IOP-independent risk factors for disc hemorrhage

This cohort review found that that history of migraine, low systolic blood pressure, and use of systemic β-blockers were risk factors for disc hemorrhage in low-pressure glaucoma patients.Perhaps these pressure-independent risk factors play a role in the pathogenesis of glaucoma.

The authors investigated risk factors for disc hemorrhage in 127 subjects (253 eyes) from the Low-Pressure Glaucoma Treatment Study, a multicenter, double-masked, prospective, randomized clinical trial that examined visual field outcomes in low-pressure glaucoma patients treated either with a topical β-adrenergic antagonist (timolol maleate 0.5%) or an α2-adrenergic agonist (brimonidine tartrate 0.2%). All patients were followed for an average of 40.6 months.

History of migraine (hazard ratio [HR], 5.737; P = .012), narrow neuroretinal rim at baseline (HR, 2.91; P = 0.048), use of systemic beta blockers (HR, 5.585; P = 0.036), low ocular perfusion pressure (HR, 1.172; P = 0.007) and low mean systolic blood pressure (HR, 1.06; P = 0.02) were all significant risk factors in multivariate analysis. Randomization assignment did not influence the frequency of disc hemorrhage detection.

They note that this study did not aim to investigate the specific role of systemic antihypertensives on disc hemorrhage occurrence because information regarding the dosage, posology, duration of treatment and 24-hour blood-pressure monitoring was not collected as part of the Low-Pressure Glaucoma Treatment Study protocol.

Future studies are needed to assess these variables and how they affect the 24-hour blood-pressure pattern and the risk of progression in low-pressure glaucoma.