While primary open-angle glaucoma (POAG) patients and glaucoma suspects with a history of disc hemorrhage (DH) have found success with IOP-lowering procedures, additional effect may be necessary to slow the structural progression rate of DH eyes, considering they still have faster progression than non-DH eyes.

This observational cohort study evaluated 166 POAG and glaucoma suspect eyes. Thirty-seven eyes had a history of DH and were followed for 4.6 years, while 129 eyes did not and were followed for 4.2 years. Participants underwent stereoscopic optic disc photography annually and SD-OCT retinal nerve fiber layer (RNFL) thickness measurements every six months. The team compared RNFL thinning rates in eyes with and without DH.

They noted that the DH group had more procedures (2.4 vs. 1.9) before follow-up and more medications (1.8 vs. 1.4) and lower mean IOP (12.69mm Hg vs. 14.41mm Hg) during follow-up compared with the non-DH group. When they adjusted using mean IOP as a covariate, they discovered that the RNFL thinning rate was two-fold faster in the DH group than in the non-DH group (-0.61μm/year vs. -0.33μm/year). The investigators added that a higher postoperative mean IOP was associated with a faster RNFL thinning rate.

Hou H, Moghimi S, Zangwill L, et al. Association between rates of retinal nerve fiber layer thinning following intraocular pressure lowering procedures and disc hemorrhage. Ophthalmol Glaucoma. November 13, 2019. [Epub ahead of print].