Optic Disc Hemorrhage Research Articles

Antivascular Endothelial Growth Factor Bevacizumab for Radiation Optic Neuropathy: Secondary to Plaque Radiotherapy

To evaluate the intravitreal antivascular endothelial growth factor, bevacizumab, for treatment of radiation optic neuropathy (RON). A prospective interventional clinical case series was performed of 14 patients with RON related to plaque radiotherapy for choroidal melanoma. The RON was characterized by optic disc edema, hemorrhages, microangiopathy, and neovascularization. The entry criteria included a subjective or objective loss of vision, coupled with findings of RON. The study subjects received a minimum of two initial injections of intravitreal bevacizumab (1.25 mg in 0.05 mL) every 6-8 weeks. The primary objectives included safety and tolerability. The secondary objectives included the efficacy as measured using the Early Treatment Diabetic Retinopathy Study chart for visual acuity, fundus photography, angiography, and optical coherence tomography/scanning laser ophthalmoscopy. Reductions in optic disc hemorrhage and edema were noted in all patients. The visual acuity was stable or improved in 9 (64%) of the 14 patients. Of the 5 patients who had lost vision, 2 had relatively large posterior tumors, 1 had had the vision decrease because of intraocular hemorrhage, and 1 had developed optic atrophy. The fifth patient who lost vision was noncompliant. No treatment-related ocular or systemic side effects were observed. Intravitreal antivascular endothelial growth factor bevacizumab was tolerated and generally associated with improved vision, reduced papillary hemorrhage, and resolution of optic disc edema. Persistent optic disc neovascularization and fluorescein angiographic leakage were invariably noted. The results of the present study support additional evaluation of antivascular endothelial growth factor medications as treatment of RON.

The Relationship between Intraocular Pressure Reduction and Rates of Progressive Visual Field Loss in Eyes with Optic Disc Hemorrhage

The Relationship between Intraocular Pressure Reduction and Rates of Progressive Visual Field Loss in Eyes with Optic Disc Hemorrhage

Optic disc hemorrhages and progression in glaucoma

The occurrence of optic disc hemorrhage in glaucoma has been noted for many years, but it has only been in the last 40 years that the association between disc hemorrhage and glaucoma progression has been realised. Normal-tension glaucoma patients have the highest prevalence of disc hemorrhage, but such hemorrhages occur in all types of glaucoma. The exact pathogenesis of disc hemorrhage is unknown, but primary vascular dysregulation appears to be the most likely cause in eyes with glaucoma. Optic disc hemorrhages have been associated with the progression of glaucomatous optic nerve damage and the progression of visual field defects. Lowering intraocular pressure (particularly with trabeculectomy) has been shown to reduce the occurrence of optic disc hemorrhage in glaucoma.

Response to: “Morphologic and functional glaucomatous change after occurrence of single or recurrent optic disc haemorrhages”

Dear Editor:We read with interest the comments by Dr. Laemmer andcolleagues regarding our recent article “Recurrent optic dischemorrhage does not increase the rate of visual fieldprogression” [1]. It is gratifying to know that their studyconfirmed our results, and that they could not detect anydifference in the rate of visual field progression betweeneyes with a single detected disc hemorrhage and eyes withrecurrent disc hemorrhage.We would like to clarify several points raised byDr. Laemmer et al. There are significant differences inmethodologies between our two studies. We used atrend-based approach to investigate visual field pro-gression to provide an objective measure of thevelocity of progression, rather than the binary catego-rization into stable versus progressive eyes that isdetermined when using an event-based approach.Trend-analysis may be a more significant and usefultool for differentiating rapidly from slowly progressingeyes [2, 3], which may help tailor clinical managementmore objectively and, therefore, effectively.We look forward to learning more about their study afterpeerreviewandpublication.Thesamplesizedescribedintheirletter is relatively small (n=60) and may not have sufficientstatistical power to confirm or refute any differences betweengroups. Additional important missing information includesthe precise methodology for disc assessment and masking ofexaminers to disc and field results. The number of patientsremaining in each group at each year of follow-up willgreatly impact the survival curves and whether they are, infact, statistically different.

Morphologic and functional glaucomatous change after occurrence of single or recurrent optic disc hemorrhages

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”

The Relationship between Intraocular Pressure Reduction and Rates of Progressive Visual Field Loss in Eyes with Optic Disc Hemorrhage

To evaluate rates of visual field progression in eyes with optic disc hemorrhages and the effect of intraocular pressure (IOP) reduction on these rates. Observational cohort study. The study included 510 eyes of 348 patients with glaucoma who were recruited from the Diagnostic Innovations in Glaucoma Study (DIGS) and followed for an average of 8.2 years. Eyes were followed annually with clinical examination, standard automated perimetry visual fields, and optic disc stereophotographs. The presence of optic disc hemorrhages was determined on the basis of masked evaluation of optic disc stereophotographs. Evaluation of rates of visual field change during follow-up was performed using the visual field index (VFI). The evaluation of the effect of optic disc hemorrhages on rates of visual field progression was performed using random coefficient models. Estimates of rates of change for individual eyes were obtained by best linear unbiased prediction (BLUP). During follow-up, 97 (19%) of the eyes had at least 1 episode of disc hemorrhage. The overall rate of VFI change in eyes with hemorrhages was significantly faster than in eyes without hemorrhages (-0.88%/year vs. -0.38%/year, respectively, P<0.001). The difference in rates of visual field loss pre- and post-hemorrhage was significantly related to the reduction of IOP in the post-hemorrhage period compared with the pre-hemorrhage period (r = -0.61; P<0.001). Each 1 mmHg of IOP reduction was associated with a difference of 0.31%/year in the rate of VFI change. There was a beneficial effect of treatment in slowing rates of progressive visual field loss in eyes with optic disc hemorrhage. Further research should elucidate the reasons why some patients with hemorrhages respond well to IOP reduction and others seem to continue to progress despite a significant reduction in IOP levels. Proprietary or commercial disclosure may be found after the references.

Current Concepts in the Diagnosis of Primary Open Angle Glaucoma

Primary open angle glaucoma is characterized by quantifiable parameters including the intraocular pressure, the aqueous outflow facility, and geometric measurements of the optic disc and visual defects. Despite this, diagnosis remains controversial. To review the current concepts in the diagnosis of primary open angle glaucoma and adapt them to situations where high technology facilities are lacking. Information was obtained from journals/medline, Hinari, the American Academy of Ophthalmology preferred practice pattern CD, and reputable textbooks using publications from 1972 to 2007. The Preferred Practice Pattern Committee of the American Academy of Ophthalmology recommends that the comprehensive initial glaucoma evaluation (history and physical examination) includes comprehensive adult eye evaluation with special attention to those factors that specifically bear on the diagnosis such as the optic disc, nerve fibre layer and visual field evaluation, open anterior chamber angles on gonioscopy and absence of secondary causes of glaucoma. Intraocular pressure is no longer relied onin the diagnosis of primary open angle glaucoma. Sequential evaluation of optic disc cup and size, neuroretinal rim size and shape, retinal nerve fiber layer, presence of peripapillary atrophy, and presence of retinal or optic disc haemorrhages enhance the ability to detect glaucomatous damages. A simple systematic approach in examination of the optic discs and visual field will improve accurate diagnosis of glaucoma.

Retinal Arteriolar Vascular Reactivity in Untreated and Progressive Primary Open-Angle Glaucoma

Purpose. To determine (1) the magnitude of retinal arteriolar vascular reactivity to normoxic hypercapnia in patients with untreated primary open-angle glaucoma (uPOAG) or progressive (p)POAG and in control subjects and (2) the effect of treatment with 2% dorzolamide on retinal vascular reactivity in uPOAG. Methods. The sample comprised 11 patients with uPOAG (after undergoing treatment, they became treated (t)POAG), 17 patients with pPOAG (i.e., manifesting optic disc hemorrhage), and 17 age-similar control subjects. The partial pressure of end-tidal CO(2) (PetCO(2)) was stabilized at 38 mm Hg at baseline. After baseline (10 minutes), normoxic hypercapnia was then induced (15 minutes) with an automated gas flow controller. Retinal arteriolar and optic nerve head (ONH) blood hemodynamics were assessed. The procedures were repeated after treatment with 2% dorzolamide for 2 weeks in tPOAG. Results. Baseline arteriolar hemodynamics were not different across the groups. In control subjects, diameter, velocity, and flow increased (P < 0.001) in response to normoxic hypercapnia. There was no change in all three hemodynamic parameters to normoxic hypercapnia in uPOAG, whereas only blood flow increased (P = 0.030) in pPOAG. Vascular reactivity was decreased in uPOAG and pPOAG patients compared with that in control subjects. After treatment with topical 2% dorzolamide for 2 weeks, the tPOAG group showed an increase in diameter, velocity, and flow (P </= 0.04) in response to normoxic hypercapnia. Similar trends were noted for ONH vascular reactivity. Conclusions. A reduced magnitude of arteriolar vascular reactivity in response to normoxic hypercapnia was shown in uPOAG and in pPOAG. Vascular reactivity improved after dorzolamide treatment in POAG.

Factors Affecting Rates of Visual Field Progression in Glaucoma Patients with Optic Disc Hemorrhage

Optic disc hemorrhage (DH) is an important risk factor for glaucoma progression. We sought to investigate factors affecting the rate of visual field (VF) progression after DH in glaucomatous eyes. Retrospective cohort study. Consecutive glaucoma patients from our Glaucoma Progression Study with > or =5 Swedish interactive threshold algorithm standard 24-2 VFs from 1999 through 2008. Disc photographs of all patients were evaluated for the presence of DH. Exclusion criteria were conditions other than glaucoma likely to affect the VF and insufficient number of VFs to create a slope after DH detection. Automated pointwise linear regression was used to determine the rate of VF loss after DH detection. Fast progression was defined as a global VF loss of > or =1.5 dB/year. Factors associated with a fast rate of VF loss after the detection of the DH were evaluated. Assessed variables included baseline (age, gender, intraocular pressure [IOP], central corneal thickness, VF mean deviation [MD], presence of migraine, Raynaud's phenomenon, low blood pressure, and exfoliation syndrome) and intercurrent data (DH recurrence, fellow eye involvement, glaucoma surgery, and IOP reduction). Odds ratios (ORs) and 95% confidence intervals (CIs) were determined for each variable. Seventy-six eyes (76 patients; mean age, 68.3+/-10.9 years) were enrolled. Mean IOP and VF MD at the time of the DH detection were 16.6+/-3.8 mmHg and -5.6+/-5.7 dB, respectively. The mean global progression rate after DH was -1.1+/-1.3 dB/year (mean follow-up, 3.8+/-2.8 years). A rate of progression of > or =1.5 dB/year was found in 20 (26%) eyes. Multivariate logistic regression analysis revealed larger baseline MD (OR, 1.11; 95% CI, 1.01-1.20; P = 0.03) and older age (OR, 1.06; 95% CI, 1.01-1.13; P = 0.04) to be significant risk factors for fast progression after DH. Eyes with a baseline MD worse than -4.0 dB had a 270% increased risk of fast progression compared with those with an MD better than -4.0 dB. The presence of a DH in older subjects with a worse VF predicted further VF global MD deterioration by more than 5 dB within 4 years. These eyes should undergo careful and frequent disease surveillance and consideration should be given to more aggressive treatment.

Risk factors associated with optic disc haemorrhage in patients with normal tension glaucoma

To evaluate the risk factors associated with optic disc haemorrhage in patients with normal tension glaucoma (NTG). Two hundred and eighty-one eyes of 281 patients with NTG (113 eyes with optic disc haemorrhage and 168 eyes without haemorrhage) were included in this study. Associations between optic disc haemorrhage and various patient-related variables (diabetes; hypertension; hypotension; cardiac disease; stroke; cold hand; migraine; constipation; use of steroids, aspirin, anticoagulant, or gingko extract; smoking history; and glaucoma family history) and eye-related variables (baseline intraocular pressure (IOP); maximum, minimum, and range of IOP; vertical and horizontal cup/disc ratio; mean deviation and pattern standard deviation of the visual field; corneal thickness; and average retinal nerve fibre layer (RNFL) thickness measured by optical coherence tomography) were investigated by univariate and multivariate logistic regression analyses. Differences in risk factors between patients with single optic disc haemorrhages and recurrent haemorrhages were also analysed. Optic disc haemorrhage was associated with systemic hypertension (odds ratio, 1.998; 95% confidence interval, 1.094-3.651; P=0.001). IOP range (P=0.080), diabetes (P=0.056), and use of aspirin (P=0.079) also tended to be associated with optic disc haemorrhage. No risk factor was significantly different between the single haemorrhage group and the recurrent haemorrhage group. Optic disc haemorrhage was associated with systemic hypertension in patients with NTG.

Progression of Macular Ischemia Following Intravitreal Bevacizumab

A 37-year-old woman with bilateral obliterative retinal vasculitis and macular ischemia received intravitreal bevacizumab for rapidly progressive neovascularization of the optic disc and vitreous hemorrhage in the left eye. One week after treatment, she presented with central scotoma and fluorescein angiography revealed increased parafoveal capillary dropout and progressive macular ischemia in the treated eye.

The Glaucoma Research Community and FDA Look to the Future: A Report from the NEI/FDA CDER Glaucoma Clinical Trial Design and Endpoints Symposium*

On March 13–14, 2008, the National Eye Institute (NEI), of the National Institutes of Health (NIH), and the Food and Drug Administration Center for Drug Evaluation and Research (FDA CDER) held the NEI/FDA CDER Glaucoma Clinical Trial Design and Endpoints Symposium to discuss the possible use of new structural and functional endpoints for evaluating glaucoma therapies in clinical trials. It was an important meeting where the FDA and the glaucoma research community advanced their common understanding of glaucoma clinical trials. An appreciation was gained by researchers and others within the glaucoma community of the receptivity of the FDA to new endpoints. Glaucoma is a complex, progressive optic neuropathy. It is the leading cause of irreversible and preventable blindness, affecting an estimated 2.2 million people in the United States and 70 million worldwide. Basic and clinical research initiatives are revealing the pathobiology and clinical course of glaucoma and are setting the stage for possible new treatments. Currently, clinical drug trials are focused on intraocular pressure (IOP) measurements and/or visual field tests (a functional outcome measure) for the assessment of clinical IOPlowering efficacy and changes in optic nerve function. In some studies, stereoscopic optic disc photography (a structural outcome measure) has been used as a secondary endpoint. The FDA considers optic nerve and retinal nerve fiber layer (RNFL) structural changes and new changes in visual function to be outcome measures in clinical trials that serve as the basis for approving neuroprotective glaucoma therapies, provided those outcomes are proven predictive of function that is clinically relevant to a patient. Although there are data suggesting the early involvement of central vision, glaucoma generally affects peripheral vision first in standard clinical testing. Functional visual field tests evaluate the presence and amount of visual field loss. Clinical observation of the optic nerve and examination of optic nerve photographs can be used to determine the presence of structural changes such as narrowing of the neuroretinal rim, loss of parapapillary fibers from the RNFL, increased excavation of the optic cup, -zone parapapillary atrophy, and optic disc hemorrhage. Accurate interpretation of the structural events has traditionally been dependent on the experience and subjective judgment of the observer. New computerized imaging devices for viewing the optic nerve are used widely to detect glaucomatous changes in the optic disc and RNFL and also to quantitate these changes. Measurements generally are objective and reproducible. Among these imaging technologies are confocal scanning laser ophthalmoscopy, scanning laser polarimetry, and optical coherence tomography. The purpose of the NEI/FDA CDER Glaucoma Clinical Trial Design and Endpoints Symposium was to provide a forum for discussing outcome measures— based on the newer technologies—for evaluating neuroprotective products (i.e., those that protect the optic nerve) for glaucoma in clinical trials to facilitate bringing safe and efficacious glaucoma pharmacotherapies to the U.S. market. Although there was no discussion in the Symposium directly comparing the various technologies and instruments, a future meeting on this subject is anticipated. The meeting was held in the Natcher Auditorium on the NIH campus. Participants from the glaucoma community left with a clearer understanding of FDA expectations for demonstrating the safety and efficacy of new pharmacotherapies, the relevancy of new endpoints, and the role of the FDA in providing guidance for meeting recognized standards for approval of new therapeutic agents. Symposium organizers were Robert N. Weinreb, MD, Uni

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

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.

Optic Disc Hemorrhage May Be Associated with Retinal Nerve Fiber Loss in Otherwise Normal Eyes

To evaluate quantitatively the structural damage of the peripapillary retinal nerve fiber layer (RNFL) in eyes with disc hemorrhage (DH). Prospective cross-sectional study. Seventy patients with DH (70 eyes; mean age +/- standard deviation, 60.0+/-11.8 years) and 100 healthy control subjects (100 eyes; mean age +/- standard deviation, 57.7+/-8.0 years) were enrolled from the Glaucoma Clinic of Seoul National University Hospital. Normal eyes without DH (group 1: normal control group) served as controls. Eyes with DH were divided into the following groups: (1) eyes with a DH, accompanied by no visible RNFL defect according to red-free fundus photography and normal visual fields (group 2: DH only group); (2) eyes with a DH and a localized RNFL defect in the same quadrant, accompanied by normal visual fields (group 3: DH-preperimetric group); and (3) eyes with a DH and a localized RNFL defect in the same quadrant, accompanied by glaucomatous visual field defect in the corresponding hemifield location (group 4: DH-perimetric group). Optical coherence tomography (OCT)-measured RNFL thicknesses were compared. Average and segmental (4 quadrants and 12 clock-hours) OCT-measured RNFL thicknesses. The number of eyes in groups 1, 2, 3, and 4 was 100, 25, 22, and 23 eyes, respectively. The OCT-measured RNFL thickness was significantly different among the 4 groups in average RNFL thickness and in inferior, superior, and nasal quadrants (P<0.01, 1-way analysis of variance). On post hoc analysis, the eyes of groups 2 and 3 showed thinner average RNFL thickness than those of group 1, and the average RNFL thickness of group 4 was significantly lower than that of groups 2 and 3 (P<0.001, 1-way analysis of variance and Tukey's test). The OCT-measured RNFL thickness revealed a topographic relationship with the DH location. Significant RNFL loss was already present in the DH only eyes with apparently normal RNFL configuration by red-free fundus photography, indicating that preperimetric changes of the RNFL are already present. These results suggest that OCT has the potential to detect subclinical or preperimetric RNFL loss in the eyes with DH. The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Hemorragia peripapilar em pacientes com glaucoma e sua relação com o tronco vascular retiniano

To investigate the correlation between optic disc hemorrhages (ODHs) and the position of the central retinal vessel trunk (RVT) in patients with glaucoma. Fundus photographs of 1,830 participants were reviewed. The exit position of the central retinal vessel trunk was classified as being in the superior or inferior hemisphere of the optic disc and the relative vertical position was expressed as a fraction of the disc diameter (ratio between the position of the trunk and the diameter of the disk). A group of patients from the same population, but without ODHs, was randomly selected and compared with the patients with ODHs. Among the 1,830 patients, 53 hemorrhages were detected in 41 patients with glaucoma or suspected glaucoma. We found an inverse relationship between the inferior/superior position of the central RVT and the inferior/superior position of the hemorrhages (Kappa=-0.34). Using the trunk/disc ratio, we found that superior ODHs correlated with inferior RVTs (trunk/disc ratio, 0.450; SD=0.070) and inferior ODHs correlated with superior RVTs (trunk/disc ratio, 0.510; SD=0.054) (p=0.027). The number of patients with normal tension glaucoma was significantly higher among patients with ODHs than among those without ODHs (p=0.009). Our patients had a negative correlation between the position of central RVT and the location of the ODHs. Normal tension glaucoma was more prevalent among patients with ODHs than among those without it.

Population-based prevalence of optic disc haemorrhages in elderly Japanese

To estimate the population-based prevalence of disc haemorrhages (DHs) in an elderly Japanese population and evaluate related factors including optic disc morphology. Colour fundus photographs were taken during the screening examination of the Tajimi Study, during which 3021 of 3870 eligible residents of the city aged 40 years or older were screened (response rate, 78.1%). All fundus photographs were graded by one masked examiner to determine the presence of DHs. Good quality fundus photographs were available for both eyes of 2761 subjects. DHs were found in at least one eye of 34 subjects (1.2%; 95% confidence interval (CI) 0.8-1.6%). The prevalence was 14.0% (95% CI, 8.0-19.9%), 9.7% (2.9-16.6%), and 0.4% (0.1-0.6%) in subjects with definitive glaucoma, glaucoma suspects, and subjects without glaucoma, respectively. Logistic regression analyses indicated that DHs were associated with glaucoma (P<0.001), glaucoma suspects (P<0.001), and older age (P=0.032). No Heidelberg Retina Tomograph parameters differed between subjects with and without DHs. The prevalence of DHs was 1.2% in an elderly Japanese population, which was similar to other population studies. In addition to glaucoma, older age was associated with higher prevalence of DHs.

Retinal folds and retinoschisis in accidental and non-accidental head injury

To report the similarity of retinal findings in an infant who sustained an accidental head injury and an infant with non-accidental head trauma. Two male infants sustained head injuries with skull fractures. Case 1 was an accidental head injury and case 2 was a non-accidental head injury. On examination, in case 1, there were four superficial retinal haemorrhages in the right fundus. The left eye had a haemorrhagic optic disc oedema with extensive retinal haemorrhages, retinal folds, and schitic cavities within the retina at the posterior pole. In case 2, the right fundus had a single blot haemorrhage at the posterior pole. The left fundus revealed optic disc haemorrhage and oedema with extensive retinal haemorrhages. There was a haemorrhagic retinoschisis with a retinal fold. The two cases, one with accidental and the other with non-accidental injury, demonstrate very similar ophthalmic findings. This supports the argument that there may be no retinal signs seen exclusively in non-accidental head injury.

Asymptomatic Peripapillary Subretinal Hemorrhage: A Study of 10 Cases

Peripapillary subretinal hemorrhage (PSH) is often found together with optic disc drusen, optic disc edema, peripapillary subretinal neovascular membranes, vitreous traction, and bleeding diatheses. Previous reports have stated that such optic disc hemorrhages are associated with intrapapillary bleeding largely in patients of Asian origin who are visually symptomatic from this process. We have encountered patients with PSH who have clinical features that differ from those described in these reports. This is a retrospective observational case series. Medical records of 10 patients with isolated peripapillary subretinal hemorrhages were reviewed for clinical characteristics and ancillary testing, including demographics, history, complete eye examination, visual fields, fundus photos, ultrasound, and fluorescein angiography (four patients) at presentation and follow-up. We excluded patients with drusen, neovascular membranes, disc edema, and intrapapillary hemorrhages. There were 10 patients, all white women without visual symptoms, who had isolated, monocular, nasal, or superonasal peripapillary subretinal hemorrhage, a dysplastic crowded-tilted optic disc, myopia, and normal visual function. The hemorrhages resolved without sequelae over 3-6 months. The findings were frequently discovered on routine examination and suspected of representing papilledema. We have described a benign syndrome of isolated PSH in crowded and tilted optic discs in myopic eyes of white women. The PSHs do not cause visual symptoms and resolve spontaneously. We propose that an interplay of ocular motor forces, scleral thinning, and vitreopapillary traction acting on a morphologically vulnerable optic disc explains these hemorrhages.

Optic disc hemorrhages in a patient with hemophilia A

To report a hemophilia patient complicated with optic disc hemorrhages. A 13-year-old boy presented to our emergency room with a black shadow in the left eye for 1 day. The best-corrected visual acuity was 6/6 in both eyes. Peripapillary retinal and subretinal hemorrhages were found in the left eye. Result of the laboratory examination showed an extremely low level of coagulation factor VIII (1.9%). Factor VIII concentrate was given for 8 weeks. A follow-up 3 months later showed absorption of the hemorrhages, black shadow diminished, and the vision was 6/6.

Risk factors for primary open angle glaucoma progression: what we know and what we need to know

Recent literature is reviewed in order to identify possible risk factors leading to primary open angle glaucoma progression and blindness. Several risk factors have been suggested to be important for progression of open angle glaucoma. Intraocular pressure appears to be an important risk factor for progression of glaucoma. It is still not clear if intraocular pressure fluctuation and central corneal thickness are related to progression. Myopia might be related to glaucoma progression as well as optic disc hemorrhages. Vascular factors appear to be related to progression also. Genetics seem to play an important role in open angle glaucoma. Identifying risk factors associated with progression of patients with primary open angle glaucoma is essential to our clinical practices. The level of understanding regarding those risks is suboptimal at this point. Prospective long-term studies are needed if we wish to better understand the disease and help those patients at greater risk of progression and blindness.