Deterioration of visual fields in patients with glaucoma with and without optic disc hemorrhages
M. T. Rasker, A. van den Enden, D. Bakker and P. F. Hoyng
Department of Experimental Ophthalmology, The Netherlands Ophthalmic Research Institute, Amsterdam.
OBJECTIVE: To evaluate visual field deterioration in patients with glaucoma
with and without optic disc hemorrhages (DHs). DESIGN: A prospective study
at quarterly base involving annual perimetry; mean follow-up of 9 years.
SETTING: Outpatient department, nonreferral basis. PATIENTS: Sixty-eight
patients with primary open-angle glaucoma, 34 with normal pressure glaucoma
(NPG), and 125 with ocular hypertension. RESULTS: Visual field
deterioration occurred in 32%, 32%, and 6% of the patients without DHs who
had NPG, primary open-angle glaucoma, or ocular hypertension, respectively,
while visual field deterioration occurred in 80%, 89%, and 14% of patients
with DH, respectively. Cox proportional hazards ratio(CHR) for
deterioration in patients with vs patients without DHs was 5.4 for NPG
(P<.01) and 3.6 for primary open-angle glaucoma (P<.01). In patients
with NPG and DHs, ipsilateral eyes with DHs deteriorated in 58%, while
contralateral eyes without DHs deteriorated in 11% (CHR, 8.9; P<.04).
For primary open-angle glaucoma and ocular hypertension, progression did
not differ between eyes with DHs and contralateral eyes without DHs. Mean
(+/-SD) interval between DHs and ipsilateral visual field deterioration was
3.1+/-1.7 years. No difference in the proportion of eyes progressing after
single or recurrent DHs was noted. The position of DHs was related to the
site of the visual field loss in 44% of the eyes. CONCLUSIONS: The presence
of DHs increased the risk of visual field deterioration. Disc hemorrhages
were indicative only of deterioration in ipsilateral eyes in patients with
NPG.
