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PURPOSE: The authors investigated the relationship between disc hemorrhage in normal-tension glaucoma and the progression of visual field defects and, additionally, whether hemorrhage plays a role in the pathogenic process of the chronic disease. METHODS: The authors retrospectively reviewed the charts of 70 patients with normal-tension glaucoma (mean follow-up, 5.6 years) who were not medicated for glaucoma, and they applied a regression analysis of survival data based on the Cox proportional hazards model. Several clinical factors were investigated to find a possible association with the progression of glaucomatous visual field defined by two different definitions: one by mean deviation change and the other by glaucoma change probability analysis. RESULTS: Disc hemorrhage, corrected-pattern standard deviation, age, systolic blood pressure, and pulse rate had a significant influence on the visual field defect. The cumulative probability of progression of visual field loss was significantly greater for patients with disc hemorrhage than for patients without disc hemorrhage by either criterion for progression (p = 0.0008, log rank test). All eyes that had at least two occurrences of disc hemorrhage showed progression, whereas only three of nine eyes showed progression in the nonrecurrent disc hemorrhage group by the glaucoma change probability analysis. The difference was statistically significant (p < 0.0001, Fisher's exact probability test). Furthermore, there was a significant relationship between the location of the disc hemorrhage and the area of the progression of visual field loss in 65.4% of progressive patients with disk hemorrhage. CONCLUSIONS: Several clinical factors other than intraocular pressure are significantly associated with the progression of visual field loss during the natural course of normal-tension glaucoma. Among these, disc hemorrhage is a significantly negative prognostic factor in patients with normal-tension glaucoma and may be a sign of progressive damage of the retinal nerve fiber layer, leading to functional deterioration of the visual field.
Dr. K. Ishida, Department of Ophthalmology, Gifu University School of Medicine, Gifu-shi, Japan
9.2.2 Other risk factors for glaucoma (Part of: 9 Clinical forms of glaucomas > 9.2 Primary open angle glaucomas)