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

Rafael L. Furlanetto, Carlos Gustavo De Moraes, Christopher C. Teng, Jeffrey M. Liebmann, David S. Greenfield, Stuart K. Gardiner, Robert Ritch, Theodore Krupin

Research output: Contribution to journalArticlepeer-review

65 Scopus citations


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.

Original languageEnglish
Pages (from-to)945-952.e1
JournalAmerican Journal of Ophthalmology
Issue number5
StatePublished - May 2014
Externally publishedYes


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