Risk Factors for Optic Disc Hemorrhage in the Low-Pressure Glaucoma Treatment Study

• Published in: American journal of ophthalmology 2014-05, Vol.157 (5), p.945-952.e1
• Main Authors: Furlanetto, Rafael L, De Moraes, Carlos Gustavo, Teng, Christopher C, Liebmann, Jeffrey M, Greenfield, David S, Gardiner, Stuart K, Ritch, Robert, Krupin, Theodore
• Format: Article
• Language: English
• Subjects: Antihypertensive Agents - therapeutic use; Blood Pressure; Brimonidine Tartrate; Clinical trials; Colleges & universities; Confidence intervals; Diabetic retinopathy; Double-Blind Method; Female; Follow-Up Studies; Glaucoma; Headaches; Heart attacks; Heart rate; Humans; Intraocular Pressure - drug effects; Low Tension Glaucoma - complications; Low Tension Glaucoma - drug therapy; Male; Middle Aged; Migraine; Multivariate analysis; Ophthalmology; Optic Disk - physiopathology; Optic nerve; Patients; Proportional Hazards Models; Quinoxalines - therapeutic use; Raynaud disease; Retinal Hemorrhage - diagnosis; Retinal Hemorrhage - etiology; Retinal Hemorrhage - physiopathology; Risk Factors; Timolol - therapeutic use
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2014.02.009

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.