Analysis of neuroretinal rim distribution and vascular pattern in eyes with presumed large physiological cupping: a comparative study.

BACKGROUND: To investigate possible differences in neuroretinal rim distribution, vascular pattern, and peripapillary region appearance between eyes with presumed large physiological optic disc cupping (pLPC) and eyes with minimal optic disc excavation. METHODS: We prospectively enrolled consecutive subjects with pLPC and individuals with minimal excavation (optic disc excavation within normal limits; control group). All eyes had normal visual fields and untreated intraocular pressure (IOP) <21 mmHg. Eyes with pLPC required vertical cup-to-disc ratio (VCDR) ≥ 0.6 and ≥ 30 months of follow-up with no evidence of glaucomatous neuropathy. For controls, VCDR was limited to ≤ 0.5. We compared ocular signs and characteristics related to the neuroretinal rim distribution, vascular pattern, peripapillary region appearance and disc size between groups. Whenever both eyes were eligible, one was randomly selected for analysis. RESULTS: A total of 74 patients (mean age, 45.6 ± 14.9 years) with pLPC and 45 controls (mean age, 44.8 ± 11.6 years) were enrolled (p = 0.76). Median disc size and VCDR was significantly larger in eyes with pLPC compared to controls (p < 0.01). The proportion of eyes with violation of the ISNT rule, laminar dot sign, nasal shifting of the central vessels, nasal excavation and baring of circumlinear vessel was significantly greater in the eyes with pLPC compared to controls (p < 0.01). There were no significant differences regarding the proportions of eyes with peripapillary atrophy between groups (p < 0.09). Finally, disc size was significantly associated with VCDR (r(2) = 0.47, p < 0.01), with an increase of 0.21 in VCDR for each 1 mm(2) in disc area. CONCLUSION: Compared to normal controls, eyes with pLPC may present a higher proportion of optic nerve head findings frequently observed in glaucomatous eyes. This seems to be explained in part by the larger discs found in these eyes. We believe care should be taken while classifying them as glaucomatous or not based solely on these characteristics.

Clinical Profiles of Glaucomatous Patients With High-tension and Low-tension Optic Disc Hemorrhages: A Comparative Study.

PRCIS: Patients with low-tension optic disc hemorrhages (DHs) are more frequently women, have a diagnosis of normal-tension glaucoma (NTG) diagnosis and greater visual field (VF) loss. Symptoms of vascular dysregulation and Asian race also seem to be more prevalent in this clinical subtype. PURPOSE: Optic DH is an important glaucoma risk factor, and occurs in a wide intraocular pressure (IOP) range. We sought to characterize distinct clinical subtypes of patients with high-tension disc hemorrhage (HTDH) and low-tension disc hemorrhage (LTDH). PATIENTS AND METHODS: In this cross-sectional study, treated glaucomatous patients with DHs from 2 glaucoma services were consecutively enrolled. Disc photographs were evaluated for the presence of DH by 2 glaucoma specialists. After inclusion, patients were classified on HTDH (IOP≥16 mm Hg) and LTDH (IOP<16 mm Hg; median split). Clinical and ocular data from the time of DH detection were compared between groups. RESULTS: One hundred thirty-three DH patients were included (LTDH=66 eyes; HTDH=67 eyes). Patients with LTDH were more often women than those with HTDH (77% vs. 42%; P=0.030). There was also a trend for a higher prevalence of Asian descendants (24% vs. 9%; P=0.058) and symptoms suggestive of vascular dysregulation (34% vs. 14%; P=0.057) in LTDH patients. Eyes with LTDH also had worse VF mean deviation index (P=0.037), higher prevalence of NTG diagnosis (46% vs. 17%; P<0.001), and tended to have thinner central corneas (P=0.066). CONCLUSIONS: Patients developing DHs with treated IOPs in the low teens seem to more frequently fit in a profile represented by women, NTG diagnosis and greater VF loss. The presence of symptoms suggestive of vascular dysregulation and race also seem to differ between these 2 clinical subtypes. A closer optic disc surveillance is recommended for patients with the LTDH subtype, as they may develop DHs despite seemingly well-controlled IOP.