Clinic: Glaucoma Workup Flashcards

1
Q

Provide a suggested sequence for a Glaucoma workup (8)

A

(VA) –> SL–> IOP –> Gonio –> pachymetry –> VF (dilation as doing) –> OCT –> Fundus lens –> Repeat IOP

NB: subject to change based on supervisor/patient. It’s variable. Could also include red cap perhaps?

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2
Q

Do you always have to do refraction on a glaucoma patient? Why/why not?

A

No. If we do refraction, we might not fit everything in. You need to prioritize based on patient’s needs/wants

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3
Q

How long after diagnosing glaucoma does the patient typically see an ophthalmologist? Does this vary?

A

4 months. But it’s up to the patient. Some patients are happy to just keep seeing the optom

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4
Q

How should you evaluate the RNFL in fundus examination for glaucoma? (3)

A

Look for:
superior + inferior dropout (loss of ISNT
Slit or wedge defects + assoc. notches in NRR
BDB presence/distribution (check with red free filter if needed)

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5
Q

List 7 reasons for glaucoma suspicion on fundus examination

A
Vertical notching
Loss of ISNT
increase in CD size over time
Deepening of cup 
CD asymmetry of > 0.2
Drance Haemorrhages
Baring of circumlinear vessels
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6
Q

What Visual field test options are there for glaucoma (3)

A

Humphrey 30-2 SITA standard
Humphrey 24-2 SITA standard
Medmond Fast Threshold

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7
Q

How should the patient be set up for visual field testing?

A

with near correction + px properly positioned and watched

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8
Q

What is the most important aspect to measure for OCT in a glaucoma patient?

A

Change over time

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9
Q

What OCT test should you perform on a glaucoma patient?

A

Mac Vertical (= Glaucoma TSNIT) (whereas mac horizontal is a more general scan and can be used for other conditions like AMD)

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10
Q

How many IOP measurements should you make, at minimum, when measuring IOP?

A

2 measurements per eye

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11
Q

What IOP value should we consider very seriously even in the absence of other findings?

A

Any IOP of 26mmHg or over

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12
Q

What CCT values are considered a risk factor for glaucoma?

A

<555 microns

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13
Q

When should you perform gonio on a glaucoma patient?

A

1st review and regularly thereafter. Measure deepest angle in all 4 quadrants + level of pigmentation if present.

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14
Q

How often do we generally review glaucoma patients?

A

Typically 6 or 12 monthly, depending on risk. Sometimes we’ll have 1 month reviews (e.g. if wanting to monitor the use of new drops)

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15
Q

What differential should we ensure we aren’t missing when assessing glaucoma?

A

Neurological problems

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16
Q

What should you consider in history for a glaucoma assessment? (3)

A

FOH: which relative, age of onset, type/duration, tx, effect on vision
Other Risk Factors: age>50yo, race (african), CV disease, DM, Migraines, Sleep apnoea, Myopia, Smoking
Relevant Meds: b-blockers, steroids, etc, any side effects of glaucoma meds such as breathing, sore eyes, cardiovascular