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Disc haemorrhages in glaucoma

Mohamed Noriega, Jibran; (2022) Disc haemorrhages in glaucoma. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Background: Disc haemorrhages (DH) are associated with glaucomatous progression. However, the effect of lowering intraocular pressure (IOP) in patients with DHs seems controversial; it may reduce visual field (VF) progression, but it does not reduce the frequency of DHs. Experiments and investigations: A survey of glaucoma specialists investigated the effect of new DHs on their clinical management. A method based on scanning laser ophthalmoscopy (SLO) to detect DHs was developed and compared to fundus photography and clinical examination. The detection of DHs and their role in visual field progression was investigated in the United Kingdom Glaucoma Treatment Study (UKGTS). The effect of medical and surgical reduction of intraocular pressure was investigated in the UKGTS and a cohort of normaltension glaucoma patients, respectively. Risk factors for DHs and a probability analysis exploring how often DHs appear simultaneously in both eyes were analysed to explore possible pathogenic mechanisms. Results: When a new DH is detected, 80% of clinicians modify their management plan, but the modifications vary. An SLO-based method for DH detection has very good within- and between-observers agreement. A comparison with fundus photography showed that photography is marginally better than SLO when the results of all observers are averaged but similar when the best observers are analysed independently. We confirmed the association between DHs and visual field deterioration. Treatment with latanoprost reduces the risk of VF deterioration in patients with and without DHs, but the frequency of DHs is not affected. Trabeculectomy reduced VF deterioration and the frequency of DHs. Conclusion: The detection of DHs guides most ophthalmologists to modify clinical decisions. An image-based method is required to increase the detection rate of DHs and the SLO-based method is an alternative for detection. IOP lowering with medication or surgery reduces VF progression in patients with DHs.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: Disc haemorrhages in glaucoma
Language: English
Additional information: Copyright © The Author 2022. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request.
UCL classification: UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Institute of Ophthalmology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL
URI: https://discovery.ucl.ac.uk/id/eprint/10147325
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