The clinical profile of low-tension DH patients described in this study may help you determine which patients are at the highest risk. Photo: Sarah B. Klein, OD.
The clinical profile of low-tension DH patients described in this study may help you determine which patients are at the highest risk.  Photo: Sarah B. Klein, OD. Click image to enlarge.

Optic disc hemorrhage (DH) occurs in a wide IOP range and has been consistently associated with glaucoma development and progression. Researchers in Brazil sought to characterize distinct clinical subtypes of patients with high- and low-tension DH. The team found that these categories differ not only in some systemic characteristics (gender, race and symptoms of primary vascular dysregulation), but also in ocular features (disease stage, normal tension glaucoma [NTG] diagnosis and corneal central thickness). DH patients with treated IOP in the low teens seem to more frequently fit in a profile represented by women, NTG diagnosis, thinner corneas and greater visual field loss.

The cross-sectional study enrolled 133 treated glaucoma patients with DH, classified as high-tension (IOP ≥16mm Hg, n=67) and low-tension (IOP <16mm Hg, n=66). Clinical and ocular data from the time of DH detection were compared between groups.

Low-tension DH patients were more often women than those with high-tension DH (77% vs. 42%). The study also noted a trend for a higher prevalence of people of Asian descent (24% vs. 9%) and symptoms suggestive of vascular dysregulation (34% vs. 14%) in low-tension DH patients.

Still, the study adopted strict criteria to define glaucomatous DH, and some patients with DH related to other (non-glaucomatous) conditions might have been included.

The researchers believe this clinical profile of low-tension DH patients may represent a population of eyes in which vascular mechanisms play a more prominent role than mechanical causes in DH occurrence. “Our findings may help clinicians in the identification and surveillance of patients at a higher risk for DH—and consequent glaucoma progression—even with IOP in the low-teens and seemingly well-controlled,” they concluded.

Almeida INF, Dias DT, Alhadeff PA, et al. Clinical profiles of glaucomatous patients with high- and low-tension optic disc hemorrhages: a comparative study. J Glaucoma. September 10, 2021. [Epub ahead of print].