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Comparative Study
. 2006 Dec;113(12):2137-43.
doi: 10.1016/j.ophtha.2006.06.022. Epub 2006 Sep 25.

Detection and prognostic significance of optic disc hemorrhages during the Ocular Hypertension Treatment Study

Donald L Budenz  1 , Douglas R Anderson, William J Feuer, Julia A Beiser, Joyce Schiffman, Richard K Parrish 2nd, Jody R Piltz-Seymour, Mae O Gordon, Michael A Kass; Ocular Hypertension Treatment Study Group
Affiliations
Comparative Study

Detection and prognostic significance of optic disc hemorrhages during the Ocular Hypertension Treatment Study

Donald L Budenz et al. Ophthalmology. 2006 Dec.

Abstract

Purpose: To compare the rates of detection of optic disc hemorrhages by clinical examination and by review of optic disc photographs at the Optic Disc Reading Center (ODRC), to assess the incidence of and the predictive factors for disc hemorrhages in the annual disc photographs of the Ocular Hypertension Treatment Study (OHTS), and to determine whether optic disc hemorrhages predict the development of primary open-angle glaucoma (POAG) in the OHTS.

Design: Cohort study.

Participants: Three thousand two hundred thirty-six eyes of 1618 participants.

Methods: Both eyes of participants were examined for optic disc hemorrhages every 6 months by clinical examination, with dilated fundus examinations every 12 months, and by annual review of stereoscopic disc photographs at the ODRC.

Main outcome measures: Incidence of optic disc hemorrhages and POAG end points.

Results: Median follow-up was 96.3 months. Stereophotography-confirmed glaucomatous optic disc hemorrhages were detected in 128 eyes of 123 participants before the POAG end point. Twenty-one cases (16%) were detected by both clinical examination and review of photographs, and 107 cases (84%) were detected only by review of photographs (P<0.0001). Baseline factors associated with disc hemorrhages were older age, thinner corneas, larger vertical cup-to-disc ratio, larger pattern standard deviation index on perimetry, family history of glaucoma, and smoking status. The occurrence of a disc hemorrhage increased the risk of developing POAG 6-fold in a univariate analysis (P<0.001; 95% confidence interval, 3.6-10.1) and 3.7-fold in a multivariate analysis that included baseline factors predictive of POAG (P<0.001; 95% confidence interval, 2.1-6.6). The 96-month cumulative incidence of POAG in the eyes without optic disc hemorrhage was 5.2%, compared with 13.6% in the eyes with optic disc hemorrhage. In eyes with a disc hemorrhage in which a POAG end point developed, the median time between the 2 events was 13 months.

Conclusions: Review of stereophotographs was more sensitive at detecting optic disc hemorrhage than clinical examination. The occurrence of an optic disc hemorrhage was associated with an increased risk of developing a POAG end point in participants in the OHTS. However, most eyes (86.7%) in which a disc hemorrhage developed have not experienced a POAG end point to date.

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Figures

Figure 1
Figure 1
Splinter hemorrhage typical of glaucoma (left panel). Non-glaucomatous peripapillary hemorrhage between the neural retina and the retinal pigment epithelium and therefore sharply delimited at the disc margin. This hemorrhage is not in the nerve fiber layer (middle panel). Multiple disc and retinal hemorrhages typical of central retinal vein occlusion (right panel). All images are of subjects in the Ocular Hypertension Treatment Study.
Figure 2
Figure 2
Cumulative incidence of optic disc hemorrhages in annual photographs of treated and observation groups
See this image and copyright information in PMC

References

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