Factors associated with optic disc hemorrhages in glaucoma

Purpose To evaluate factors associated with optic disc hemorrhages (ODHs) in patients with open-angle glaucoma. Design Cohort study. Participants One hundred thirty-seven patients with open-angle glaucoma, with an initial mean age of 60.0 years (standard deviation [SD], 11.0 years) followed up for a mean of 9.5 years (SD, 5.0 years). Methods The association between ODHs and various patient-related variables (diabetes, systemic hypertension, heart disease, hypercholesterolemia, migraine, hypothyroidism, use of platelet antiaggregant agents) and eye-related variables (mean and range of intraocular pressure, refractive error, and severity of disease) was investigated using multivariate time-to-event analyses in patients with open-angle glaucoma. To determine the influence of the level of intraocular pressure (IOP) on the occurrence of ODHs, we compared the IOP at the time the first ODH was noted with the mean IOP of the previous 3 visits. As a control, a similar analysis was performed on the same eyes using a randomly selected visit before the occurrence of the first ODH. Main outcome measurements Patient-related and eye-related variables associated with ODHs and the comparative level of IOP in which these ODHs were observed. Results Fifty eyes of 38 patients (28%) had 1 or more ODHs during the follow-up period. The ODHs were associated with presence of diabetes (hazard ratio, 4.43; 95% confidence interval [CI], 1.8-10.50; P = 0.001) and use of aspirin (hazard ratio, 2.30; 95% CI, 1.2-4.6; P = 0.019). The IOP at the time of the first ODH was, on average, 1.4 mmHg lower than the mean IOP of the 3 previous visits (95% CI, -2.2 to -0.6 mmHg; P<0.001), whereas in the control analysis, the respective value was 0.3 mmHg lower (95% CI, -1.0 to 0.5; P = 0.410). Conclusions Optic disc hemorrhages were associated with diabetes and aspirin use and were observed at relatively lower IOP during follow-up.