Rates of Visual Field Change in Eyes with Optic Disc Hemorrhage in the Ocular Hypertension Treatment Study

Abstract

Purpose: : To determine rates of visual field (VF) change in eyes with and without optic disc hemorrhage (DH) detected on stereophotographs and to determine whether VF change (local vs. global) is influenced by DH occurrence.

Methods: : We included OHTS participants with ≥10 reliable VF tests and ≥5 years of follow-up. We excluded eyes that reached an endpoint that was considered non-glaucomatous by the OHTS endpoint committee (261 eyes of 202 participants). Stereophotographs were reviewed at the Optic Disc Reading Center and DH were defined according to previously published reports. VF change was assessed using 2 methods of trend-analyses: 1) regression of mean deviation over time to determine its rate of change (MDR), and 2) pointwise linear regression (PLR) in which the sensitivity at each VF location (30-2 pattern) was regressed over time and change was defined as a slope ≤-0.5 dB/yr with p≤0.01 at ≥1 location, ≥2 locations or ≥2 neighboring locations.

Results: : Data from 2,607 eyes of 1,378 participants were included. The mean number of VFs in a test sequence was 23.7±4.9 spanning an average of 12.2±2.0 years. At least one DH was detected in 187 eyes (7.2%). 135 eyes had 1 DH and 52 eyes had > 1 DH. The MDR was significantly worse in DH compared to non-DH eyes (-0.17±0.19 vs. -0.07±0.27 dB/yr, p<0.01). Eyes with a single DH and eyes with recurrent DH were not significantly different in their MDR (-0.16±0.29 dB/yr vs. -0.20± 0.18 dB/yr, p=0.29). There was a significant association between DH and determination of progression using PLR by all three criteria described above (Odds Ratio =3.6, p<0.01; 2.8, p<0.01; 2.5, p<0.01 respectively - logistic generalized estimating equations). In contrast to the MDR results, eyes with 2 or more DH were significantly more likely to display PLR progression by all 3 criteria described above than eyes with only 1 DH (Odds Ratio =4.2, p=0.01; 3.4, p<0.01; 3.6, p<0.01 respectively).

Conclusions: : Eyes with one or more DH during follow-up had more rapid VF deterioration when assessed by global (MDR) or local (PLR) methods when compared to eyes without DH. Eyes with recurrent DH had statistically similar rates of global VF change (MDR) when compared to eyes with a single DH. However, recurrent DH was associated with a higher likelihood of VF progression by PLR.

Clinical Trial: : http://www.clinicaltrials.gov NCT00000125

Keywords: visual fields • optic disc • clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials