Prospective observational study of disc haemorrhages (POSH). Comparison of ocular and systemic variables between visits with and without disc haemorrhages.

Abstract

Purpose : Ocular and systemic variables previously reported to be associated with the presence of disc haemorrhages (DH) are compared in visits with and without DH.

Methods : Thirty patients with open-angle glaucoma and a new DH were recruited from Moorfields Eye Hospital for 5 visits (0, 1, 3, 6, and 12 months). The following examinations acquired in all visits were compared between DH+ and DH- visits: optic disc photography, nailbed capillaroscopy (4^th and 5^th fingers of the non-dominant hand), autorefraction, ocular response analyzer, heart rate and blood pressure, questionnaires to assess the number of days during the previous month with headache, aura, cold hands, hearing loss, insomnia, and reduced thirst, and the European Quality of Life-5 Dimensions (EQ-5D) questionnaire. A DH+ visit was defined as the presence of a DH in one or both eyes based on fundus photography. All visits started with the questionnaires and nailbed capillaroscopy; the patient and examiner were unaware of that visit DH status.
In all included participants and for all variables, the difference between the mean of DH+ visits was compared with a paired t-test with the mean value of DH- visits.

Results : Four patients were excluded from this analysis because all of their visits were classified as DH+. The 26 included participants attended 127 scheduled visits, 64 were DH+ and 63 DH-. Nailbed haemorrhages were identified in 24 (38%) of DH+ visits compared to 31 (49%) of the DH- visits (p= 0.183). In 44% of the visits, the same haemorrhage status was identified in the disc and the nailbed. Continuous variables are presented in Table 1. A higher corneal resistance factor (CRF) was identified in each eye during DH+ visits. Although it was not statistically significant, there was a trend toward more headaches during DH+ visits. IOP values were very similar between DH+ and DH-visits.

Conclusions : There was a tendency toward more headaches during DH+ visits. The CRF was higher in both eyes during DH+ visits, although it is unlikely to change between visits. The difference in CRF may be related to IOP or multiple testing. There was a high rebleeding rate in the disc and nailbed. The trends observed over only 5 visits in this small exploratory study warrant further investigations comparing systemic and ocular variables between DH+ and DH- visits.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.