Imaging as a Valuable Diagnostic Tool in the Differential Between Optic Disc Hemorrhage and Vitreopapillary Traction

An acute presentation of an optic disc hemorrhage can indicate true optic nerve head damage or can be a result of tractional forces on the vitreopapillary interface. An isolated optic disc hemorrhage secondary to vitreopapillary traction (VPT) can mimic the clinical presentation of a glaucomatous process or that of an underlying ocular or systemic condition. This article highlights the use of spectral domain optical coherence tomography (SD-OCT) 5 line raster (5LR) in differentiating true optic disc hemorrhages from those as a result of tractional forces. Two examples are given of patients presenting to our clinic with unilateral optic disc hemorrhages and various underlying disease processes as risk factors. With the use of SD-OCT 5LR imaging, VPT was implicated as the cause of the disc hemorrhages in both patients. Although this imaging tool alone is not enough to rule out a disease process such as glaucoma or prevent the need for additional diagnostic testing, SD-OCT 5LR is a noninvasive and valuable clinical tool in distinguishing VPT from other etiologies of an optic nerve hemorrhage.

Glaucoma Progression After the First-detected Optic Disc Hemorrhage by Optical Coherence Tomography

To evaluate the progression of glaucoma after first detected disc hemorrhage (DH) by time-domain optical coherence tomography (OCT). Forty-four eyes with a unilateral DH were allocated to the DH group and 44 fellow eyes to the non-DH group. OCT signal decrease indicating retinal nerve fiber layer thinning was defined as a decrease beyond the upper 95% limit of test-retest variability defined at the 95% confidence level of 44 control patients. The DH and non-DH groups were compared in terms of OCT-derived glaucoma progressions after the first detected DH. In addition, clock-hour locations of the OCT-derived progression were compared with those of DHs. After a median 38.8±10.8 months of follow-up, 72.7% (32 of 44) of eyes in the DH group showed OCT-determined progression on a clock-hour basis, compared with 27.3% (12 of 44) of the fellow eyes in the non-DH group (P<0.0001, Fisher exact test). Eyes in the DH group showed more rapid and greater falls in clock-hour-based progression than fellow eyes in the non-DH group (P<0.0001, log-rank test). Twenty-nine eyes (90.6%) showed progression within 1 clock hour of the location of DH. However, no significant intergroup differences were observed in terms of OCT-determined progression on quadrant or average basis (P>0.05, respectively, Fisher exact test). Rapid, spatially compatible, localized thinning of the retinal nerve fiber layer after the first detected DH was shown by Stratus OCT.

Ophthalmic Features of Optic Disc Drusen

Purpose: To evaluate the ophthalmoscopic manifestations of patients with visible and hidden optic disc drusen (ODD). Method: We studied 55 patients (100 eyes) with ODD that were confirmed using B-scan ultrasonography and a control group of 60 patients (100 eyes) for differential diagnosis. We analysed the optic nerve features with stereoscopic photography and compared the characteristics between visible and hidden ODD and between hidden ODD and papilloedema. Results: The patients with ODD presented the following ophthalmoscopic features: visible drusen (52%), blurred edges (84%), raised optic disc (74%), absence of optic disc cupping (69%), absence of venous pulse (54%), abnormal vascular branching (81%), presence of cilioretinal vessels (42%), peripapillary atrophy (56%) and haemorrhages (2%). Comparison of the qualitative characteristics of the papillae of the eyes with visible and hidden ODD showed statistically significant differences in all parameters studied, except for morphological alterations (p = 0.851) and haemorrhage (p = 0.954). Comparison of hidden ODD with papilloedema showed statistically significant differences in blurred edges, disc elevation, absence of optic disc cupping, altered colour, anomalous vascular branching and optic disc haemorrhages (p < 0.005). Conclusions: Ophthalmologic features associated with ODD can help us to diagnose their presence and avoid confusing them with papilloedema.

Detection of progressive macular thickness loss using optical coherence tomography in glaucoma suspect and glaucomatous eyes

To examine the rate of macular thickness loss using time-domain optical coherence tomography (OCT) in functionally progressing versus non-progressing eyes, determined by standard automated perimetry (SAP). Glaucoma suspects (GS) and glaucomatous (G) eyes underwent SAP and OCT imaging every 6 months. Functional progression was determined using pointwise linear regression, defined as 2 contiguous locations losing ≥1.0 dB/year at P<1.0% in the same hemifield. The annual rate of macular thickness loss was calculated from inner and outer regions of the macular map. 72 eyes (43 GS and 29G) with ≥30 months of follow-up were enrolled. Fourteen eyes demonstrated SAP progression. The annual rate of macular thickness loss (μm/year) in progressing eyes was faster (all P<0.05) than non-progressing eyes in temporal outer (-1.90±2.97 vs 0.33±2.77), nasal inner (-1.70±2.66 vs 0.14±2.76), superior inner (-2.15±4.57 vs 0.51±2.99), temporal inner quadrants (-2.58±5.05 vs -0.38±2.34), and the average of inner macular quadrants (-1.84±2.90 vs 0.03±2.10). The rate of loss in the nasal inner (P=0.02) and temporal outer (P=0.02) macular regions was associated with optic disc haemorrhage. Eyes with SAP progression have significantly greater rates of macular thickness loss consistent with glaucomatous retinal ganglion cell atrophy, as compared with non-progressing eyes.

Risk factors for progression of normal‐tension glaucoma under β‐blocker monotherapy

To prospectively study prognostic factors for normal-tension glaucoma (NTG) under treatment with topical β-blocker. One hundred and forty-six eyes of 146 patients with NTG with a mean untreated intraocular pressure (IOP) of 14 mmHg, mild to moderate visual field damage and mean spherical equivalent refraction of -3.5 (-8.0 to +2.0) dioptre were randomized to topical nipradilol or timolol and followed for 3 years. The Humphrey full threshold 30-2 visual field test was performed every 6 months, and optic disc photographs were obtained every 12 months. Progression was defined as visual field progression, optic disc and/or peripapillary nerve fibre layer change, and factors relating to progression were evaluated using Cox proportional hazards models. IOP decreased by 1.0 mmHg over the 3-year period, during which 35% showed progression according to the aforementioned criteria. Optic disc haemorrhage (hazard ratio [HR] 4.00, p < 0.001) and less extent of myopia (per dioptre, HR 1.15, p = 0.013) were significant risk factors. When progression was defined by visual field progression only, less extent of myopia was again a significant risk factor (HR 1.17, p = 0.038). Beside optic disc haemorrhage, less extent of myopia was a risk factor for progression in the current NTG population where most patients were mildly myopic and IOP during follow-up averaged 13.2 mmHg under topical β-blocker.

Clinical Optic Disc Evaluation in Glaucoma

Examination of the optic nerve head (ONH) is essential for the diagnosis of glaucoma and assessment of its progression. Slit-lamp biomicroscopy with a handheld lens is the best method of ONH examination since it provides good stereopsis and magnification. ONH stereo photographs are complementary and may identify findings missed on slit-lamp examination. As a result of its subjective nature, a standardised approach should be utilised for clinical ONH evalaution, including an assessment of ONH size and careful evaluation of the neuroretinal rim contour, the presence of retinal nerve fibre layer (RNFL) defects and optic disc haemorrhages. Other aspects, such as peripapillary chorioretinal atrophy, vessel alterations and asymmetry between fellow eyes, might help differentiate normal from glaucomatous eyes. Progressive changes in the appearance of the ONH or RNFL are best identified with optic disc photographs or automated devices. The findings of clinical ONH evaluation are of greater value when corroborated with other aspects of clinical examination and clinical test.

Anterior Ischemic Optic Neuropathy in a Patient with Churg-Strauss Syndrome

We describe a patient with Churg-Strauss syndrome who developed unilateral anterior ischemic optic neuropathy. A 54-year-old man with a history of bronchial asthma, allergic rhinitis, and sinusitis presented with sudden decreased visual acuity in his right eye that had begun 2 weeks previously. The visual acuity of his right eye was 20 / 50. Ophthalmoscopic examination revealed a diffusely swollen right optic disc and splinter hemorrhages at its margin. Goldmann perimetry showed central scotomas in the right eye and fluorescein angiography showed remarkable hyperfluorescence of the right optic nerve head. Marked peripheral eosinphilia, extravascular eosinophils in a bronchial biopsy specimen, and an increased sedimentation rate supported the diagnosis of Churg-Strauss syndrome. Therapy with methylprednisolone corrected the laboratory abnormalities, improved clinical features, and preserved vision, except for the right central visual field defect. Early recognition of this systemic disease by ophthalmologists may help in preventing severe ocular complications.

Nail Bed Hemorrhage

To examine the characteristics of nailfold capillary changes in patients with glaucoma and to analyze their possible relationship to other clinical characteristics of glaucoma. One hundred eight glaucoma patients and 38 control patients were enrolled in the study. Eighty-six patients were classified as having normal tension glaucoma and 22 patients as having primary open-angle glaucoma. All patients underwent a complete ophthalmic examination and then a physical examination (in the rheumatology department) and were questioned regarding a history of systemic symptoms. Nailfold capillaroscopy was performed, and the results were analyzed by a single observer in a masked manner. Both the χ(2) test and multivariate logistic regression analysis were performed to determine which ocular characteristics were associated with the findings of nailfold capillaroscopy. In the glaucoma patients, 55.6% showed dilated vessels, 35.2% showed loss of capillaries, and 19.4% showed nail bed hemorrhages by nailfold capillaroscopy. Disc hemorrhage was significantly associated with avascular area (odds ratio, 11.13; P < .001) and nail bed hemorrhage (81.59; P < .001). By multivariate logistic regression analysis, avascular area and nail bed hemorrhage continued to be independently associated with the presence of disc hemorrhages in glaucoma patients. No significant differences of association were found between patients having normal tension glaucoma and those having primary open-angle glaucoma. Nailfold capillaroscopy may give valuable information about some features of patients with glaucoma. Nail bed hemorrhage and loss of nail capillaries were strongly associated with the presence of optic disc hemorrhage, and the association was stronger with nail bed hemorrhage. No differences were observed between patients with normal tension glaucoma and patients with primary open-angle glaucoma.

Optical coherence tomography shows progressive local nerve fiber loss after disc hemorrhages in glaucoma patients

The aim of this work is to investigate whether optic disc hemorrhages (ODH) lead to significant loss of nerve fibers at the lesion site over time and whether such a loss is reflected by visual field defects corresponding to the affected nerve fiber bundle. In this retrospective study of ten sequential glaucoma patients (ten eyes) with ODH, we used high-resolution OCT circular scans (Spectralis HRA + OCT, Heidelberg Engineering, Heidelberg, Germany) to determine peripapillary retinal nerve fiber layer (RNFL) thickness at the time of ODH presentation and at follow-up visit between 3 and 6 months. Corresponding perimetric data were analyzed for global (mean defect, MD) and localized progression of visual field defects. ODH were mostly located in the inferior quadrant as determined clinically and from fundus photographs. Iterative OCT imaging revealed a significant RNFL reduction in the affected quadrant relative to the respective quadrant in the fellow eye (RNFL change = -2.25 ± 2.69μm vs. 0.75 ± 2.78μm, p = 0.01) within 120 ± 43days. However, only three cases presented with new/progressive nerve fiber bundle defects corresponding to the lesion site within the given follow-up period. ODH lead to a significantly higher RNFL loss at the lesion site relative to the overall structural progression in glaucoma patients. However, this focal change is not generally reflected by respective nerve fiber bundle defects in the time frame investigated.

Optic disc haemorrhage: the more we look the more we find

Optic disc haemorrhage: the more we look the more we find

Erratum

Acta OphthalmologicaVolume 89, Issue 3 p. e299-e299 Free Access Erratum This article corrects the following: Can the prevalence of open-angle glaucoma be estimated from a retrospective clinical material? A study on the west coast of Iceland Gauti Jóhannesson, Guðrún J. Guðmundsdóttir, Christina Lindén, Volume 83Issue 5Acta Ophthalmologica Scandinavica pages: 549-553 First Published online: July 29, 2005 First published: 16 March 2011 https://doi.org/10.1111/j.1755-3768.2011.02156.xAboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat In Jóhannesson et al. (2005), the following error was published on page 550, 3rd column, 2nd paragraph, line 8: “The diagnosis of manifest glaucoma was based on at least one of the following criteria: 1 glaucomatous cupping of the optic disc (i.e. totally excavated optic disc, excavation to the disc margin, cup disc asymmetry of 0.2 or more between the eyes, vertical excavation ratio greater than horizontal or optic disc haemorrhage, and 2 visual field defects consistent with glaucoma and not explicable on other grounds as judged by the ophthalmologist (GG). The minimum criterion for judging a visual field as glaucomatous was an elevated loss variance (>6 dB) in combination with a cluster of two or more abnormal (p < 0.005) points.” This should have read: “The diagnosis of manifest glaucoma was based on at least two of the following criteria: 1 glaucomatous cupping of the optic disc (i.e. totally excavated optic disc, excavation to the disc margin, cup disc asymmetry of 0.2 or more between the eyes, vertical excavation ratio greater than horizontal or optic disc haemorrhage), and 2 visual field defects consistent with glaucoma and not explicable on other grounds as judged by the ophthalmologist (GG). The minimum criterion for judging a visual field as glaucomatous was an elevated loss variance (>6 dB) in combination with a cluster of two or more abnormal (p < 0.005) points, and 3 progression of glaucomatous cupping or repeatable visual field defects or clinically deemed clear-cut glaucoma.” Reference Jóhannesson G, Guðmundsdóttir GJ & Lindén C (2005): Can the prevalence of open-angle glaucoma be estimated from a retrospective clinical material? A study on the west coast of Iceland Acta Ophthalmol Scand 83: 549– 553. Wiley Online LibraryPubMedWeb of Science®Google Scholar Volume89, Issue3May 2011Pages e299-e299 ReferencesRelatedInformation

Period prevalence and incidence of optic disc haemorrhage in normal tension glaucoma and primary open-angle glaucoma

To investigate and compare the period prevalences and incidences of optic disc haemorrhages in normal tension glaucoma and primary open-angle glaucoma. Hospital-based retrospective study. Four hundred and four patients with normal tension glaucoma and 210 patients with primary open-angle glaucoma that underwent consecutive disc examinations at least quarterly for at least 1 year and stereoscopic optic disc photographs at intervals of 6 to 12 months between 1992 and 2007. The period prevalence of disc haemorrhages, gender predominance among patients with disc haemorrhage, and cumulative incidence of normal tension glaucoma and primary open-angle glaucoma were compared. Period prevalence, cumulative incidence, and gender predominance of DHs in patients with NTG and POAG. Three hundred and eighty-seven patients (387 eyes) of normal tension glaucoma patients and 205 patients (205 eyes) of primary open-angle glaucoma patients were finally enrolled in the study. The period prevalence and incidence rates of the stereoscopic optic disc photograph-confirmed glaucomatous disc haemorrhages were 33.3% (129/387), 0.46 ± 0.18 times/year in the normal tension glaucoma group, and 17.6% (36/205), 0.34 ± 0.23 times/year in the primary open-angle glaucoma group, respectively. The absolute values and ratios of primary open-angle glaucoma and normal tension glaucoma in period prevalences and incidence rates in the present study were higher than in previous studies. No significant difference in gender ratios was found between patients that did or did not develop disc haemorrhage for both types of open-angle glaucoma (P > 0.05, respectively). The primary open-angle glaucoma group had higher period prevalences and incidence rates of disc haemorrhage than those reported previously. Disc haemorrhages were found to develop independent of gender.

Clinical characteristics of eyes with unilateral disc hemorrhage in normal tension glaucoma patients

To investigate the clinical characteristics of the eyes with unilateral disc hemorrhage (DH) in normal tension glaucoma (NTG) patients. 37 normal-tension glaucoma patients with unilateral DH were studied. Extensive parameters were analyzed to evaluate which parameters differ significantly between the DH eyes and the companion eyes. These parameters are: (1) intraocular pressure (IOP), (2) dioptres of refractive errors, (3) central corneal thickness (CCT), (4) disc area, (5) disc shape including horizontal diameter, vertical diameter and horizontal diameter/vertical diameter, (6) global parameters of optic disc, including rim area (G-RA), rim volume (G-RV), mean retinal never fiber layer thickness (G-MRNFLT), cup shape measure (G-CSM) and height variation contour (G-HVC), (7) sectorial parameters of DH located area, including S-RA, S-RV, S-MRNFLT, S-CSM and S-HVC, (8) parameters of the peripapillary atrophy (PPA) beta zone including the incidence rate, area, extent and maximum width. The global and sectorial parameters of the optic disc were obtained directly from HRT-II. The other parameters, such as optic disc horizontal diameter, vertical diameter and PPA, were obtained by processing the raw optic disc images acquired from HRT-II using computer software Image-pro plus version 6. Univariate and multivariate regression analyses were performed on the acquired parameters. The disc vertical diameter (P < 0.01) and incidence rate (P = 0.031) of zone beta appeared to be significantly larger in the DH eyes than the ones in the contra-lateral eyes, while horizontal diameter/vertical diameter was significantly smaller in the DH eyes. As for the optic disc global parameters, the G-MRNFLT (P = 0.028), G-HVC (P = 0.047) were significantly lower in the DH eyes than in the contra-lateral eyes while the G-CSM was significantly higher in DH eyes (P = 0.047). The differences of G-RA, G-RV between two eyes were not significant. As for the regional parameters, S-RA, S-RV, S-MRNFLT were significantly smaller in the DH eyes than in the contra-lateral eyes with P-values 0.033, 0.01 and 0.008 respectively. S-CSM was significantly larger in DH eyes (P = 0.021). S-HVC did not display significant difference between two groups. There were also no significant differences in CCT, dioptres of refractive errors, IOP, PPA parameters (including area, extent and maximum width) between DH eyes and companion eyes. Multivariate regression analysis demonstrated that contained disc area, dioptres of refractive errors, G-RA, G-MRNFLT, G-CSM, horizontal diameter/vertical diameter and zone beta extent, the horizontal diameter/vertical diameter were the significant factors independently associated with disc hemorrhage (P = 0.032, OR < 0.001: < 0.001 - 0.35). Logistic regression analysis also showed that contained disc area, dioptres of refractive errors, S-RA, S-MRNFLT, S-CSM, horizontal diameter/vertical diameter and zone beta extent, the horizontal diameter/vertical diameter and S-MRNFLT were the significant factors independently associated with disc hemorrhage (S-MRNFLT: P = 0.019, OR < 0.001: < 0.001 - 0.154; horizontal diameter/vertical diameter: P = 0.02, OR < 0.001: < 0.001 - 0.124). Our study indicates that horizontal diameter/vertical diameter is significantly smaller in NTG patients with unilateral optic disc hemorrhages. The DH located area also appears to have thinner RNFL thickness. Unilateral optic disc hemorrhages tend to have severe RNFL damage in DH located area and their optic disc shape tend to be longer, therefore we hypothesis that the elongation of the optic disc may be associated with the occurrence of DH.

Automated alternation flicker for the detection of optic disc haemorrhages

Optic disc haemorrhages are associated with active glaucomatous neurodegeneration and ongoing visual field loss. We sought to determine whether automated alternation flicker enhances the detection of disc haemorrhages in serial images from patients with glaucoma when compared to side-by-side photographic evaluation and single-image display. Serial sets of optic nerve photographs of 394 eyes from 234 patients followed for glaucoma at the authors' institutions were included in this study. Eyes with disc haemorrhages were graded for difficulty level and randomized along with nondisc haemorrhage control images into one of three presentation groups (automated alternation flicker, side-by-side or single image). Seven graders viewed all images and assessed for the presence or absence of disc haemorrhages. The sensitivity of automated alternation flicker for disc haemorrhage detection (0.878) was higher than side-by-side (0.705; p = 0.002) and single photographs (0.757; p = 0.01). There was no specificity difference between pairs of presentation groups (all p ≥ 0.7). Automated alternation flicker was a more sensitive method for disc haemorrhage detection than the current clinical standards and may have an important role in the management of glaucoma.