Localized wedge-shaped defects of retinal nerve fiber layer and disc hemorrhage in glaucoma

Objective: To evaluate frequencies of localized wedge-shaped defects of the retinal nerve fiber layer (RNFL) in eyes with and without disc hemorrhage in normal-tension glaucoma (NTG) and primary open-angle glaucoma (POAG). This study also aims to define a topographic correlation between disc hemorrhage and localized RNFL defects in POAG. Design: Cross-sectional study. Participants and Controls: The authors studied 83 eyes of 83 patients with NTG (male/female = 23/60; age; 58.8 +/- 12.9 years) and 20 eyes of 20 patients with POAG (male/female = 9/11;age, 61.6 +/- 11.4 years); subjects in both groups had developed new disc hemorrhage at the time of enrollment. The authors randomly selected 45 eyes of 45 patients with NTG (male/female = 20/25; age, 62.0 +/- 9.3 years) and 24 eyes of 24 patients with POAG (male/female = 13/11; age, 56.3 +/- 14.5 years) with no history of disc hemorrhage during the follow-up period of more than 2 years. Methods: Visual field in the patients with POAG was matched to that of the patients with NTG regarding global indices for both the hemorrhage and the nonhemorrhage groups. Localized wedge-shaped defects of RNFL were identified by scanning laser ophthalmoscopy using an argon-blue laser. Main Outcome Measures: The frequency of localized RNFL defects and the relationship between the locations of disc hemorrhages and localized RNFL defects were determined. Results: Localized wedge-shaped defects of RNFL occurred significantly more often in the hemorrhage group than in the nonhemorrhage group in both NTG (Fisher's exact probability test, P < 0.0001) and POAG (P < 0.05) patients. Regardless of the presence of disc hemorrhage, there was no significant difference in the frequency of localized RNFL defects between patients with NTG and those with POAG. Most disc hemorrhages were present in the vicinity of the border between localized RNFL defects and relatively healthy-looking RNFL in both patients with POAG and those with NTG. Conclusion: Disc hemorrhage is associated with localized damage of RNFL in both NTG and POAG.