OPTIC DISC HEMORRHAGES AND PROGRESSION OF GLAUCOMA

Purpose: To assess progressive changes of the optic nerve head and vis ual fields in patients with glaucoma and ocular hypertension after opt ic disc hemorrhage. Methods: The authors reviewed the charts of 91 pat ients with 121 disc hemorrhages who had a mean follow-up of 41.9 +/- 3 .6 months. The frequency of visual field and optic nerve head changes in these patients was studied. Results: The mean intraocular pressure at the examination when the disc hemorrhage was noted was 18.9 +/- 0.5 mmHg. Overall, 64 (63%) of 101 eyes showed progressive changes of vis ual fields after disc hemorrhage, compared with 24 (24%) of 101 contro l eyes (P < 0.0005). Similarly, 56 (79%) of 71 eyes showed progressive changes of optic nerve head contour by masked evaluation of stereopho tographs, compared with 16 (22%) of 71 control eyes (P < 0.0005). Eyes with disc hemorrhage showed significantly greater progression of visu al field defects in patients with open-angle glaucoma (P < 0.001), low -tension glaucoma (P < 0.05), and ocular hypertension (P = 0.0067) com pared with control eyes matched by age, follow-up time, and diagnosis. Similarly, progressive changes of optic nerve head contour were obser ved more often in eyes after disc hemorrhage in patients with open-ang le glaucoma (P < 0.0005), low-tension glaucoma (P < 0.025), and ocular hypertension (P < 0.005), compared with controls. The mean time inter val to progression after disc hemorrhage was observed was 16.8 +/- 2.0 months for visual field changes and 23.8 +/- 2.9 months for optic ner ve head changes. In eyes with disc hemorrhage, 27 (22%) of 121 had rec urrent hemorrhages at a mean interval of 21.5 +/- 2.9 months after pre vious hemorrhage. The most common site of disc hemorrhage was the infe rotemporal quadrant. Eyes with disc hemorrhage that occurred on the te mporal side of the optic nerve head had a significantly lower intraocu lar pressure (P < 0.02) and greater progressive changes of the optic d iscs (P < 0.001) compared with eyes with hemorrhage on the nasal side. Conclusion: The authors' results indicate that disc hemorrhages in ey es with glaucoma or ocular hypertension often are associated with prog ressive changes of the optic nerve head and visual fields.