Clinical profiles of glaucomatous patients with high- and low-tension optic disc hemorrhages: a comparative study

Background/Aims Optic disc hemorrhage (DH) is an important glaucoma risk factor, and occurs in a wide intraocular pressure (IOP) range. We sought to characterize distinct clinical subtypes of patients with high- (HTDH) and low-tension DHs (LTDH). Methods In this cross-sectional study, treated glaucomatous patients with DHs from two Glaucoma Services were consecutively enrolled. Disc photographs were evaluated for the presence of DH by two glaucoma specialists. After inclusion, patients were classified on HTDH (IOP ≥ 16mmHg) and LTDH (IOP< 16mmHg; median split). Clinical and ocular data from the time of DH detection were compared between groups. Results One hundred thirty-three DH patients were included (LTDH = 66 eyes; HTDH = 67 eyes). Patients with LTDH were more often women than those with HTDH (77% vs 42%; p = 0.030). There was also a trend for a higher prevalence of Asian descendants (24% vs 9%; p = 0.058) and symptoms suggestive of vascular dysregulation (34% vs 14%; p = 0.057) in LTDH patients. Eyes with LTDH also had worse visual field (VF) mean deviation index (p = 0.037), higher prevalence of normal-tension glaucoma (NTG) diagnosis (46% vs 17%; p< 0.001) and tended to have thinner central corneas (p = 0.066). Conclusion Patients developing DHs with treated IOPs in the low teens seem to more frequently fit in a profile represented by women, NTG diagnosis and greater VF loss. The presence of symptoms suggestive of vascular dysregulation and race also seem to differ between these two clinical subtypes. A closer optic disc surveillance is recommended for patients with the LTDH subtype, as they may develop DHs despite seemingly well-controlled IOP. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement No funding supported ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: ethics committee and the institutional review board of the New York Eye and Ear Infirmary and the Federal University of Sao Paulo All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data referred to in the manuscript is available