Recurrent disc hemorrhage does not increase the rate of visual field progression

  • Heather C. de BeaufortEmail author
  • Carlos Gustavo V. De Moraes
  • Christopher C. Teng
  • Tiago S. Prata
  • Celso Tello
  • Robert Ritch
  • Jeffrey M. Liebmann



To determine whether recurrent disc hemorrhage (DH) accelerates glaucomatous visual field (VF) loss compared to an isolated, single, detected DH.


We evaluated the disc photographs of consecutive patients with ≥5 SITA-Standard fields for DH. Group A had patients with a single DH in one eye, and group B had at least one recurrence in the same eye. Automated pointwise linear regression analysis was used to calculate rates of progression. Logistic regression was used to determine ocular or systemic variables associated with DH recurrence after baseline assessment.


One hundred and seventeen patients were enrolled (group A = 72, group B = 45). The mean age was 67.1 ± 10.8 years; most patients were women (65%) of European ancestry (92%) diagnosed with primary open-angle glaucoma (47%). The mean number of VF after the initial DH was 7.9 ± 2.9, spanning a mean of 4.6 ± 2.2 years. None of the ocular or systemic characteristics revealed a significant difference between groups. The mean global rate of progression (group A, −0.8 ± 0.6 vs group B, −0.8 ± 0.7 dB/year, p = 0.93) and number of eyes reaching a progression endpoint (group A, 70% vs group B, 73%, p = 0.80) did not differ between groups. Recurrent DH eyes showed a tendency to be followed longer, with a greater number of disc photographs, which was not significant in the multivariate analysis. The global rates of progression between groups remained non-significant even after adjusting to follow-up time and number of VF tests (p = 0.69).


Recurrent DH does not result in a faster rate of VF progression compared to a single detected DH. Eyes with single or recurrent DH have similar risks for future disease progression.


Disc hemorrhage Recurrence Glaucoma Progression 



Supported by the Edith C. Blum Foundation, New York, NY and the New York Glaucoma Research Institute, NY, NY.

Financial disclosure



  1. 1.
    Airaksinen PJ, Tuulonen A (1984) Early glaucoma changes in patients with and without an optic disc haemorrhage. Acta Ophthalmol (Copenh) 62:197–202CrossRefGoogle Scholar
  2. 2.
    Airaksinen PJ, Mustonen E, Alanko HI (1981) Optic disc haemorrhages precede retinal nerve fibre layer defects in ocular hypertension. Acta Ophthalmol (Copenh) 59:627–641CrossRefGoogle Scholar
  3. 3.
    Drance SM (1989) Disc hemorrhages in the glaucomas. Surv Ophthalmol 33:331–337CrossRefPubMedGoogle Scholar
  4. 4.
    Ocular Hypertension Treatment Study Group, Budenz DL, Anderson DR, Feuer WJ et al (2006) Detection and prognostic significance of optic disc hemorrhages during the Ocular Hypertension Treatment Study. Ophthalmology 113:2137–2143CrossRefPubMedGoogle Scholar
  5. 5.
    Bengtsson B, Leske MC, Yang Z, Heijl A et al (2008) Disc hemorrhages and treatment in the early manifest glaucoma trial. Ophthalmology 115:2044–2048CrossRefPubMedGoogle Scholar
  6. 6.
    Jonas JB, Xu L (1994) Optic disc hemorrhages in glaucoma. Am J Ophthalmol 118:1–8PubMedGoogle Scholar
  7. 7.
    Ahn JK, Park KH (2002) Morphometric change analysis of the optic nerve head in unilateral disk hemorrhage cases. Am J Ophthalmol 134:920–922CrossRefPubMedGoogle Scholar
  8. 8.
    Siegner SW, Netland PA (1996) Optic disc hemorrhages and progression of glaucoma. Ophthalmology 103:1014–1024PubMedGoogle Scholar
  9. 9.
    Sugiyama K, Tomita G, Kitazawa Y et al (1997) The associations of optic disc hemorrhage with retinal nerve fiber layer defect and peripapillary atrophy in normal-tension glaucoma. Ophthalmology 104:1926–1933PubMedGoogle Scholar
  10. 10.
    Sugiyama K, Uchida H, Tomita G et al (1999) Localized wedge shaped defects of retinal nerve fiber layer and disc hemorrhage in glaucoma. Ophthalmology 106:1762–1767CrossRefPubMedGoogle Scholar
  11. 11.
    Rasker MT, van den Enden A, Bakker D et al (1997) Deterioration of visual fields in patients with glaucoma with and without optic disc hemorrhages. Arch Ophthalmol 115:1257–1262PubMedGoogle Scholar
  12. 12.
    De Moraes CG, Prata TS, Liebmann CA et al (2009) Spatially consistent, localized visual field loss before and after disc hemorrhage. Invest Ophthalmol Vis Sci 50:4727–4733CrossRefPubMedGoogle Scholar
  13. 13.
    Parrish RK 2nd, Gedde SJ, Scott IU et al (1997) Visual function and quality of life among patients with glaucoma. Arch Ophthalmol 115:1447–1455PubMedGoogle Scholar
  14. 14.
    Viswanathan AC, Fitzke FW, Hitchings RA (1997) Early detection of visual field progression in glaucoma: a comparison of PROGRESSOR and STATPAC 2. Br J Ophthalmol 81:1037–1042CrossRefPubMedGoogle Scholar
  15. 15.
    Nouri-Mahdavi K, Hoffman D, Gaasterland D, Caprioli J (2004) Prediction of visual field progression in glaucoma. Invest Ophthalmol Vis Sci 45:4346–4351CrossRefPubMedGoogle Scholar
  16. 16.
    Vesti E, Johnson CA, Chauhan BC (2003) Comparison of different methods for detecting glaucomatous visual field progression. Invest Ophthalmol Vis Sci 44:3873–3879CrossRefPubMedGoogle Scholar
  17. 17.
    Kim SH, Park KH (2006) The relationship between recurrent optic disc hemorrhage and glaucoma progression. Ophthalmology 113:598–602CrossRefPubMedGoogle Scholar
  18. 18.
    Ishida K, Yamamoto T, Sugiyama K et al (2000) Disk hemorrhage is a significantly negative prognostic factor in normal tension glaucoma. Am J Ophthalmol 129:707–714CrossRefPubMedGoogle Scholar
  19. 19.
    Ahrlich K, De Moraes CG, Teng CC et al (2009) Visual field progression differences between normal-tension and exfoliative high-tension glaucoma patients. Invest Ophthalmol Vis Sci Dec 30 [Epub ahead of print]Google Scholar
  20. 20.
    Drance S, Anderson DR, Schulzer M (2001) Risk factors for progression of visual field abnormalities in normal-tension glaucoma. Am J Ophthalmol 131:699–708CrossRefPubMedGoogle Scholar
  21. 21.
    Gloster J (1981) Incidence of optic disc haemorrhages in chronic simple glaucoma and ocular hypertension. Br J Ophthalmol 65:452–456CrossRefPubMedGoogle Scholar
  22. 22.
    Kitazawa Y, Shirato S, Yamamoto T (1986) Optic disc hemorrhage in low-tension glaucoma. Ophthalmology 93:853–857PubMedGoogle Scholar
  23. 23.
    Begg IS, Drance SM, Sweeney VP (1971) Ischaemic optic neuropathy in chronic simple glaucoma. Br J Ophthalmol 55:73–90CrossRefPubMedGoogle Scholar
  24. 24.
    Sonnsjö B, Krakau CE (1993) Arguments for a vascular glaucoma etiology. Acta Ophthalmol (Copenh) 71:433–444CrossRefGoogle Scholar
  25. 25.
    Law SK, Choe R, Caprioli J (2001) Optic disk characteristics before the occurrence of disk hemorrhage in glaucoma patients. Am J Ophthalmol 132:411–413CrossRefPubMedGoogle Scholar
  26. 26.
    Jonas JB, Martus P, Budde WM et al (2002) Morphologic predictive factors for development of optic disc hemorrhages in glaucoma. Invest Ophthalmol Vis Sci 43:2956–2961PubMedGoogle Scholar
  27. 27.
    Boden C, Blumenthal EZ, Pascual J et al (2004) Patterns of glaucomatous visual field progression identified by three progression criteria. Am J Ophthalmol 138:1029–1036CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Heather C. de Beaufort
    • 1
    • 4
    • 5
    Email author
  • Carlos Gustavo V. De Moraes
    • 1
    • 2
  • Christopher C. Teng
    • 1
    • 2
    • 3
  • Tiago S. Prata
    • 2
  • Celso Tello
    • 2
    • 3
  • Robert Ritch
    • 2
    • 3
  • Jeffrey M. Liebmann
    • 1
    • 2
    • 3
    • 4
  1. 1.OphthalmologyNew York University School of MedicineNew YorkUSA
  2. 2.Einhorn Clinical Research CenterNew York Eye and Ear InfirmaryNew YorkUSA
  3. 3.New York Medical CollegeValhallaUSA
  4. 4.Manhattan EyeEar and Throat HospitalNew YorkUSA
  5. 5.New YorkUSA

Personalised recommendations