Subjects with larger disc hemorrhages showed faster global mean deviation loss in this study.
Subjects with larger disc hemorrhages showed faster global mean deviation loss in this study. Photo: Sarah B. Klein, OD. Click image to enlarge.

A recent analysis examining the correlation between optic disc hemorrhage (DH) size and glaucoma progression found that DH size is associated with the rate of visual field deterioration.

This retrospective observational cohort study included 250 open-angle glaucoma (OAG) patients with disc hemorrhage. Researchers followed participants for at least five years and conducted a minimum of five visual field tests.

To calculate the disc hemorrhage area, the pixel numbers of the DH area were compared with the disc area based on optical coherence tomography (OCT). In cases of recurrent disc hemorrhage, the average DH area was calculated. Study authors classified DH size as large or small based on the median value. Disc hemorrhage size and longitudinal visual field progression were the main outcome measures.

With a mean follow-up period of 11.1 ± 3.6 years, large DH showed faster global mean deviation (MD) loss compared to small DH cohort, the research team reported. Additionally, the multivariable model revealed that mean DH size, maximum DH size and initial MD were significantly associated with the overall rate of MD loss.

“This study demonstrates that glaucoma patients who exhibit large DHs experience a more rapid deterioration of their visual field. It is essential to highlight the fact that the rate of VF deterioration differed significantly by DH size in both the global and the affected hemifield, but not in the unaffected hemifield,” the study authors wrote in their recent American Journal of Ophthalmology paper.

“The rate of visual field deterioration in the unaffected hemifield remained consistent between the large DH and small DH groups, despite it being the same eye of the same patient,” they stated. “Since the size of DH is the sole distinguishing factor within the eye, we can consider it to be highly reliable evidence that DH size is an important factor associated with a faster rate of deterioration following hemorrhage.”

Overall, these findings demonstrate the connection between DH size and VF deterioration rate. Since eyes with larger DH are shown to have more pronounced visual field progression, the study authors emphasized the importance of closely monitoring these patients.

Jeong Y, Bak E, Jang M, et al. Clinical significance of optic disc hemorrhage size in visual field progression in glaucoma. american journal of ophthalmology. february 21, 2024 [epub ahead of print].