Surgeons debate the role of disc hemorrhage in glaucoma

VIENNA. Austria — Is disc hemorrhage an important risk factor in glaucoma, or is it merely a sign of the disease? Two ophthalmologists faced off in a debate on the subject at the World Glaucoma Congress here.

Arguing for the importance of disc hemorrhage in glaucoma, Kyoko Ishida, MD, cited two studies that he said prove the link between the hemorrhages and normal tension glaucoma.

One study included 70 eyes of patients with normal tension glaucoma followed for an average of 5.6 years. Results showed that disc hemorrhage, age, corrected-pattern standard deviation, systolic blood pressure and pulse rate had significant associations with visual field loss progression, Dr. Ishida said.

A second study included 42 patients with normal tension glaucoma and disc hemorrhage. The study found that, of 64 disc hemorrhages, 80% occurred near the border of the retinal nerve fiber layer defect and adjacent to healthy-looking areas of the retina.

“Disc hemorrhage is strongly associated with retinal nerve fiber layer defect,” Dr. Ishida said. “Local rim volume and retinal nerve fiber layer thickness were significantly thinner in eyes with disc hemorrhage.”

Taking an opposing view, P. Juhani Airaksinen, MD, maintained that disc hemorrhage is “merely a sign” of glaucoma and not a major risk factor.

“Occurrence does not seem to be linked to glaucoma progression,” Dr. Airaksinen said.

According to Dr. Airaksinen, “an optic disc hemorrhage is normally followed by a localized notch in the neural tissue of the optic disc,” he said.

Dr. Airaksinen said studies do not confirm that disc hemorrhage is an important risk factor for glaucoma, along with other risk factors such as age and elevated IOP, but rather suggest that it is a separate disease.

“If you see the hemorrhage, you are not looking at the risk factor but the disease itself,” he concluded.