NYMC Faculty Publications

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

Author Type(s)

Faculty

DOI

10.1016/j.ajo.2014.02.009

Journal Title

American Journal of Ophthalmology

First Page

945

Last Page

952

Document Type

Article

Publication Date

5-1-2014

Department

Ophthalmology

Keywords

Antihypertensive Agents, Blood Pressure, Brimonidine Tartrate, Double-Blind Method, Female, Follow-Up Studies, Humans, Intraocular Pressure, Low Tension Glaucoma, Male, Middle Aged, Optic Disk, Proportional Hazards Models, Quinoxalines, Retinal Hemorrhage, Risk Factors, Timolol

Disciplines

Medicine and Health Sciences

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.

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