Spatially Consistent, Localized Visual Field Loss before and after Disc Hemorrhage

PURPOSE. To evaluate the rate and location of visual field (VF) progression before and after detection of disc hemorrhage (DH). METHODS. Disc photographs of consecutive patients with glaucoma with >= 5 SITA-Standard 24-2 VF in either eye were evaluated for the presence and location of DH. Exclusion criteria included disorders other than glaucoma likely to affect the VF and an insufficient number of VF test results to create a slope before or after DH detection. Automated pointwise linear regression was used to calculate global and localized rates of progression before and after DH. RESULTS. One hundred sixty-eight DHs were identified in 122 patients (mean age, 68.9 +/- 11.2 years). The mean number of VF tests was 9.0 +/- 4.4, spanning a mean of 6.7 +/- 3.8 years. Mean global progression rates before and after DH were -0.6 +/- 0.8 and -1.0 +/- 1.2 dB/y, respectively (P < 0.01). The mean rate of progression points corresponding to the DH sector before and after detection were -2.02 +/- 1.0 and -3.7 +/- 3.6 dB/y, respectively (P < 0.01). 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 85% of cases. After the detection of DH, the same VF sector maintained the fastest progression rate in almost all eyes (92%). CONCLUSIONS. Spatially consistent, localized VF change occurred in regions of subsequent DH and continued to progress in the same regions at a faster rate. This finding suggests that rapid, localized disease progression predisposes to DH and that progressive VF loss continues because of the ongoing damage at or adjacent to this location. (Invest Ophthalmol Vis Sci. 2009;50:4727-4733) DOI: 10.1167/iovs.09-3446