Clinical Profiles of Glaucomatous Patients With High- And Low-Tension Optic Disc Hemorrhages: A Comparative Study

Abstract

Background/Aims: Optic disc hemorrhage (DH) is an important glaucoma risk factor, and occurs in a wide intraocular pressure (IOP) range. We sought to characterize distinct clinical subtypes of patients with high- (HTDH) and low-tension DHs (LTDH). Methods: In this cross-sectional study, treated glaucomatous patients with DHs from two Glaucoma Services were consecutively enrolled. Disc photographs were evaluated for the presence of DH by two glaucoma specialists. After inclusion, patients were classified on HTDH (IOP≥16mmHg) and LTDH (IOP<16mmHg; median split). Clinical and ocular data from the time of DH detection were compared between groups. Results: One hundred thirty-three DH patients were included (LTDH=66 eyes; HTDH=67 eyes). Patients with LTDH were more often women than those with HTDH (77% vs 42%; p=0.030). There was also a trend for a higher prevalence of Asian descendants (24% vs 9%; p=0.058) and symptoms suggestive of vascular dysregulation (34% vs 14%; p=0.057) in LTDH patients. Eyes with LTDH also had worse visual field (VF) mean deviation index (p=0.037), higher prevalence of normal-tension glaucoma (NTG) diagnosis (46% vs 17%; p<0.001) and tended to have thinner central corneas (p=0.066). Conclusion: Patients developing DHs with treated IOPs in the low teens seem to more frequently fit in a profile represented by women, NTG diagnosis and greater VF loss. The presence of symptoms suggestive of vascular dysregulation and race also seem to differ between these two clinical subtypes. A closer optic disc surveillance is recommended for patients with the LTDH subtype, as they may develop DHs despite seemingly well-controlled IOP.