Tip of the Month
Publishing date: July 2016
Tip Editors: John Salmon and Gordana Sunaric Mégevand
Tip reviewer: Roger Hitchings
The Science behind the Tip
Prospective studies have shown that splinter-shaped haemorrhages at the optic disc margin are an important risk factor for progression of glaucoma (1). They are present for 4 to 8 weeks before they resorb and can be easily missed if magnification is not used to examine the disc. Importantly, stereophotographs are significantly more sensitive at detecting optic disc haemorrhages than clinical examination (2).
Disc haemorrhages are a marker for higher susceptibility to glaucoma progression, but are unlikely to be in the causal pathway (3). They are not only a strong predictor of future visual field progression, but they also indicate a faster rate of retinal ganglion cell loss (3,4). Lowering of the intraocular pressure has been shown to slow further visual field loss after a disc haemorrhage (5).
Contributor: J F Salmon MD Consultant Ophthalmologist - Oxford Eye Hospital (UK)
1) Leske C, Heijl A, Hyman L et al. Predictors of long-term progression in the early manifest glaucoma trial. Ophthalmology 2007; 114: 1965-1972.
2) Budenz DL, Anderson DR, Feuer WJ et al. Detection and prognostic significance of optic disc hemorrhages during the Ocular Hypertension Treatment Study. Ophthalmology 2006; 113:2137-43
3) Gracitelli CPB, Tatham AJ, Zangwill LM, et al. Estimated rates of retinal ganglian cell loss in glaucomatous eyes with and without optic disc hemorrhages. PloS One. 2014; 9 (8) e105611.
4) De Moraes CG, Prata TS, Liebmann CA et al. Spatially consistent localized visual field loss before and after disc hemorrhage. Invest Ophthalmol Vis Sci 2009; 50: 4727-4733
5) Medeiros FA, Alencar LM, Sample PA, et al. The relationship between intraocular pressure reduction and rates of progressive visual field loss in eyes with optic disc hemorrhage. Ophthalmology 2010 117: 2061-2066.