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Editors Selection IGR 22-4

Clinical Examination Methods: Higher Temperatures and Disc Hemorrhage

Tanuj Dada
Saurabh Verma

Comment by Tanuj Dada & Saurabh Verma on:

98896 Analysis of Variation in Incidence of Optic Disc Hemorrhage According to Seasonal and Temperature Changes, Jang M; Kim YK; Jeoung JW et al., American Journal of Ophthalmology, 2022; 239: 84-89


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Jang et al. evaluated the seasonal variation in optic disc hemorrhage (DH) by review of fundus photographs over two years to answer the research question ‐ what is the impact of temperature on the incidence of DH in glaucoma patients?

Fundus images of 13,514 eyes were reviewed, and 454 eyes (3.36%) were confirmed to have DH. The DH incidence ratio was 1.53 (95% CI 1.23-1.91, P < .01) for the Temperature (T) < 10 °C group relative to the T ≥ 20 °C group. The IOP of the patients with DH in winter was significantly higher than that measured in summer and an increase in temperature by 1 °C, was associated with a reduction in the DH risk ratio to 0.979 (95% confidence interval [CI] 0.969-0.989, P < .01). The study concluded that DH is affected by temperature, and as such, shows seasonal variability.

This variation is in line with several studies that have shown seasonal variability in IOP which tends to be higher in colder months.1,2 Elevated IOP in winter months leading to stretching of the lamina cribrosa and mechanical vascular disruption may be a possible cause for this variation.

Additionally, more than 64% of eyes with DH were diagnosed cases of normal-tension glaucoma (NTG) an entity where vascular dysregulation is a major contributing factor to disease pathogenesis.3 Patients of primary vascular dysregulation are known to respond unfavorably to cold temperatures leading to an increase vasospasm. Females constituted almost two thirds of the total cases of DH and vascular dysregulation is also known to be more common in females.4 The higher incidence of DH in winter months can also be attributed to vascular dysregulation due to autonomic dysfunction, which is exacerbated by colder temperatures and impact on blood coagulability and plasma viscosity. However, this was not evaluated in the present study.

A significant proportion of patients (almost 44%) with DH had diabetes or hypertension which are independent risk factors for DH and a separate analysis evaluating concomitant changes in blood pressure/glycemic control would be a useful addition to study seasonal variation of DH in this subgroup group. Although the study reports variation in DH with temperature, the clinical significance of these results requires further evaluation related to the impact on disease progression and additional imaging modalities such as OCT angiography to establish objective changes in peripapillary circulation.

References

  1. Kuze M, Ayaki M, Yuki K, et al. Seasonal variation of intra-ocular pressure in glaucoma with and without dry eye. Sci Rep. 2020;10(1):13949.
  2. Mansouri K, Gillmann K, Rao HL, Weinreb RN. Weekly and seasonal changes of intraocular pressure measured with an implanted intraocular telemetry sensor. Br J Ophthalmol. 2021;105(3):387-391.
  3. Flammer J, Konieczka K, Flammer AJ. The primary vascular dysregulation syndrome: implications for eye diseases. EPMA Journal. 2013;4(1):14.
  4. Grieshaber MC, Mozaffarieh M, Flammer J. What Is the Link Between Vascular Dysregulation and Glaucoma? Survey of Ophthalmology. 2007;52(6):S144-154.


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