News reports from the conference

Optic disc hemorrhage an important warning sign

Optic disc hemorrhage (ODH) is associated with an increased risk for the development of glaucoma or the progression of existing disease and, as such, warrants attention.

That was the main message of a plenary address on the subject delivered by Dr. Dale Heuer professor and chairman of the Department of Ophthalmology at the Medical College of Wisconsin in Milwaukee.

He noted that while the prevalence of ODH in the general population is low - he referenced studies showing a range of 0.79%-1.4% - prevalence in patients with glaucoma is far higher. He also noted that patients with ODH are nine times more likely to have glaucomatous nerve damage than those without ODH.

"This is an invaluable finding," he said.

Heuer noted that a number of randomized controlled trials have shown that patients with ODH have a significantly elevated risk of developing primary open-angle glaucoma. He cited, for example, a multivariate analysis in the Ocular Hypertension Treatment Study that showed that eyes with ODH were 3.7 times more likely to develop glaucoma within a median time period of 13 months post-hemorrhage.

Even though patients with ODH are known to have an increased risk of glaucoma, Heuer suggested that ophthalmologists are not as good at detecting these hemorrhages, as they should be. He noted that the presenting signs are variable, as is the location in the eye in which they can occur.

While questions remain about the etiology of ODH and whether they cause glaucoma or are an early sign of the disease, Heuer stressed that a finding of ODH should not be ignored.

According to Heuer, in patients without glaucoma, a finding of ODH means that more intensive follow-up is needed. As it can take several years for a finding of ODH to progress to glaucoma, he said, patients need to be monitored for more than a year.

In glaucoma patients with good intraocular pressure (IOP) control, a finding of ODH might merit a discussion of adherence to treatment, Heuer suggested, whereas for those with marginal IOP control, consideration should be given to starting or intensifying therapy.