We appreciate Dias and associates’ interest in our article. They suggested important issues about the nature of disc hemorrhage (DH) and its association with glaucoma progression.

DH has been known as a powerful risk factor to induce glaucoma progression, but intraocular pressure (IOP)-lowering treatment did not reduce the frequency of DH. However, still we tend to apply IOP-lowering treatment more aggressively in many glaucoma progression cases with DH. In some cases treatment is successful, but not all. And we are not sure if the successful results are due to the effective treatment. One of the reasons why we apply IOP-lowering treatment may because IOP is the only proven modifiable parameter to reduce glaucoma progression.

We agree with the opinion that we know the DH is associated with increasing the risk of glaucoma development and progression, but we still do not know which type of DH is associated with progression. Some clues that each DH has different characteristics may exist. Our recent study showed that the effect of the DH on the development of glaucoma was different according to the location of DH. Some were associated with glaucoma, but others were not. Some previous studies also showed similar results in recurrent DH.

In our current study, we excluded the subjects who were taking medications that were known to alter platelet function (eg, aspirin). Some drugs may increase the risk of DH. But we do not know whether this induced platelet dysfunction may affect the course of glaucoma or not. Also, our study was a cross-sectional study, which fortunately can be a type of baseline assessment for longitudinal study. Most of the enrolled subjects are regularly visiting our glaucoma clinic. Thus, we believe follow-up of the subjects would be feasible.

We note again our appreciation for the encouragement of our research and the valuable observations regarding our study. We do hope our next longitudinal research efforts will explore more aspects of the nature of DH.