June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Rates of Local Retinal Nerve Fiber Layer (RNFL) Thinning before and after Disc Hemorrhage (DH) in Glaucoma Patients
Author Affiliations & Notes
  • Tadamichi Akagi
    Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, San Diego, California, United States
    Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
  • Linda M Zangwill
    Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, San Diego, California, United States
  • Luke J Saunders
    Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, San Diego, California, United States
  • Adeleh Yarmohammadi
    Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, San Diego, California, United States
  • Patricia Isabel C Manalastas
    Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, San Diego, California, United States
  • Min Hee Suh
    Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, San Diego, California, United States
    Ophthalmology, Haeundae Paik Hospital, Inje University, Busan, Korea (the Republic of)
  • Felipe Medeiros
    Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, San Diego, California, United States
  • Christopher A Girkin
    School of Medicine, University of Alabama, Birmingham, Alabama, United States
  • Jeffrey M Liebmann
    Bernard and Shirlee Brown Glaucoma Research Laboratory, Harkness Eye Institute, Columbia University Medical Center, New York, New York, United States
  • Robert N Weinreb
    Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, San Diego, California, United States
  • Footnotes
    Commercial Relationships   Tadamichi Akagi, Alcon (R), Kowa (R), Pfizer (R), Santen (R), Senju (R); Linda Zangwill, Carl Zeiss Meditec (F), Heidelberg Engineering (F), National Eye Institute (F), Optovue (F), Topcon (F); Luke Saunders, None; Adeleh Yarmohammadi, None; Patricia Isabel Manalastas, None; Min Hee Suh, None; Felipe Medeiros, Alcon (R), Alcon (F), Allergan (F), Allergan (R), Allergan (C), Bausch & Lomb (F), Carl Zeiss Meditec (F), Carl Zeiss Meditec (R), Carl Zeiss Meditec (C), Heidelberg Engineering (F), Merck (F), National Eye Institute (F), Novartis (C), Reichert (R), Reichert (F), Sensimed (F), Topcon (F); Christopher Girkin, Carl Zeiss Meditec (F), EyeSight Foundation of Alabama (F), Heidelberg Engineering (F), National Eye Institute (F), Research to Prevent Blindness (F), SOLX (F); Jeffrey Liebmann, Alcon (C), Allergan (C), Bausch & Lomb (C), Bausch & Lomb (F), Carl Zeiss Meditec (C), Carl Zeiss Meditec (F), Heidelberg Engineering (C), Heidelberg Engineering (F), National Eye Institute (F), Optovue (F), Reichert (C), Reichert (F), Topcon (F), Valeant Pharmaceuticals (C); Robert Weinreb, Aerie Pharmaceutical (C), Alcon (C), Allergan (C), Bausch & Lomb (C), Carl Zeiss Meditec (F), Eyenovia (C), Genentech (F), Heidelberg Engineering (F), Optovue (F), Quark (F), Sensimed (C), Topcon (F), Unity (C)
  • Footnotes
    Support  John Mung Program from Kyoto University Global Frontier Project for Young Professionals
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 1588. doi:
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    • Get Citation

      Tadamichi Akagi, Linda M Zangwill, Luke J Saunders, Adeleh Yarmohammadi, Patricia Isabel C Manalastas, Min Hee Suh, Felipe Medeiros, Christopher A Girkin, Jeffrey M Liebmann, Robert N Weinreb; Rates of Local Retinal Nerve Fiber Layer (RNFL) Thinning before and after Disc Hemorrhage (DH) in Glaucoma Patients. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1588.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : The relationship between structural damage and DHs is not well understood. We investigated longitudinal temporal and spatial associations between rates of RNFL thinning before and after DHs and the influence of glaucoma treatment on the results.

Methods : Eyes with at least 1 superior or inferior DH episode and with spectral-domain optical coherence tomography (OCT; Spectralis HRA+OCT; Heidelberg Engineering, Heidelberg, Germany) follow-up both before and after DH were included from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study. All subjects underwent optic disc photography every 12 months and spectral-domain OCT imaging every 6 months. The location of the DH or RNFL thickness was classified into 4 90-degree sectors. The rates of RNFL thinning was compared before and after DH and also between DH-located and non DH-located quadrants using multivariate linear mixed-effects models. Treatment intensification was defined as the glaucoma surgery or increase in the number of glaucoma medications.

Results : 36 eyes of 33 glaucoma patients and glaucoma suspects were included. The rates of RNFL thinning (mean±SD) were significantly faster at DH-located quadrants than non DH-quadrants after DH (-2.25±1.49 versus -0.69±1.14 μm/yr, P <.001), but not significantly different between DH-located and non DH-located quadrants before DH (-2.01±1.49 versus -1.91±1.69 μm/yr, P =.71). In 18 eyes with treatment intensification after DH, the rate of RNFL thinning at non DH quadrant became significantly slower after DH (P <.001), while the rate in the DH quadrant did not change (P =.19). In contrast, in 18 eyes with unchanged treatment after DH, the rate of RNFL thinning in DH quadrant was much faster after DH than before DH (P =.008), while the rate in the non-DH quadrant did not change (P =.69). Overall, the intensification of glaucoma treatment after DH significantly reduced the global and local rates of RNFL thinning after DH compared to before DH (global, P =.004; DH-located, P =.005; non DH-located, P <.001).

Conclusions : There is a worsening of the rate of RNFL thinning in a DH-located quadrant after DH. Moreover, glaucoma treatment intensification has a beneficial effect to reduce the rate of RNFL thinning after DH.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

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