1. Rate of Visual Field Progression in Eyes With Optic Disc Hemorrhages in the Ocular Hypertension Treatment Study De Moraes CG, Demirel S, Gardiner SK, et al; Ocular Hypertension Treatment Study Group. Rate of visual field progression in eyes with optic disc hemorrhages in the Ocular Hypertension Treatment Study. Arch Ophthalmol. Published online August 13, 2012. doi:10.1001/archophthalmol.2012.2324. Copyright restrictions may apply

2. Introduction Optic disc hemorrhage (DH) is an important risk factor for glaucoma onset and progression. The Ocular Hypertension Treatment Study (OHTS) showed that eyes experiencing DH have a 3-fold increased risk of conversion to glaucoma. Objectives: –To compare rates of visual field (VF) change in ocular hypertensive eyes with and without DH in the OHTS. –To compare whether treated and untreated eyes had different rates of DH detection. Copyright restrictions may apply

3. Study Design: Randomized clinical trial. Participants: OHTS participants who had a minimum of 10 reliable VF tests and were followed up for at least 5 years. Copyright restrictions may apply Methods

4. Data Analysis: Trend analyses of VF sequences over time of DH and non- DH eyes were assessed by regression of mean deviation (MDR) and pointwise linear regression (PLR). Limitations: –All VFs (before and after DH detection) were included when calculating the rates of VF change. –Patients had optic disc photographs taken every 12 months, and DH eyes may have been missed. –The group with DH had more risk factors for progression at baseline than the group without DH. Copyright restrictions may apply Methods

5. At least 1 DH was detected in 187 eyes (7.2%); 52 eyes had recurrent DH. In the univariable analysis, the MD deteriorated significantly faster in DH eyes compared with non-DH eyes (mean [SD], −0.17 [0.27] vs −0.07 [0.19] dB/y, respectively; P <.01). In the multivariable model, DH remained an independent factor associated with faster rates of VF change even after adjusting for differences at baseline (P <.01). Eyes initially randomized to treatment were less likely to have a DH during follow-up. Copyright restrictions may apply Results

6. Copyright restrictions may apply Results Comparison of Baseline Risk Factors Between DH and Non-DH Eyes

7. Copyright restrictions may apply Results Comparison of Baseline Risk Factors for Single and Recurrent DHs

8. Copyright restrictions may apply Results Multivariable Model: Association Between Baseline Variables, DH, and the Global Rate of VF Change (Mean Deviation Rate)

9. The presence of DH affects clinical outcomes and should alert the physician to an increased patient risk profile that may require more aggressive therapy. Recurrent DH does not appear to affect the global rate of VF change as captured by MDR but may impact localized rates as captured via PLR. Initial randomization to treatment significantly decreased the risk of developing a DH compared with eyes in the observation group, while the previous OHTS report found no statistical significance between groups. Copyright restrictions may apply Comment

10. Both the mechanism of DH development and why it leads to faster progression need to be elucidated. New models for risk calculation in patients with ocular hypertension might benefit from inclusion of DH as a risk factor. Assuming linearity of VF change, DH eyes will take half as long to reach VF sensitivity values consistent with meaningful visual impairment. Frequent optic disc photography is mandatory for monitoring and risk assessment in patients with ocular hypertension. Copyright restrictions may apply Comment

11. If you have questions, please contact the corresponding author: –Carlos Gustavo De Moraes, MD, 310 E 14th St, New York, NY 10003 (demoraesmd@gmail.com). Funding/Support This work was supported by National Institutes of Health grants EY09307 and EY09341; the National Center on Minority Health and Health Disparities; Research to Prevent Blindness; the Edith C. Blum Foundation Research Fund of the New York Glaucoma Research Institute; Legacy Good Samaritan Foundation; Merck Inc; and Pfizer Inc. Copyright restrictions may apply Contact Information