Chronic glaucoma (Primary open-angle glaucoma)

Question 1

Glaucoma is a common eye condition where the optic nerve is damaged due to a rise in intraoccular pressure (IP). The IP is typically due to a blockage in the aqueous humour leaving the eye. What is the prevalence of chronic glaucoma in the UK in 80 year old?

1 - 25%
2 - 15%
3 - 10%
4 - 5%

Answer 1

4 - 5%

This is 2% in 40 years olds

Question 2

Is chronic glaucoma more common in men or women?

Answer 2

• women
• 3:1

Question 3

Which of the following is NOT typically a risk factor for chronic glaucoma?

1 - age
2 - positive family history
3 - African-Caribbean decent
4 - T1DM

Answer 3

4 - T1DM

Question 4

Chronic glaucoma is defined as a progressive optic neuropathy which has characteristic optic nerve changes, visual field changes and may also be associated with raised intraoccular pressure. Do patients typically present immediately with this?

Answer 4

• no
• patients are typically asymptomatic until significant visual field loss has occurred

Question 5

In chronic glaucoma, there is chronic damage to the optic nerve. Do patients typically experience pain with this?

Answer 5

• no

acute = severe pain
chronic = no pain

Question 6

In acute glaucoma, there is increased intraoccular pressure that causes the iris to bulge and push, blocking drainage of aqueous humour into trabecular meshwork, leading to increased intraoccular pressure. Does this occur in chronic gluacoma?

Answer 6

• no

Question 7

In patients with chronic glaucoma, serious and irreversible visual defects are common. Once this occurs, can this be reversed?

Answer 7

• no

Question 8

In chronic glaucoma the intraoccular pressure can rise above the normal intraoccular pressure, which is what?

1 - 1-5mmHg
1 - 5-15mmHg
3 - 10-21mmHg
4 - 15-30mmHg

Answer 8

3 - 10-21mmHg

Sustained pressure above this is what damages the retinal ganglion cells and their axons

Question 9

In a healthy eye would we expect to see a high, low or roughly equal cup to disc ratio?

Answer 9

• healthy eye = roughly equal cup to disc ratio

Can be small as well

Question 10

Can the severity and chronicity of glaucoma be judged on the cup to disc ratio?

Answer 10

• yes

More damage typically means the cup will be larger

• optic disc = optic nervce entering the eye

Question 11

Although chronic glaucoma can often go undetected until significant visual defects occur, what is the optimal approach to managing patients with suspected chronic glaucoma?

1 - commence >65 on mannitol (hyperosmotic agent)
2 - screen high risk patients, and encourage regular optometry eye checks
3 - provide equipment at patients home to screen themselves
4 - 1 - commence >45 on mannitol (hyperosmotic agent)

Answer 11

2 - screen high risk patients, and encourage regular optometry eye checks

Allows for the detection of early glaucoma signs and initiate treatment to prevent sight loss

Question 12

Once a patient has glaucoma, can it be stopped?

Answer 12

• no

It can be slowed, but not stopped.

Slowing its progression ensure patients sight for as long as possible

Question 13

There are 3 main groups for therapy for chronic glaucoma, drugs, surgery or laser therapy. One of the drugs is Acetazolamide. How is this drug used to treat chronic glaucoma?

1 - Carbonic anhydrase inhibitor, reducing production of aqueous humour
2 - osmosis, draining aqueous humour from the eye into the blood
3 - beta blocker, reducing production of aqueous humour
4 - sympathomimetic, reducing reducing production of aqueous humour and increase uveoscleral outflow

Answer 13

1 - Carbonic anhydrase inhibitor, reducing production of aqueous humour

Typically given orally

Question 14

There are 3 main groups for therapy for chronic glaucoma, drugs, surgery or laser therapy. One of the drugs is Timolol. How is this drug used to treat chronic glaucoma?

1 - Carbonic anhydrase inhibitor, reducing production of aqueous humour
2 - osmosis, draining aqueous humour from the eye into the blood
3 - beta blocker, reducing production of aqueous humour
4 - sympathomimetic, reducing reducing production of aqueous humour and increase uveoscleral outflow

Answer 14

3 - beta blocker, reducing production of aqueous humour

Question 15

There are 3 main groups for therapy for chronic glaucoma, drugs, surgery or laser therapy. One of the drugs is Latanoprost. How is this drug used to treat chronic glaucoma?

1 - synthetic prostaglandin, reduces intraoccular pressure
2 - osmosis, draining aqueous humour from the eye into the blood
3 - beta blocker, reducing production of aqueous humour
4 - sympathomimetic, reducing reducing production of aqueous humour and increase uveoscleral outflow

Answer 15

1 - synthetic prostaglandin, reduces intraoccular pressure

Question 16

In chronic glaucoma, laser therapy can be used. Typically which part of the eye is targeted using laser therapy?

1 - iris
2 - trabecular meshwork
3 - lens
4 - cornea

Answer 16

2 - trabecular meshwork

Called a trabeculoplasty

Helps drain aqueous humour

Question 17

Surgery can also be performed for patients with chronic glaucoma. What part of the eye is typically treated?

1 - iris
2 - trabecular meshwork
3 - lens
4 - cornea

Answer 17

2 - trabecular meshwork

Called a trabeculectomy