Recurrent Optic Disc Hemorrhage and Its Association with Visual Field Deterioration in Glaucoma.

PURPOSE: To investigate the association among optic disc hemorrhage (ODH) recurrence, location, and visual field (VF) progression. DESIGN: Prospective, observational study. PARTICIPANTS: Patients with bilateral glaucoma or unilateral glaucoma with a fellow glaucoma suspect eye were enrolled. METHODS: Patients received optic disc photography every 3 months and VF testing every 4 months. The disc was partitioned into 8 sectors to match 8 visual field (VF) sectors. The frequency of ODH in each sector was quantified over an average of 64 months. Global VF progression rate was calculated using linear regression on mean deviation. Sectoral progression rate was calculated using linear regression on the sensitivity at each VF location over time and then selecting the largest and second largest significant (P < 0.05) negative slope within that sector. The association between ODH and VF progression rate globally and within a sector was calculated using linear mixed modeling. MAIN OUTCOME MEASURES: Global and sectoral VF progression, ODH frequency, and ODH recurrence (globally and sectoral) and its association with VF progression rate. RESULTS: A total of 151 eyes from 77 patients completed the study with mean follow-up of 64 months, 20 disc photographs, and 16 VF tests. With global VF analysis, eyes with ODH in 2 different sectors of the disc had worse progression rate than eyes with ODH in 1 sector (P = 0.012) and eyes with no ODH (P < 0.001). Regarding the largest sectoral VF progression, sectors with 1 ODH had a faster VF progression rate than those with no ODH (P < 0.017) and progressed at a similar rate to those with 2 to 8 ODH (P = 0.592). Sectors with >8 ODH had faster VF progression than all other groups (all P < 0.001). CONCLUSIONS: High-frequency ODH within optic disc sectors, equivalent to detecting ODH in 45% of 3 monthly eye examination visits, was associated with significantly worse VF progression than sectors with moderate or only 1 observed ODH. In addition, ODH occurring in different sectors in the same eye was more strongly associated with greater global VF progression compared with those occurring within the same sector.

The association between retinal vein pulsation pressure and optic disc haemorrhages in glaucoma.

PURPOSE: To explore the potential relationship between optic disc haemorrhage, venous pulsation pressure (VPP), ocular perfusion pressures and visual field change in glaucomatous and glaucoma suspect eyes. MATERIALS AND METHODS: This prospective observational study examined 155 open angle glaucoma or glaucoma suspect eyes from 78 patients over 5 years. Patients were followed with 3 monthly non-mydriatic disc photographs, 6 monthly standard automated perimetry and annual ophthalmodynamometry. The number of disc haemorrhages in each hemidisc was counted across the study period. Visual field rate of change was calculated using linear regression on the sensitivity of each location over time, then averaged for the matching hemifield. VPP and central retinal artery diastolic pressure (CRADP) were calculated from the measured ophthalmodynanometric forces (ODF). The difference between brachial artery diastolic pressure (DiastBP) and CRADP was calculated as an index of possible flow pathology along the carotid and ophthalmic arteries. RESULTS: Mean age of the cohort was 71.9 ± 7.3 Years. 76 out of 155 eyes (49%) followed for a mean period of 64.2 months had at least 1 disc haemorrhage. 62 (81.6%) of these 76 eyes had recurrent haemorrhages, with a mean of 5.94 recurrences over 64.2 months. Using univariate analysis, rate of visual field change (P<0.0001), VPP (P = 0.0069), alternative ocular perfusion pressure (CRADP-VPP, P = 0.0036), carotid resistance index (DiastBP-CRADP, P = 0.0108) and mean brachial blood pressure (P = 0.0203) were significantly associated with the number of disc haemorrhages. Using multivariate analysis, increased baseline visual field sensitivity (P = 0.0243, coefficient = 0.0275) was significantly associated with disc haemorrhage, in conjunction with higher VPP (P = 0.0029, coefficient = 0.0631), higher mean blood pressure (P = 0.0113, coefficient = 0.0190), higher carotid resistance index (P = 0.0172, coefficient = 0.0566), and rate of visual field loss (P<0.0001, coefficient = -2.0695). CONCLUSIONS: Higher VPP was associated with disc haemorrhage and implicates the involvement of venous pathology, but the effect size is small. Additionally, a greater carotid resistance index suggests that flow pathology in the ophthalmic or carotid arteries may be associated with disc haemorrhage.

Retinal detachment surgery in Western Australia (2000-2013): a whole-population study.

AIMS: To determine the background incidence rate of retinal detachment (RD) in Western Australia (WA) between 2000 and 2013, identify sociodemographic features associated with increased risk of incident RD and examine trends in surgical repair technique. METHODS: A whole-population retrospective observational study of all people in WA was carried out using linked hospital inpatient records. Cases of RD were identified using a combination of International Classification of Diseases, Ninth revision, Clinical Modification (ICD-9-CM) and ICD-10-AM (Australian modification) diagnosis and procedure codes from routinely collected hospital inpatient data provided by the WA Data Linkage Branch. A Poisson regression model was used to examine the influence of age group, gender, season and year of surgery on RD incidence rates. MAIN OUTCOME MEASURES: Age-standardised and sex-standardised incidence of first-eye RD and incidence rate ratio (IRR) of first-eye RD associated with age, sex and season. Counts of RD repair according to surgical technique. RESULTS: There were 4376 first-eye RD between 2000 and 2013. Age-standardised incidence ranged between 12.78 and 16.20 cases per 1 00 000 person-years. After adjusting for age, year and season, males had a higher risk than females for incident detachment (IRR 1.82, 95% CI (CI) 1.71 to 1.93), as did those aged 60-79 years (IRR 33.26, 95% CI 27.60 to 40.08) compared with those aged less than 20 years. RD repair with vitrectomy alone increased by 59% over the study period. CONCLUSION: The incidence of first-eye RD remained stable between 2000 and 2013. The risk was higher in males and with older age.