Rates of Local Retinal Nerve Fiber Layer Thinning before and after Disc Hemorrhage in Glaucoma

Abstract

Purpose To investigate longitudinal temporal and spatial associations between disc hemorrhage (DH) and rates of local retinal nerve fiber layer (RNFL) thinning before and after DHs. Design Longitudinal observational cohort study. Participants Forty eyes of 37 participants (23 with glaucoma and 17 with suspect glaucoma at baseline) with DH episodes during follow-up from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study. Methods All subjects underwent optic disc photography annually and spectral-domain optical coherence tomography (OCT) RNFL thickness measurements every 6 months. The rates of RNFL thinning were calculated using multivariate linear mixed-effects models before and after DH. Main Outcome Measures Rates of global and local RNFL thinning. Results Thirty-six eyes of 33 participants with inferior or superior DHs were analyzed. The rates of RNFL thinning were significantly faster in DH quadrants than non-DH quadrants after DH (−2.25 and −0.69 μm/year, P < 0.001). In the 18 eyes with intensified treatment after DH, the mean rate of RNFL thinning significantly slowed after treatment compared to before treatment in the non-DH quadrants (−2.89 and −0.31μm/year, P < 0.001), but not in the DH quadrants (−2.64 and −2.12 μm/year, P = 0.19). In 18 eyes with unchanged treatment, the rate of RNFL thinning in DH quadrant was much faster after DH than before DH (P = 0.008). Moreover, compared to eyes without a treatment change, intensification of glaucoma treatment after DH significantly reduced the global, non-DH quadrants and DH quadrant rates of RNFL thinning after DH compared to before DH (global, P = 0.004; non-DH quadrant, P < 0.001; DH quadrant, P = 0.005). In the multiple linear regression analysis, treatment intensification (β, 1.007; P = 0.005), visual field MD (β, 0.066; P = 0.049), and difference in IOP before and after DH (β, −0.176; P = 0.034) were associated significantly with the difference of global RNFL slope values before and after DH. Conclusions Although there is a worsening of the rate of RNFL thinning in a DH quadrant after DH, glaucoma treatment intensification may have a beneficial effect in reducing this rate of thinning.

Evaluation of Ganglion Cell–Inner Plexiform Layer Thinning in Eyes With Optic Disc Hemorrhage: A Trend-Based Progression Analysis

“…Intensifying treatment can slow the rate of RNFL thinning in eyes with DH and should be considered when interpreting the clinical significance of recurrent DH. 31 The present study has some limitations. First, the number of GCIPL image acquisitions was limited.…”

Impact of optic disc hemorrhage on subsequent glaucoma progression in mild-to-moderate myopia

“…Optic disc hemorrhage (DH) is one of the most important risk factors with respect to glaucoma progression [ 1 – 4 ]. There have been many reports of strong associations between structural glaucoma deterioration and DH.…”

Elucidation of the Strongest Factors Influencing Rapid Retinal Nerve Fiber Layer Thinning in Glaucoma

“…42 Although DH was a significant factor associated with rapid RNFL thinning in the conventional regression analysis, it was not presented as a prognostic factor in the regression tree model. DH is a known strong risk factor for glaucoma progression 13,43,44 and may indicate ongoing glaucomatous damage. [45][46][47] It is possible that that some DH was left undetected between the follow-ups by paucity of optic disc examinations, which have weakened the influence of DH on the rate of RNFL thinning.…”