Detection and Prognostic Significance of Optic Disc Hemorrhages during the Ocular Hypertension Treatment Study
Presented in part at: Association for Research in Vision and Ophthalmology Annual Meeting, May 2004, Ft. Lauderdale, Florida, and American Academy of Ophthalmology Annual Meeting, October 2004, New Orleans, Louisiana.
Received 16 January 2006; accepted 22 June 2006. published online 21 September 2006.
Purpose
To compare the rates of detection of optic disc hemorrhages by clinical examination and by review of optic disc photographs at the Optic Disc Reading Center (ODRC), to assess the incidence of and the predictive factors for disc hemorrhages in the annual disc photographs of the Ocular Hypertension Treatment Study (OHTS), and to determine whether optic disc hemorrhages predict the development of primary open-angle glaucoma (POAG) in the OHTS.
Design
Cohort study.
Participants
Three thousand two hundred thirty-six eyes of 1618 participants.
Methods
Both eyes of participants were examined for optic disc hemorrhages every 6 months by clinical examination, with dilated fundus examinations every 12 months, and by annual review of stereoscopic disc photographs at the ODRC.
Main Outcome Measures
Incidence of optic disc hemorrhages and POAG end points.
Results
Median follow-up was 96.3 months. Stereophotography-confirmed glaucomatous optic disc hemorrhages were detected in 128 eyes of 123 participants before the POAG end point. Twenty-one cases (16%) were detected by both clinical examination and review of photographs, and 107 cases (84%) were detected only by review of photographs (P<0.0001). Baseline factors associated with disc hemorrhages were older age, thinner corneas, larger vertical cup-to-disc ratio, larger pattern standard deviation index on perimetry, family history of glaucoma, and smoking status. The occurrence of a disc hemorrhage increased the risk of developing POAG 6-fold in a univariate analysis (P<0.001; 95% confidence interval, 3.6–10.1) and 3.7-fold in a multivariate analysis that included baseline factors predictive of POAG (P<0.001; 95% confidence interval, 2.1–6.6). The 96-month cumulative incidence of POAG in the eyes without optic disc hemorrhage was 5.2%, compared with 13.6% in the eyes with optic disc hemorrhage. In eyes with a disc hemorrhage in which a POAG end point developed, the median time between the 2 events was 13 months.
Conclusions
Review of stereophotographs was more sensitive at detecting optic disc hemorrhage than clinical examination. The occurrence of an optic disc hemorrhage was associated with an increased risk of developing a POAG end point in participants in the OHTS. However, most eyes (86.7%) in which a disc hemorrhage developed have not experienced a POAG end point to date.
1Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida.
2Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri.
3Glaucoma Care Center, Keystone Eye Associates Subspecialty Center, Philadelphia, Pennsylvania.
Correspondence to Donald L. Budenz, MD, MPH, Bascom Palmer Eye Institute, 900 NW 17th Street, Miami, FL 33136.
Manuscript no. 2006-85.
Supported by the National Eye Institute, Office of Research on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland (grant nos.: EY09341, EY09307); Merck Research Laboratories, Whitehouse Station, New Jersey; and Research to Prevent Blindness, Inc., New York, New York.
ABSTRACT