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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: 3,236 eyes of 1,618 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 endpoints.Results: Median follow-up was 96.3 months. Stereophotograph-confirmed glaucomatous optic disc hemorrhages were detected in 128 eyes of 123 participants prior to POAG. Twenty one (16%) were detected by both clinical examination and review of photographs and 107 (84%) only by review of photographs (P <0.0001). Baseline factors associated with disc hemorrhages were older age, thinner corneas, larger vertical cup/disc ratio, larger PSD index on perimetry, family history of glaucoma, and smoking. 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 to 13.6% in the eyes with optic disc hemorrhage. In eyes with a disc hemorrhage that developed a POAG endpoint, the median time between the two events was 13 months.Corresponding Author: Donald L. Budenz, MD, MPH, Bascom Palmer Eye Institute, 900 NW 17th St, Miami, FL 33136. Telephone 305−326−6384. FAX 305−326−6337. E-mail: dbudenz@med.miami.edu Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conclusion: Review of stereo photographs 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 endpoint in participants in the OHTS. However, the majority of eyes (86.7%) that developed a disc hemorrhage have not developed a POAG endpoint to date.

Purpose To determine the change in intraocular pressure (IOP) after cataract extraction in the Observation Group of the Ocular Hypertension Treatment Study (OHTS). Design Comparative case series Participants Forty-two participants (63 eyes) who underwent cataract surgery in at least one eye during the study and a control group of 743 participants (743 eyes) who did not undergo cataract surgery Methods We defined the “split date” as the study visit date that cataract surgery was reported in the cataract surgery group, and a corresponding date in the control group. Preoperative IOP was defined as the mean IOP of up to 3 visits prior to split date. Postoperative IOP was the mean IOP of up to 3 visits including the split date (0, 6, and 12 months with ‘0 months’ equaling the split date). In both groups, we censored data after initiation of ocular hypotensive medication, or glaucoma surgery of any kind. Main outcome measures Difference in preoperative and postoperative IOP. Results In the cataract group, postoperative IOP was significantly lower than the preoperative IOP (19.8 ± 3.2 mmHg vs. 23.9 ± 3.2 p<0.001). The postoperative IOP remained lower than preoperative IOP for at least 36 months. The average decrease in postoperative IOP from preoperative IOP was 16.5%, and 39.7% of eyes had postoperative IOP ≥ 20% below preoperative IOP. A greater reduction in postoperative IOP occurred in the eyes with the highest preoperative IOP. In the control group, the corresponding mean IOP’s were 23.8 ± 3.6 prior to the split date and 23.4 ± 3.9 after the split date. Conclusion Cataract surgery decreases IOP in ocular hypertensive patients over a long period of time.

Objectives: (1) To develop a classification system for visual field (VF) abnormalities, (2) to determine interreader and test-retest agreement, and (3) to determine the frequency of various VF defects in the Ocular Hypertension Treatment Study. Methods: Follow-up VFs are performed every 6 months and are monitored for abnormality, indicated by a glaucoma hemifield test result or a corrected pattern SD outside the normal limits. As of January 1, 2002, 1636 patients had 2509 abnormal VFs. Three readers independently classified each hemifield using a classification system developed at the VF reading center. A subset (50%) of the abnormal VFs was reread to evaluate test-retest reader agreement. A mean deviation was calculated separately for the hemifields as an index to the severity of VF loss. Main Outcome Measures: A 97% interreader hemifield agreement. Results: The average hemifield classification agreement (between any 2 of 3 readers) for 5018 hemifields was 97% and 88% for the 1266 abnormal VFs that were reread (agreement between the first and second classifications). Glaucomatous patterns of loss (partial arcuate, paracentral, and nasal step defects) composed the majority of VF defects. Conclusion: The Ocular Hypertension Treatment Study classification system has high reproducibility and provides a possible nomenclature for characterizing VF defects.

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