Glaucoma

Question 1

What is glaucoma?

Answer 1

A group of ocular diseases leading to optic neuropathy and peripheral vision loss

Characterized by thinning of the retinal nerve fibre, cupping of the optic disc, and peripheral field vision loss.

Question 2

What are the two main types of glaucoma?

Answer 2

• Open-angle glaucoma
• Angle-closure glaucoma

These types refer to the state of the anterior chamber angle.

Question 3

What is the most important and only modifiable risk factor for glaucoma?

Answer 3

Elevated intraocular pressure (IOP)

Ocular hypertension is critical in the pathogenesis of glaucoma.

Question 4

List some symptoms associated with acute types of glaucoma.

Answer 4

• Eye pain
• Blurred vision
• Halos around lights
• Headache
• Nausea and vomiting

Symptoms warrant urgent referral to an ophthalmologist.

Question 5

What are the goals of therapy for glaucoma?

Answer 5

• Prevent, halt or slow progressive visual loss
• Preserve the structure and function of the optic nerve
• Eliminate pain and improve vision in acute forms
• Improve quality of life and functional vision

These goals guide treatment strategies.

Question 6

What is the significance of gonioscopy in glaucoma assessment?

Answer 6

Examines the anterior chamber angle

Important for determining the type of glaucoma.

Question 7

True or false: Screening for elevated IOP alone is sufficient for detecting glaucoma.

Answer 7

FALSE

Up to 50% of people with glaucoma may have normal IOP.

Question 8

What are some risk factors for open-angle glaucoma?

Answer 8

• Elevated intraocular pressure
• Advanced age
• Positive family history
• Myopia
• Vascular diseases
• Type 2 diabetes mellitus
• Female gender

These factors contribute to the development of glaucoma.

Question 9

What is the definitive treatment for acute angle-closure glaucoma?

Answer 9

Laser iridotomy or surgical iridectomy

Aggressive medical treatment is required until the procedure is performed.

Question 10

Name a first-line therapy for lowering IOP in open-angle glaucoma.

Answer 10

• Prostaglandin analogues (e.g., latanoprost, travoprost)

These agents increase outflow of aqueous humor.

Question 11

What are beta-blockers used for in glaucoma treatment?

Answer 11

Decrease IOP by inhibiting aqueous humor formation

Examples include timolol and betaxolol.

Question 12

What are carbonic anhydrase inhibitors used for?

Answer 12

Lower IOP by inhibiting aqueous humor production

Examples include dorzolamide and brinzolamide.

Question 13

What is the role of fixed-combination preparations in glaucoma treatment?

Answer 13

Improve adherence and reduce cumulative exposure to preservatives

These products combine multiple agents for convenience.

Question 14

What is the most common preservative in eye drops?

Answer 14

Benzalkonium chloride

It can cause allergic reactions and ocular surface damage.

Question 15

What are oral carbonic anhydrase inhibitors used for?

Answer 15

Lower IOP by decreasing aqueous humor production

Reserved for emergencies due to significant adverse effects.

Question 16

What is the Canadian Ophthalmological Society’s stance on cannabis for glaucoma treatment?

Answer 16

Does not support its use

The text cuts off before providing further details.

Question 17

The likelihood of cross-reactivity between nonantibacterial sulfonamides and sulfonamide antibiotics is extremely low due to what?

Answer 17

Significant differences in chemical structures

This is supported by data from clinical trials.

Question 18

The Canadian Ophthalmological Society does not support the use of cannabis for the treatment of what condition?

Answer 18

Glaucoma

Due to short duration of action and undesirable psychotropic and systemic side effects.

Question 19

What are the two main cannabinoids mentioned that affect IOP regulation?

Answer 19

• Tetrahydrocannabinol (THC)
• Cannabidiol (CBD)

CBD can elevate IOP and interfere with the IOP-lowering effects of THC.

Question 20

To reduce systemic absorption of topical glaucoma medications, patients should perform what action after instillation?

Answer 20

Digital occlusion of the nasolacrimal drainage system

This should be done for several minutes following instillation.

Question 21

Patients should wait how many minutes between the instillation of different eye drops?

Answer 21

5 minutes

This is to avoid washout of previously administered medication.

Question 22

Patients using soft contact lenses should wait at least how many minutes after each dose before reinserting lenses?

Answer 22

15 minutes

This is to ensure proper absorption of the medication.

Question 23

True or false: Nonprescription antihistamine products are safe for use in patients with glaucoma.

Answer 23

FALSE

They may have potential anticholinergic side effects.

Question 24

What is the primary caution regarding intermittent use of medications with anticholinergic effects in glaucoma patients?

Answer 24

Can precipitate angle-closure glaucoma in predisposed individuals

Particularly in elderly females with specific risk factors.

Question 25

What is the **first-line treatment** for open-angle glaucoma according to management algorithms?

Answer 25

Individual patient factors must always be considered ## Footnote Treatments are presented in usual order of preference.

Question 26

What are the **adverse effects** of brimonidine 0.2%?

Answer 26

* Local allergic reaction * Dry mouth * Tachycardia * Hypotension * Headache * Tremor ## Footnote Contraindicated with MAO inhibitors.

Question 27

What is the **dosage** for brimonidine 0.15%?

Answer 27

1 drop Q8H ## Footnote It has a lower incidence of ocular allergy than brimonidine 0.2%.

Question 28

What is the **cost range** for apraclonidine 0.5%, 1%?

Answer 28

$15–30 ## Footnote It is rarely used chronically due to a high incidence of ocular allergy.

Question 29

What are the **systemic effects** of beta-blockers like timolol?

Answer 29

* Bronchospasm * Exacerbation of CHF * Dyspnea * Bradycardia * Hypotension * Syncope * Depression * Impotence * Altered response to hypoglycemia * Reduction of high-density lipoproteins ## Footnote Avoid in patients with asthma or severe chronic obstructive pulmonary disease.

Question 30

What is the **dosage** for dorzolamide 2% as monotherapy?

Answer 30

1 drop Q8H ## Footnote It can also be used as adjunctive therapy at 1 drop Q12H.

Question 31

What are the **adverse effects** of pilocarpine?

Answer 31

* Reduced vision in cataracts * Blurred vision due to refractive shift * Brow ache * GI upset (rare) * Retinal tear/detachment (rare) ## Footnote Poorly tolerated in children and younger adults.

Question 32

What is the **recommended dosing** for bimatoprost?

Answer 32

1 drop once daily in the evening ## Footnote Once-daily dosing should not be exceeded.

Question 33

What is the **combination** of brimonidine 0.2% and timolol 0.5% known as?

Answer 33

Combigan ## Footnote It has local and systemic adverse effects similar to its individual components.

Question 34

What is the **cost range** for acetazolamide?

Answer 34

< $15 ## Footnote It is contraindicated in patients with hepatic dysfunction.

Question 35

What are the **side effects** of methazolamide?

Answer 35

* Paresthesias of the extremities * Metabolic acidosis * Hypokalemia * GI upset * Urolithiasis * Lethargy and depression * Aplastic anemia (rare) * Stevens-Johnson syndrome (rare) ## Footnote Side effects are less severe than with acetazolamide.

Question 36

What are some **side effects** of the medication mentioned?

Answer 36

* Paresthesias of the extremities * Metabolic acidosis * Hypokalemia * GI upset * Urolithiasis * Lethargy and depression * Aplastic anemia (rare) * Stevens-Johnson syndrome (rare) ## Footnote Side effects are less severe than with acetazolamide.

Question 37

In which patients is the medication **contraindicated**?

Answer 37

* Patients with hepatic dysfunction * Patients with renal insufficiency ## Footnote Contraindications are important to consider for patient safety.

Question 38

What does the abbreviation **CHF** stand for?

Answer 38

congestive heart failure ## Footnote Abbreviations are commonly used in medical contexts for efficiency.

Question 39

What does the abbreviation **CNS** stand for?

Answer 39

central nervous system ## Footnote Understanding abbreviations is crucial for interpreting medical documents.

Question 40

What does the abbreviation **GI** stand for?

Answer 40

gastrointestinal ## Footnote GI refers to the digestive tract and related organs.

Question 41

What does the abbreviation **MAO** stand for?

Answer 41

monoamine oxidase ## Footnote MAO is an enzyme that breaks down neurotransmitters in the brain.

Question 42

True or false: **Dosage adjustment** may be required in renal impairment.

Answer 42

TRUE ## Footnote It is important to adjust dosages based on renal function to avoid toxicity.

Question 43

What is included in the cost of the smallest available pack size or **30-day supply** for oral medications?

Answer 43

Drug cost only ## Footnote This cost does not include other potential expenses such as consultations or additional treatments.

Question 44

How are **ophthalmic solutions** applied?

Answer 44

In affected eye(s) ## Footnote Proper application is essential for the effectiveness of ophthalmic treatments.