Risk factors for optic disc hemorrhage in the low-pressure glaucoma treatment study

Am J Ophthalmol. 2014 May;157(5):945-52. doi: 10.1016/j.ajo.2014.02.009. Epub 2014 Feb 7.

Abstract

Purpose: To investigate risk factors for disc hemorrhage detection in the Low-Pressure Glaucoma Treatment Study.

Design: Cohort of a randomized, double-masked, multicenter clinical trial.

Methods: Low-Pressure Glaucoma Treatment Study patients with at least 16 months of follow-up were included. Exclusion criteria included untreated intraocular pressure (IOP) of more than 21 mm Hg, 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%. Stereophotographs were reviewed independently by 2 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. Ocular and systemic risk factors for disc hemorrhage detection were analyzed using the Cox proportional hazards model and were tested further for independence in a multivariate model.

Results: Two hundred fifty-three eyes of 127 subjects (mean age, 64.7 ± 10.9 years; women, 58%; European ancestry, 71%) followed up for an average ± standard deviation of 40.6 ± 12 months were included. In the multivariate analysis, history of migraine (hazard ratio [HR], 5.737; P = .012), narrower neuroretinal rim width at baseline (HR, 2.91; P = .048), use of systemic β-blockers (HR, 5.585; P = .036), low mean systolic blood pressure (HR, 1.06; P = .02), and low mean arterial ocular perfusion pressure during follow-up (HR, 1.172; P = .007) were significant and independent risk factors for disc hemorrhage detection. Treatment randomization was not associated with either the occurrence or recurrence of disc hemorrhages.

Conclusions: 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 β-blockers were risk factors for disc hemorrhage detection. Randomization assignment did not influence the frequency of disc hemorrhage detection.

Trial registration: ClinicalTrials.gov NCT00317577.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antihypertensive Agents / therapeutic use*
  • Blood Pressure
  • Brimonidine Tartrate
  • Double-Blind Method
  • Female
  • Follow-Up Studies
  • Humans
  • Intraocular Pressure / drug effects*
  • Low Tension Glaucoma / complications*
  • Low Tension Glaucoma / drug therapy
  • Male
  • Middle Aged
  • Optic Disk / physiopathology*
  • Proportional Hazards Models
  • Quinoxalines / therapeutic use
  • Retinal Hemorrhage / diagnosis
  • Retinal Hemorrhage / etiology*
  • Retinal Hemorrhage / physiopathology
  • Risk Factors
  • Timolol / therapeutic use

Substances

  • Antihypertensive Agents
  • Quinoxalines
  • Brimonidine Tartrate
  • Timolol

Associated data

  • ClinicalTrials.gov/NCT00317577