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Verena Juncal, Flávio Lopes, Paula Alhadeff, Robert Ritch, Tiago S Prata; Factors associated with paracentral visual field involvement in glaucomatous eyes with optic disc hemorrhages. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1053.
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To assess factors associated with paracentral visual field (VF) involvement in glaucomatous eyes with disc hemorrhages (DH).
In this observational study, we enrolled glaucomatous patients with DHs from two Glaucoma Services. Disc photographs of all patients were evaluated for the presence of DH by 2 glaucoma specialists. On the basis of 2 reliable, consistent 24-2 Swedish interactive threshold algorithm standard VFs, patients were divided into two groups: those with parafoveal scotoma (PFS group: ≥3 adjacent points with P<5% within the central 10 degrees of fixation, ≥1 point with P<1% lying at the innermost paracentral points, in the same hemifield) and those without PFS (controls). Clinical and ocular data from the time of DH detection were collected and compared between groups.
A total of 130 patients were included (PFS group = 77 patients [mean age, 68.2 years]; controls = 53 patients [mean age, 65.1 years]; p=0.12). The PFS group had a higher prevalence of caucasian patients than controls (82% vs 50%; p<0.01). Eyes with PFS had a more negative spherical equivalent and a worse mean deviation index (p≤0.01). Although eyes with PFS had lower IOP values than controls at the time of DH detection (median, 15 mmHg vs 18 mmHg), this difference did not reach statistical significance (p=0.10). No significant differences were found regarding gender, systemic risk factors (hypotension and migraine), central cornea thickness, type of glaucoma, frequency of previous intraocular surgery, optic disc phenotypes, presence of peripapillary atrophy, localized retinal nerve fiber layer defects, DHs location and DHs recurrences (p≥0.25). Logistic regression analysis revealed PFS to be significantly associated with Caucasian race (OR, 2.2), myopia (<-3D; OR, 3.4) and lower IOP (<16 mmHg; OR, 2.1;p≤0.04). Including all significant factors in a multivariable analysis (controlling for VF mean deviation index), only myopia (as a continuous or categorical variable) remained significant in this model (p=0.03).
In this large series, the presence and extent of myopia were found to be significantly associated with paracentral VF involvement in glaucomatous eyes with DH. Our results may help clinicians in the identification and surveillance of these eyes at higher risk of central field loss.
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