Detection and predictive value of optic disc hemorrhages in the Ocular Hypertensive Treatment Study

Abstract

Abstract: : Purpose: To compare detection of optic disc hemorrhages (ODH) by clinical examination vs. review of disc photography at the Optic Disc Reading Center (ODRC). To determine the predictive value of optic disc hemorrhages for the development of primary open angle glaucoma (POAG). Methods: Both eyes of all participants were monitored for ODHs every 6 months by clinical examination and annually using stereoscopic disc photographs by the ODRC. Detection of ODHs by these 2 methods were compared using the Χ² test and predictive accuracy of ODHs for the development of POAG was determined. Results: 3,238 eyes of 1,619 subjects with at least one follow–up visit were analyzed. ODHs were detected in a total of 152 eyes of 144 participants during an average follow–up of 96 months. Of the 152 ODHs, 25 (16%) were detected by both clinical examination and by review of photographs by the ODRC, 15 (9.9%) by clinical examination and not the ODRC, and 112 (74%) by the ODRC and not clinic examination (P <0.0001). Of these 152 eyes, 30 (20%) developed POAG during follow–up and 122 (80%) did not. Of the 3,086 eyes in which ODHs were not detected, 159 (5%) developed POAG. Median time from disc hemorrhage to POAG was 16.3 + 21 mos. Conclusion: The ODRC may be more sensitive at detecting ODH than clinical examinations. ODH is associated with an increased risk of developing POAG in OHTS, but is not synonymous with developing POAG. Because ODH was an exclusion criterion for entry into the OHTS, the risk of POAG associated with ODHs may be underestimated in this study.

Keywords: optic disc