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October 1997

Deterioration of Visual Fields in Patients With Glaucoma With and Without Optic Disc Hemorrhages

Author Affiliations

From the St Lucas Hospital (Dr Hoyng), the Department of Experimental Ophthalmology (Drs Rasker and Hoyng) and the Department of Visual System Analysis (Mr van den Enden), The Netherlands Ophthalmic Research Institute, and The Glaucoma Department, Academic Medical Center (Mr Bakker and Dr Hoyng), Amsterdam, the Netherlands.

Arch Ophthalmol. 1997;115(10):1257-1262. doi:10.1001/archopht.1997.01100160427006

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.

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