Optic disc hemorrhages strongly correlate to the development and progression of glaucoma, yet the pathophysiology of this associated finding remains unknown. Looking to bridge this gap, a study recently reported that central visual field (VF) loss is accelerated in glaucomatous eyes with disc hemorrhage and corresponds topographically to the location of the hemorrhage. The researchers recommend supplementing 10-2 VFs with 24-2 VFs in these patients.

The prospective study evaluated 343 eyes of 220 subjects who had at least three years of follow-up with a minimum of five visits that included 10-2 and 24-2 VF testing. Of the total eyes, only 39 had disc hemorrhage.

The team found that eyes with disc hemorrhage had rates of 10-2 mean deviation (MD) loss that were three-times faster than controls (-0.36 dB/year) and were 3.7-times more likely to progress. In early glaucoma, the rate of 10-2 MD loss increased to 5.5-times faster. Disc hemorrhage eyes also had a faster rate of 24-2 MD deterioration, but it did not reach statistical significance.

A larger proportion of glaucomatous eyes showed central VF progression rather than peripheral VF progression in the disc hemorrhage group (30.8% vs. 20.5%, respectively) compared with the non-hemorrhage group (10.9% vs. 9.2%, respectively). Superonasal and superotemporal central VF regions progressed more rapidly than other regions, especially in eyes with disc hemorrhage.

“Disc hemorrhages are an independent predictor for more accelerated central VF loss in glaucoma, especially in early stages of the disease,” the study authors concluded. “Therefore, examination of the central VF using a 10-2 strategy should be considered in glaucoma patients with a history of disc hemorrhage for sensitive detection of disease progression.”

David RCC, Moghimi S, Do JL, et al. Characteristics of central visual field progression in eyes
with optic disc hemorrhage. Am J Ophthalmol. June 6, 2021. [Epub ahead of print].