Long-Term Clinical Course and Progression Patterns of Normal-Tension Glaucoma Following Disc Hemorrhage.

Area of Science:

• Ophthalmology
• Glaucoma Research
• Retinal Imaging Analysis

Background:

• Normal-tension glaucoma (NTG) is a progressive optic neuropathy.
• Disc hemorrhage (DH) is a known risk factor for progression in NTG.
• Understanding long-term RNFL thinning patterns post-DH is crucial for patient management.

Purpose of the Study:

• To determine the long-term clinical course of retinal nerve fiber layer (RNFL) thinning in normal-tension glaucoma (NTG) eyes after disc hemorrhage (DH).
• To identify patterns of progressive RNFL thinning and associated risk factors.
• To analyze factors influencing distinct progression and stabilization patterns.

Main Methods:

• Longitudinal case series of 227 NTG eyes followed for at least 10 years post-DH.
• Assessment of global RNFL thinning rates using linear and nonlinear regression.
• Risk factor and pattern analysis using random-forest modeling and SHAP analysis.

Main Results:

• 93.8% of eyes showed significant RNFL thinning; 33.0% had nonlinear progression.
• Key predictors of rapid thinning included more IOP-lowering medications, less severe visual field damage, and smaller %IOP reduction.
• Decelerating progression was linked to thicker lamina cribrosa, greater %IOP reduction, more medications post-DH, and younger age.

Conclusions:

• RNFL thinning post-DH presents diverse patterns, with many eyes achieving late-phase stabilization.
• Factors suggesting reduced mechanical stress appear to attenuate glaucoma progression after DH.
• Clinical features indicating lower mechanical stress are likely important in slowing glaucoma progression.