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Editors Selection IGR 16-4

Progression: Progression after the first OD Hemorrhage

Comment by Jeffrey Liebmann on:

46013 Glaucoma progression after the first-detected optic disc hemorrhage by optical coherence tomography, Suh MH; Park KH; Kim H et al., Journal of Glaucoma, 2011;

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Splinter hemorrhages of the optic disc are a hallmark of glaucomatous optic neuropathy and are characterized by blood in the retina nerve fiber layer adjacent to the optic disc, within the rim tissue, or just off the disc margin. Disc hemorrhages occur across the glaucoma spectrum, from ocular hypertension to advanced disease. The medical literature indicates a close relationship between the discovery of a disc hemorrhage and future optic nerve functional or structural progression. Both primary vascular disease and mechanical processes (tissue collapse) have been hypothesized to be responsible for the development of disc hemorrhage. More controversially, some authors have suggested that the appearance of a disc hemorrhage represents ongoing progression of the disease (i.e., that progression has already occurred) rather than simply indicating that future progression is more likely. Although most prior research publications have defined future progression based upon visual field analyses, evidence is emerging that progressive structural damage to the optic nerve also occurs. In the present retrospective study, Suh et al. (857) demonstrate that in individuals with an observed unilateral disc hemorrhage, the eye with the disc hemorrhage develops localized structural damage as detected by optical coherence tomography much more frequently than the fellow eye. This damage is extremely focal (as is the disc hemorrhage) with the damage being better detected when analyzing smaller (clock hour) segments of the peripapillary OCT image than larger (quadrant) regions. Almost all (90%) of the progression occurred within one clock hour of the optic disc hemorrhage, indicating good spatial consistency between the disc hemorrhage and the progressive damage to the retinal nerve fiber layer, suggesting a strong connection between the two and supporting other research demonstrating spatial-consistency between disc hemorrhage and future visual field loss. The findings of the present study, combined with prior published work about optic disc hemorrhages suggests that careful examination of the optic disc for the presence of disc hemorrhage is critical for the diagnosis, management, and progression of glaucoma.

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