Original articles
Rates of Circumpapillary Retinal Nerve Fiber Layer Thinning and Capillary Density Loss in Glaucomatous Eyes with Disc Hemorrhage

https://doi.org/10.1016/j.ajo.2021.09.013Get rights and content

Purpose

To investigate longitudinal changes in rates of optic nerve head circumpapillary retinal nerve fiber layer (cpRNFL) thinning and vessel density loss in patients with primary open-angle glaucoma with or without a history of disc hemorrhage (DH).

Design

Observational cohort.

Methods

In this longitudinal study, 34 eyes with DH and 134 eyes without DH that had ≥1.5 years of follow-up and 3 optical coherence tomography and optical coherence tomography angiography follow-up scans were enrolled. A linear mixed-effects model was used to compare the rates of cpRNFL thinning and vessel density loss between DH and non-DH eyes.

Results

Rates of whole image capillary density loss were faster in the DH group compared with the non-DH group (mean difference [95% confidence interval] −0.32% [−0.59% to −0.04%] per year; P = .027). Faster mean rates of vessel density loss were found in the inferotemporal, inferonasal, and nasal sectors in eyes with DH than without DH (P < .05). There was no statistically significant difference in the global rate of cpRNFL thinning between the 2 groups (P = .679). The mean rate of cpRNFL thinning was faster in the DH group compared with the non-DH group only in the inferotemporal sector (mean difference [95% confidence interval] −1.01 μm (−1.62 μm to −0.40 μm) per year; P = .001).

Conclusions

Mean rates of vessel density loss between DH and non-DH eyes were different not only in the affected area but also in the other regions. In contrast, a significant difference in cpRNFL thinning between the 2 groups was detected only in the inferotemporal sector. Disc hemorrhage is an independent predictor of faster vessel density loss in glaucoma suspects and patients with primary open-angle glaucoma.

Section snippets

METHODS

In this observational cohort study, subjects were enrolled from the Diagnostic Innovations Glaucoma Study (DIGS), a prospective longitudinal study designed to evaluate structural and functional changes in glaucoma. Participants were assessed longitudinally according to a pre-established protocol consisting of regular follow-up visits with clinical examination, imaging, and functional tests. All participants from the DIGS study who met the inclusion criteria described below were included in the

RESULTS

In this study, 34 eyes with DH and 134 eyes without DH that had ≥1.5 years of follow-up and 3 OCTA follow-up scans were enrolled. Initial DH occurrence was recorded with an average of 3.9 years before OCTA evaluation, and the most recent DH occurrence was an average of 1.9 years before the OCTA evaluation. Eyes with recent DH occurrence earlier than average (1.9 years) had mean (95% CI) wiCD loss of −0.77% (−1.14% to −0.39%) per year, while those later than average had −1.14% (−1.47% to −0.80%)

DISCUSSION

DHs have been identified as a risk factor for the development and progression of glaucoma.3, 4, 5, 6, 7, 8, 9, 10, 11 In this study, OCTA-derived measures of the rates of vessel density loss are significantly faster in DH eyes compared with non-DH eyes. Differences between the DH and non-DH groups were detected in the global rates of vessel density loss as well as in several sectoral rates of vessel density loss. While these findings support changes in optic disc microvasculature as being

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    Supplemental Material available at AJO.com.

    Drs Moghimi and Nishida served jointly as first authors.

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