Association Between Nocturnal Blood Pressure Dips and Optic Disc Hemorrhage in Patients With Normal-Tension Glaucoma

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.

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Optic disc assessment using confocal scanning laser ophthalmoscope in normal tension glaucoma with disc hemorrhage

Acta Ophthalmologica ◽

10.1111/j.1755-3768.2011.4355.x ◽

2011 ◽

Vol 89 (s248) ◽

pp. 0-0

Author(s):

S LIM

Keyword(s):

Optic Disc ◽

Normal Tension Glaucoma ◽

Scanning Laser Ophthalmoscope ◽

Scanning Laser ◽

Disc Hemorrhage ◽

Confocal Scanning Laser Ophthalmoscope ◽

Confocal Scanning ◽

Confocal Scanning Laser

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Association between Nocturnal Blood Pressure Reduction and Progression of Visual Field Defect in Patients with Primary Open-Angle Glaucoma or Normal-Tension Glaucoma

Japanese Journal of Ophthalmology ◽

10.1007/s10384-003-0071-6 ◽

2004 ◽

Vol 48 (4) ◽

pp. 380-385 ◽

Cited By ~ 64

Author(s):

Takaharu Tokunaga ◽

Kenji Kashiwagi ◽

Toyoaki Tsumura ◽

Kazuyuki Taguchi ◽

Shigeo Tsukahara

Keyword(s):

Blood Pressure ◽

Visual Field ◽

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Blood Pressure Reduction ◽

Normal Tension Glaucoma ◽

Pressure Reduction ◽

Open Angle ◽

Nocturnal Blood Pressure ◽

Field Defect

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The effect of systemic blood pressure on optical coherence tomography angiography in glaucoma patients with optic disc hemorrhage

Acta Ophthalmologica ◽

10.1111/j.1755-3768.2019.5125 ◽

2019 ◽

Vol 97 (S263) ◽

Author(s):

Hyoung Won Bae ◽

Chan Keum Park ◽

Sang Yeop Lee ◽

Gong Je Seong ◽

Chan Yun Kim

Keyword(s):

Blood Pressure ◽

Optical Coherence Tomography ◽

Optic Disc ◽

Optical Coherence Tomography Angiography ◽

Systemic Blood Pressure ◽

Optical Coherence ◽

Systemic Blood ◽

Disc Hemorrhage

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The Associations of Optic Disc Hemorrhage with Retinal Nerve Fiber Layer Defect and Peripapillary Atrophy in Normal-tension Glaucoma

Ophthalmology ◽

10.1016/s0161-6420(97)30005-0 ◽

1997 ◽

Vol 104 (11) ◽

pp. 1926-1933 ◽

Cited By ~ 87

Author(s):

Kazuhisa Sugiyama ◽

Goji Tomita ◽

Yoshiaki Kitazawa ◽

Eiji Onda ◽

Hisashi Shinohara ◽

...

Keyword(s):

Nerve Fiber ◽

Optic Disc ◽

Retinal Nerve Fiber Layer ◽

Normal Tension Glaucoma ◽

Fiber Layer ◽

Disc Hemorrhage ◽

Nerve Fiber Layer ◽

Peripapillary Atrophy ◽

Layer Defect ◽

Nerve Fiber Layer Defect

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Nocturnal blood pressure dip and parapapillary choroidal microvasculature dropout in normal-tension glaucoma

Scientific Reports ◽

10.1038/s41598-020-80705-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Joong Won Shin ◽

Youn Hye Jo ◽

Min Kyung Song ◽

Hun Jae Won ◽

Michael S. Kook

Keyword(s):

Blood Pressure ◽

Logistic Regression ◽

Optical Coherence Tomography Angiography ◽

Systemic Blood Pressure ◽

Normal Tension Glaucoma ◽

Mean Deviation ◽

Multivariate Logistic Regression ◽

Systemic Blood ◽

Nocturnal Blood Pressure ◽

Ambulatory Bp Monitoring

AbstractChoroidal microvasculature dropout (CMvD) implies compromised optic nerve head perfusion in glaucoma patients. However, there are conflicting findings whether office-hour systemic blood pressure (BP) is related to the presence of CMvD. The present study investigated which systemic BP parameters, derived from 24-h ambulatory BP monitoring (ABPM), are associated with CMvD as assessed by optical coherence tomography angiography (OCT-A) in normal-tension glaucoma (NTG). This study included 88 eyes of 88 NTG patients who underwent 24-h ABPM and OCT-A imaging. Various systemic BP parameters associated with the presence of CMvD were evaluated using logistic regression analyses. CMvD was detected in 38 NTG eyes (43.2%). NTG eyes with CMvD had nighttime diastolic BP (DBP) dip of greater magnitude and longer duration than eyes without CMvD. In multivariate logistic regression, worse VF mean deviation (MD) (odds ratio [OR] 0.786; P = 0.001), greater nighttime DBP dip “%” (OR 1.051; P = 0.034), and higher daytime peak IOP (OR 1.459; P = 0.013) were significantly associated with the presence of CMvD. Based on our findings that the eyes with CMvD are closely associated with having nighttime DBP dip, NTG patients with CMvD should be recommended to undergo 24-h ABPM.

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