Longitudinal Association Between Disc Hemorrhage and Primary Open-Angle Glaucoma Progression: A Systematic Review and Meta-Analysis

Optic disc hemorrhages (DH) are one of the hallmark signs of primary open-angle glaucoma (POAG). However, due to the scarcity of longitudinal reports, the influence of baseline DH on the progression of POAG and its subtype, normal tension glaucoma (NTG), remains unclear. We conducted a systematic review with meta-analysis to determine the association of baseline DH with progression of POAG and NTG. PubMed, Embase, Cochrane, SCOPUS, and Web of Science were searched from inception till July 1, 2025. POAG and NTG progressions were defined based on functional or structural changes. Following the PRISMA guidelines and a PROSPERO-registered protocol (CRD42021292572), two authors selected observational studies reporting glaucomatous progression in patients aged 18 years and above. We performed random-effects meta-analysis to estimate the pooled odds ratio (OR) for the association between baseline DH and progression of POAG and NTG. Additionally, we also performed a qualitative analysis for data on the location of DH and its association with visual field deterioration. We included 22 papers comprising seven prospective cohort studies and 15 retrospective cohort studies. Baseline DH was associated with the progression of POAG (OR = 4.51; 95% CI (confidence interval) = 3.24 to 6.26; I2 = 44.2%) and NTG (OR = 5.15; 95% CI = 3.72–7.14; I2 = 29%). DH were most commonly observed inferotemporally, with a topological association between the location of DH and the site of visual field deterioration. DH is an important predictor for POAG progression, particularly for NTG. The presence of baseline DH in POAG patients may warrant closer monitoring of retinal nerve fibre layer thinning and visual field loss.