Glaucoma

Question 1

Strong RF for Glaucoma

Answer 1

SHIBA

S - Steroids
H - Heritage
I - IOP
B - Blacks
A - Age (+40)

Question 2

Weak RF for Glaucoma

Answer 2

My Sweet Hyp!
My - Myopia
Sweet - DM
Hyp - HTN

Question 3

Primary Open-angle glaucoma appears in _____% of the population above the age of 45.

Answer 3

0.5-1%

Question 4

Ocular HTN w/o glaucoma appears in _____% of the population above the age of 45.

Answer 4

10%

Question 5

RF for transition from Ocular w/o glaucoma HTN to Glaucoma are:

Answer 5

PIRAT

P - PSD increase (Pattern of standard deviation)
I - IOP (the higher the riskier)
R - Ratio (cup to dick ratio - CDR, normal is 0/3)
A - Age
T - Thin CCT (Central corneal thickness)

Question 6

Thick cornea - IOP pressure recorded is ____than the truth

Thin cornea - IOP pressure recorded is ____than the truth

Answer 6

Thick cornea -> IOP pressure recorded is lower than the truth
Thin cornea -> IOP pressure recorded is higher than the truth

Question 7

When treating a glaucoma patient we have to determine his individual_______.

Answer 7

Target pressure.

Question 8

Target pressure is ______

Answer 8

20% below the pressure known to cause damage.

Question 9

___% of glaucoma patients will have a normal exam on their first doctor’s appointment

Answer 9

30%

Question 10

An increase in IOP causes cupping on the ____ aspect of the disc.

Answer 10

inferior

Question 11

What are the mechanisms (or theories) of high IOP causing glaucoma?

Answer 11

Mechanical and Avascular.

Question 12

Mechanisms (or theories) of high IOP causing glaucoma - elaborate on the mechanical mechanism.

Answer 12

Increase IOP presses on nerve fibers passing through the scleral canal (exit point out of the eye) -> disrupts axoplasmic flow -> atrophy

Question 13

Mechanisms (or theories) of high IOP causing glaucoma - elaborate on the avascular mechanism.

Answer 13

Increase IOP harms ocular perfusion -> ischemia and atrophy.

Question 14

Blood pressure issues may cause _____ that may lead to retinal ganglion cell death.

Answer 14

nocturnal BP dip and ischemia

Question 15

Every glaucoma patient goes through _____

Answer 15

Visual field testing (for potential damage assessment)

Question 16

When examining a with a Goldman goniolens we pay attention to____

Answer 16

Pigmented trabecular meshwork.

Question 17

Explain the grading system of the proximity of the iris to the Pigmented trabecular meshwork.

Answer 17

0-4
0 = no filtering (completely blocked)
1 = partily blocked

Question 18

Explain the grading system of the proximity of the iris to the Pigmented trabecular meshwork.

Answer 18

0-4
0 = no filtering (completely blocked - angle closure)
1 = partially blocked

Question 19

______ are cells that clean the Pigmented trabecular meshwork.

Answer 19

Goniocytes.

Question 20

Classification of glaucoma:

Answer 20

CaPSiD

Ca - Closed-angle
P -Primary open-angle
i
S - Secondary
D - Developmental

Question 21

Classification of glaucoma - subdivide Primary open-angle glaucoma:

Answer 21

PEN:
P - Pigment
E - Exfoliation
N - Normal tension

Question 22

Normal tension glaucoma pathophysiology:

Answer 22

Oversensitivity to tension and/or malperfusion.

Question 23

Pigmentary glaucoma finding:

Answer 23

Transillumination in mid-periphery iris.

Question 24

Closed-angle glaucoma pathophysiology:

Answer 24

Pupillary block combined with a narrow-angle, to begin with.

Question 25

______ are seen on chronic closed-angle glaucoma

Answer 25

Anterior synechia

Question 26

Classification of glaucoma - subdivide Developmental glaucoma:

Answer 26

Primary developmental - seen at birth (0-3 months) Infantile - 3 months to 3 years. Juvenile - 3 to 35 years.

Question 27

Classification of glaucoma - subdivide Secondary glaucoma:

Answer 27

HD PAINT H - Hemorrhage (clots) D - Drugs (steroids) ``` P - Phacogenic A - Absolute I - Inflammatory N - Neovascular T - Trauma (and scars) ```

Question 28

Subdivide phacogenic glaucoma:

Answer 28

Mature cataract (pushes iris forword) or subluxation of the lens (pupillary block -> iris moved forward).

Question 29

What is absolute glaucoma?

Answer 29

condition of complete atrophy and blindness due to uncontrollable IOP from an unknown reason.

Question 30

IOP of ____ can cause closure of the retinal artery.

Answer 30

60-70

Question 31

sign of acute angle closer glaucoma:

Answer 31

Fixed PHoNER Fixed - Fixed mid dilated pupil ``` P - Pain (eyes and head) H - Halos o N - Nausea/vomiting E - Endothelial pump dysfunction (blurry vision) R - Redness ```

Question 32

Fixed mid dilated pupil in acute angle closer glaucoma is due to

Answer 32

sphincter papillae unreactive due to ischemia

Question 33

Treatment of acute angle closer glaucoma:

Answer 33

CHeaP Laser! C - CAI (Aqueous production decrease) H - Hyperosmotics (IV mannitol - if vomiting, PO glycerol) P - Pilocarpine (Miosis - sphincter papillae) Day after - Yag laser. All thee CHeaP drugs are given at the same time!

Question 34

Pilocarpine usage:

Answer 34

3-4 times every 10 minutes, may not react immediately because of ischemic sphincter papillae. As IOP starts to drop, the drug will take effect.

Question 35

Describe Goniodysgenesis

Answer 35

Dysgenesis trabecular meshwork. - looks open but the function is impared.

Question 36

Congenital glaucoma epidemiology: Incidence? M: F? Bilateral?

Answer 36

Congenital glaucoma epidemiology: Incidence - 1:10,000 (90% sporadic) M: F - 65% Boys Bilateral in 75%

Question 37

Congenital glaucoma signs:

Answer 37

``` BiSHoPED: Buphthalmos i S - Spasm (Blepharospasm) H - Hazy large cornea o P - Photophobia E - Epiphora D - Decrement tears ```

Question 38

Congenital glaucoma treatment:

Answer 38

Surgical! Trabeculectomy or Goniotomy watch shot animation!

Question 39

Common scotoma in glaucoma is _____

Answer 39

Paracentral

Question 40

Paracentral scotomas can develop into

Answer 40

Archoid

Question 41

Contraindications of BB therapy?

Answer 41

ABC A - Asthma/ AV block B - Bradycardia C - COPD

Question 42

BB therapy drug commonly used? and characteristics?

Answer 42

Timolol - rule of 0.5: usually 0.5 % Begins to work after 0.5 hour for 0.5 a day The peak is at 2 hours. decease IOP by 25%

Question 43

Lasers used in glaucoma therapy?

Answer 43

Yag, ALT. SLT

Question 44

Drug of choice for open-angle glaucoma?

Answer 44

Prostaglandins.

Question 45

Lasers used in glaucoma therapy characteristics?

Answer 45

The effect lasts for 2 years, with maximum effect after 2 months. IOP decrease is about 9 mm angle has to be open to perform procedure

Question 46

Surgeries used in glaucoma therapy?

Answer 46

TIC! T - trabeculectomy (filtration) I - Implant C - ciliary body ablation watch shot animation!