Normal-tension glaucoma can be difficult to diagnose in the absence of elevated IOP, but damage to the optic nerve still exists. Research now shows that disc hemorrhage is a notable risk factor for disease progression, and its presence may indicate a need for more intense treatment.

Researchers examined otherwise healthy Japanese patients with normal-tension glaucoma to identify risk factors and occurrence probability for optic disc hemorrhage.

The prospective observational study included 117 eyes of 90 patients in their mid-fifties with normal-tension glaucoma (IOP ≤ 15mm Hg). Patients were observed semi-annually for optic disc hemorrhages and followed without treatment for five years. Mean IOP during follow-up was 12.4mm Hg. In 34 eyes, disc hemorrhage was observed at least once and in 15 eyes, more than twice.

Upon further analysis, the researchers determined that healthy patients with treatment-naïve normal-tension glaucoma had a be 31% risk of disc hemorrhage at five years. Risk factors included lower myopic refraction, higher IOP during follow-up and presence of disc hemorrhage at baseline.

Sakata R, Yoshitomi T, Araie M, et al. The occurrence of optic disc haemorrhage in primary open‐angle glaucoma eyes with lower normal pressure and its relating factors. Acta Ophthalmol. June 13, 2020. [Epub ahead of print].