Localized Visual Field Loss Predicts the Location of Future Disc Hemorrhage and Subsequent Visual Field Progression

Abstract

Purpose: : We evaluated the rate and location of visual field (VF) progression before and after detection of disc hemorrhage (DH).

Methods: : Disc photographs of glaucoma patients with ≥5 SITA-Standard 24-2 VFs in either eye between 1999 and 2008 were evaluated for the presence and location of DH. Exclusion criteria included disorders other than glaucoma likely to affect the VF and insufficient VFs to create a slope before or after DH detection. Pointwise linear regression (Progressor®) was used to calculate global and localized (Garway-Heath mapping) rates of progression before and after DH.

Results: : We found 168 DHs (120 patients; mean age: 68.9±11.2 yr). The mean number of VFs was 9.5±4.5, spanning a mean of 6.9±3.7 yrs. DH occurred most often in the inferotemporal (62%), temporal (14%), and superotemporal (11%) sectors. Mean global progression rates before and after DH were 0.80±1.2 vs 1.07±1.4 dB/yr (p=0.30), respectively. The mean rates for progressing points corresponding to the DH sector before and after detection were 1.17±1.5 and 1.90±2.4 dB/yr (p=0.06), respectively. All rates were significantly faster than in fellow, non-DH eyes (p<0.05). The VF sector with the fastest progression rate predicted the location of the future DH in 80% of cases. After the detection of DH, the same VF sector maintained the fastest progression rate in almost all eyes (92%). Eyes with nasal DHs generally showed slower progression and less agreement with the location of past or future field loss.

Conclusions: : Localized VF change occurred in regions of subsequent DH and continued to progress in the same regions at a slightly faster rate. This suggests that local rim structural collapse (with localized VF progression) may predispose to DH. Progressive VF loss continues because of the ongoing structural damage at or adjacent to this location. A DH should be viewed not only as a risk factor for future progression but also as evidence of past localized progression.

Keywords: visual fields • optic nerve • imaging/image analysis: clinical