July 2019
Volume 60, Issue 9
Free
ARVO Annual Meeting Abstract  |   July 2019
Bilateral disc haemorrhages in the United Kingdom glaucoma treatment study (UKGTS): a probabilistic approach to explore a possible systemic pathophysiological mechanism.
Author Affiliations & Notes
  • Georgios Lazaridis
    NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
    Centre for Medical Image Computing, University College London, London, United Kingdom
  • Jibran Mohamed-Noriega
    NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
    Ophthalmology department, Autonomous University of Nuevo Leon (UANL), Mexico
  • David F Garway-Heath
    NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
  • Footnotes
    Commercial Relationships   Georgios Lazaridis, Santen (F); Jibran Mohamed-Noriega, None; David Garway-Heath, Aerie (C), Alcon (C), Alcon Research Institute (F), Allergan (C), Baush & Lomb (C), Heidelberg Engineering (F), Pfizer (C), Pfizer (F), Quark (C), Quethera (C), Santen (C), Santhera (C)
  • Footnotes
    Support  Pfizer Pharmaceuticals (UK) - unresticted grant
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 4273. doi:
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      Georgios Lazaridis, Jibran Mohamed-Noriega, David F Garway-Heath; Bilateral disc haemorrhages in the United Kingdom glaucoma treatment study (UKGTS): a probabilistic approach to explore a possible systemic pathophysiological mechanism.. Invest. Ophthalmol. Vis. Sci. 2019;60(9):4273.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Disc haemorrhage (DH) is a sign associated with glaucoma progression. Theories to explain DH pathophysiology include i) mechanical (optic nerve structural changes damaging a vessel) and ii) vascular (abnormal vessels/blood flow). We hypothesised that simultaneous DHs in both eyes (BE) indicates a systemic pathophysiological mechanism and evaluated if the incidence of simultaneous DH in the UKGTS occurred by chance.

Methods : We used the DH status per eye of the 481 (93.2%) UKGTS participants who had a minimum of two visits with fundus photography or HRT3. We computed the observed incidence of DH at three levels: participant, eye, visit, as well as the conditional probabilities given all previous DH statuses. We compared the observed incidence of simultaneous DHs in BE [P(A and B)] with the expected probabilities assuming each eye to be independent [P(A)*P(B)]. Variable length Markov Chains (MC) per participant were fit to capture the full transition history and used to predict the probability of detecting DH at each visit given all possible initial DH statuses. The expected probabilities of identifying simultaneous DHs in BE were compared between participants who had a DH in one or BE, but not simultaneously (subgroup 1), and those with a DH in BE simultaneously (subgroup 2) in at least one visit.

Results : The observed incidence of DHs are in the Table. If an eye had a DH, the conditional probability of identifying another DH during following visits in either eye was 81.9%. The observed incidence of a DH increased from 5.2% to 46.1% in the RE, and from 4.2% to 37.7% in the LE, when the fellow eye previously had a DH. Across visits, the observed incidence of simultaneous DHs in BE was 0.8% compared to the expected probability computed with each eye independently of 0.2%. In the subgroup analysis, the observed incidence of DHs per eye was the same between subgroups but the expected probabilities to develop a simultaneous DH in BE were 3.2% in subgroup 1 and 9.7% in subgroup 2. Fig1A,B show the results per visit.

Conclusions : Simultaneous DHs in BE occur 4 times more often than expected from DH incidence; this may be explained by a systemic factor causing simultaneous bleeding. Treating the problem with MC modelling ensures capturing long-range between-visit correlations in subjects with a different number of visits.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

 

 

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