on the follow-up of these “normal” individuals with disc hemorrhages. In repeated glaucoma surveys performed in the population of Dalby, disc hemorrhages were found in 28 out of 3,819 individuals without glaucoma (prevalence of 0.7%). Five out of ten of these individuals who were followed developed glaucoma with a visual field defect 2–7 years after the disc hemorrhage was noted [25].

A more common situation is the occurrence of a disc hemorrhage on a healthy appearing area of the neuroretinal rim in a glaucomatous disc. Disc hemorrhages ­usually occur at the infero-temporal or supero-temporal areas of the rim. Often they recur in the same area until a notch is formed, and then will start occurring at the opposite side of the same disc where the rim is still normal (Fig. 2.2) [6, 26–28]. Studies have shown that optic disc progression occurs in 50–80% of patients with glaucoma following an optic disc hemorrhage, with median follow-up of 2–3 years [1, 29, 30]. In patients with ocular hypertension the rate of progression seems to be lower, with only 14% of patients from the OHTS with disc hemorrhage showing progressive disc changes, which occurred after a median follow-up of 13 months [1]. Therefore, it is important for the clinician to follow patients with glaucoma after optic disc hemorrhages carefully for the first few years after the episode.

Summary for the Clinician

››Disc hemorrhages occur in nonglaucomatous eyes.

››In initially nonglaucomatous eyes, it is unclear what percent of nerves and over what period of time glaucomatous change of the optic nerve occurs after disc hemorrhage. One study found a visual field defect to occur after 2–7 years in 5 of 10 eyes that were followed.

››In optic nerves with established glaucoma, disc hemorrhages are more common.

››Disc hemorrhages are typically found in the infero-temporal or supero-temporal regions of the optic nerve.

››50–80% of patients with glaucoma and disc hemorrhages have been found to progress after 2–3 years of follow-up.

››14% of patients in the OHTS study with disc hemorrhages showed progressive neuroretinal rim loss after median follow-up of 13 months.

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