Risk Factors for Optic Disc Hemorrhage
In this cohort of a randomized, double-masked, multicenter clinical trial, investigators examined risk factors for disc hemorrhage detection in the Low-pressure Glaucoma Treatment Study.
Included were Low-pressure Glaucoma Treatment Study patients with at least 16 months of follow-up. Exclusion criteria included untreated intraocular pressure (IOP) >21 mmHg, visual field mean deviation worse than –16 dB, or contraindications to study medications. Patients were randomized to topical treatment with timolol 0.5% or brimonidine 0.2% and stereophotographs were independently reviewed by two masked graders searching for disc hemorrhages. The main outcomes investigated were the detection of disc hemorrhage at any time during follow-up and their recurrence. The study investigators analyzed ocular and systemic risk factors for disc hemorrhage detection using Cox proportional hazards model and further tested them for independence in a multivariate model.
They included 253 eyes of 127 subjects (mean age, 64.7 ± 10.9 years; women, 58% European ancestry, 71%) followed for an average (±SD) of 40.6 ± 12 months. They observed that in the multivariable analysis, history of migraine (hazard ratio, HR =5.737, p=0.012), narrower neuroretinal rim width at baseline (HR=2.91, p=0.048), use of systemic beta-blockers (HR=5.585, p=0.036), low mean systolic blood pressure (HR=1.06, p=0.02), and low mean arterial ocular perfusion pressure during follow-up (HR=1.172, p=0.007) were significant and independent risk factors for disc hemorrhage detection. Furthermore, they determined that treatment randomization was not associated with either the occurrence or recurrence of disc hemorrhages.
To conclude, in this cohort of Low-pressure Glaucoma Treatment Study patients, migraine, baseline narrower neuroretinal rim width, low systolic blood pressure and mean arterial ocular perfusion pressure, and use of systemic beta-blockers were risk factors for disc hemorrhage detection. Randomization assignment did not influence the frequency of disc hemorrhage detection.