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Editors Selection IGR 22-2

Prognostic factors: Does Disc Hemorrhage Portend Central Field Progression ?

Miriam Kolko

Comment by Miriam Kolko on:

94978 Characteristics of Central Visual Field Progression in Eyes with Optic Disc Hemorrhage, David RCC; Moghimi S; Do JL et al. et al. et al., American Journal of Ophthalmology, 2021; 231: 109-119

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Several studies have documented that disc hemorrhages (DH) increase the rate of glaucoma progression. However, there is limited knowledge about the rate and characteristics of central visual field (VF) loss in the eyes of DH.

With an observational cohort study design, the current study aimed to examine precisely the characteristics and rate of central VF loss after the presence of DH. A total of 220 patients with eyes diagnosed as glaucoma or glaucoma suspect were included. Thirty-nine eyes with DH and 304 eyes without DH were examined and the mean follow-up was 5.2 years. VF progression was evaluated using a minimum of five 10-2 and 24-2 VFs.

The authors demonstrated a nearly three-fold faster rate of central VF loss in DH eyes compared to non-DH eyes. Central VF progression was significantly more common than peripheral VF progression in the DH group. Central VF loss was found to progress more rapidly in the superior hemifield compared to the inferior hemifield in response to DHs.

Central VF progression was significantly more common than peripheral VF progression in the DH group

The authors acknowledge the limitations of the study, such as the frequency of acquired optic disc photos annually when the typical resolution time of DHs is within two to six months. It is also recognized that no commercially available analysis software to date includes analysis of the progression of 10-2 VFs. However, it is emphasized that examination of the central VF using a 10-2 strategy despite this should be considered in patients with glaucoma with a known history of DH.

In conclusion, this study confirms that DHs are an independent predictor of accelerated VF loss in glaucoma patients. In particular, the study shows that central VF loss is faster in the eyes with DH history and worse VFs at baseline. The authors should be congratulated on the fine study that emphasizes that the presence of DHs in glaucoma patients must be taken seriously as it can lead to central VF loss and thus reduced quality of life.

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