Clinical and ocular factors associated with visual field progression following optic disc haemorrhage in glaucoma

Background To investigate the structural and clinical factors linked to visual field (VF) progression in glaucomatous eyes after the initial detection of optic disc haemorrhage (DH) in patients with primary open-angle glaucoma (POAG). Methods This study included 92 eyes of 92 patients who presented with at least one optic DH on stereoscopic optic disc and red-free photography. The included patients had a minimum follow-up of 3 years after initial detection of DH and at least 5 reliable standard automated perimetry investigations. VF progression was assessed using event-based guided progression analysis (GPA). Baseline demographic, clinical, and ocular parameters were examined using Cox proportional hazards regression to identify the independent predictors of functional deterioration. Results Among the patients, 32 (34.8%) showed VF progression and 60 (65.2%) remained stable. In univariate analysis, recurrent DH, longer axial length, thinner central corneal thickness (CCT), and intraocular pressure (IOP) fluctuation were significantly associated with VF progression. In multivariate analysis, recurrent DH (HR 4.008, p < 0.001), longer axial length (HR 1.287, p = 0.005), thinner CCT (HR 0.865, p = 0.005), and greater IOP fluctuation (HR 1.997, p = 0.032) remained independently associated with VF progression. Conclusions Recurrent DH, longer axial length, thinner CCT, and greater IOP fluctuation were independently associated with VF progression following optic DH. These factors may help identify glaucomatous eyes at higher risk of progression and support closer clinical monitoring after the initial detection of DH.