Transcript Title of article

Rate of Visual Field Progression in Eyes With
Optic Disc Hemorrhages in the Ocular
Hypertension Treatment Study
De Moraes CG, Demirel S, Gardiner SK, et al; Ocular Hypertension Treatment
Study Group. Rate of visual field progression in eyes with optic disc
hemorrhages in the Ocular Hypertension Treatment Study. Arch Ophthalmol.
Published online August 13, 2012. doi:10.1001/archophthalmol.2012.2324.
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Introduction
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Optic disc hemorrhage (DH) is an important risk factor for glaucoma onset
and progression.
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The Ocular Hypertension Treatment Study (OHTS) showed that eyes
experiencing DH have a 3-fold increased risk of conversion to glaucoma.
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Objectives:
– To compare rates of visual field (VF) change in ocular hypertensive
eyes with and without DH in the OHTS.
– To compare whether treated and untreated eyes had different rates of
DH detection.
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Methods
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Study Design: Randomized clinical trial.
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Participants: OHTS participants who had a minimum of 10 reliable VF tests
and were followed up for at least 5 years.
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Methods
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Data Analysis: Trend analyses of VF sequences over time of DH and nonDH eyes were assessed by regression of mean deviation (MDR) and
pointwise linear regression (PLR).
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Limitations:
– All VFs (before and after DH detection) were included when calculating
the rates of VF change.
– Patients had optic disc photographs taken every 12 months, and DH
eyes may have been missed.
– The group with DH had more risk factors for progression at baseline
than the group without DH.
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Results
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At least 1 DH was detected in 187 eyes (7.2%); 52 eyes had recurrent DH.
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In the univariable analysis, the MD deteriorated significantly faster in DH eyes
compared with non-DH eyes (mean [SD], −0.17 [0.27] vs −0.07 [0.19] dB/y,
respectively; P < .01).
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In the multivariable model, DH remained an independent factor associated
with faster rates of VF change even after adjusting for differences at baseline
(P < .01).
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Eyes initially randomized to treatment were less likely to have a DH during
follow-up.
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Results
Comparison of Baseline Risk Factors Between DH and Non-DH Eyes
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Results
Comparison of Baseline Risk Factors for Single and Recurrent DHs
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Results
Multivariable Model: Association Between Baseline Variables, DH, and
the Global Rate of VF Change (Mean Deviation Rate)
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Comment
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The presence of DH affects clinical outcomes and should alert the physician
to an increased patient risk profile that may require more aggressive
therapy.
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Recurrent DH does not appear to affect the global rate of VF change as
captured by MDR but may impact localized rates as captured via PLR.
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Initial randomization to treatment significantly decreased the risk of
developing a DH compared with eyes in the observation group, while the
previous OHTS report found no statistical significance between groups.
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Comment
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Both the mechanism of DH development and why it leads to faster
progression need to be elucidated.
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New models for risk calculation in patients with ocular hypertension might
benefit from inclusion of DH as a risk factor.
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Assuming linearity of VF change, DH eyes will take half as long to reach VF
sensitivity values consistent with meaningful visual impairment.
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Frequent optic disc photography is mandatory for monitoring and risk
assessment in patients with ocular hypertension.
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Contact Information
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If you have questions, please contact the corresponding author:
– Carlos Gustavo De Moraes, MD, 310 E 14th St, New York, NY 10003
([email protected]).
Funding/Support
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This work was supported by National Institutes of Health grants EY09307
and EY09341; the National Center on Minority Health and Health
Disparities; Research to Prevent Blindness; the Edith C. Blum Foundation
Research Fund of the New York Glaucoma Research Institute; Legacy
Good Samaritan Foundation; Merck Inc; and Pfizer Inc.
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