CUMULATIVE INCIDENCE OF PATIENTS WITH DISC HEMORRHAGES IN GLAUCOMA AND THE EFFECT OF THERAPY

Purpose: In this longitudinal study, the cumulative incidence of patie nts with glaucoma and disc hemorrhages was investigated. A possible ef fect of glaucoma therapy on the incidence rate of disc hemorrhages was evaluated. Methods: A group consisting of 68 patients with primary op en-angle glaucoma (POAG), 34 with normal-pressure glaucoma, and 125 wi th suspected glaucoma (mean follow-up, 7.3 +/- 2.5 years; range 3-13 y ears) was observed closely with quarterly examinations. Results: In no rmal-pressure glaucoma, the cumulative incidence of patients with disc hemorrhages was 35.3%, which was significantly higher than for those with POAG (10.3%; P < 0.01) and for those with suspected glaucoma (10. 4%; P < 0.001). The mean follow-up period before a first disc hemorrha ge was detected was 2.5 +/- 2.8 years. In the bleeders, recurrent disc hemorrhages were observed in 67% of the patients with normal-pressure glaucoma, 29% of those with POAG, and 54% of glaucoma suspects. In no rmal-pressure glaucoma, therapy had no effect on the incidence rate of disc hemorrhages. In glaucoma suspects, a significant reduction of th e incidence rate of disc hemorrhages per year (0.11 +/- 0.04) was obse rved during episodes with therapy compared with episodes without (0.43 +/- 0.15; P < 0.05). A concept of two populations (i.e., one with dis c hemorrhages and the other never having them) seems to be valid for n ormal-pressure glaucoma, but not for POAG and suspected glaucoma. Conc lusion: The cumulative incidence of initial disc hemorrhages increases with time in POAG and suspected glaucoma, but reaches a limit in norm al-pressure glaucoma. Glaucoma therapy may reduce the incidence rate o f all, initial and recurrent, disc hemorrhages in patients with high p ressures, but not in patients with normal-pressure glaucoma.