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Etiology > Glaucoma > Flashcards

Glaucoma Flashcards

(53 cards)

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1
Q

Primary open angle glaucoma is more common in what races?

A

Blacks and latinos

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2
Q

What is the second leading cause of blindness?

A

cataracts

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3
Q

Worldwide, how many people have glaucoma?

A

over 60 million

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4
Q

What is the difference between open angle glaucoma and closed angle glaucoma?

A

Open angle - aqueous has open access to trabecular meshwork

close angle - trabeculum is blocked by iris and aqueous cannot drain from eye. IOP rise

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5
Q

What is the leading cause of irreversible blindness in the US?

A

Glaucoma

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6
Q

How many Americans have Glaucoma in the US?

A

3 milllion

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7
Q

How many genes have been linked to glaucoma?

A

5 - 10

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8
Q

What is the MYOC gene thought to affect?

A

protein unfolding in the TM

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9
Q

What is the E50K mutation though to affect?

A

familial POAG. Optineurin collects in OPL of retina and decreases retinal ganglion cells without affecting IOP

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10
Q

What’s the difference between infantile and juvenile glaucoma?

A

infantile - before 2 years of age

juvenile - after 2 years of age

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11
Q

What is the clinical triad that indicates congenital/infantile glaucoma?

A

Epiphora
blepharospasm
photophobia

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12
Q

Why does the eye look bluer in congenital/infantile glaucoma?

A

Choroid is more easily visualized through thinner sclera

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13
Q

What are diurnal IOP norms?

A

about 3.7 - normal
over 5 - should be watched
over 10 - definitely suspect

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14
Q

What are optic disc size norms?

A

2.69 +/- 0.70 mm

two deviations away is considered macro/micro

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15
Q

Optic disc is typically larger in what meridian? Cups are typically larger in what meridian?

A

disc - larger vertical

cup - larger horiztonal

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16
Q

How much of the asian population have narrow angles that put them at risk for glaucoma?

A

1/6

1/200 whites are at risk…

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17
Q

The prevalence of glaucoma at age 20 is __% and does what every decade?

A

at age 20 - 0.25%

Doubles every ten years

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18
Q

Females are more at risk for what type of glaucoma?

A

Closed angle

No significant difference in POAG

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19
Q

How much does glaucoma cost the US every year?

A

$4 billion

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20
Q

Why is there a link between hypothyroidism and POAG?

A

patients tends to have more hyaluronic ad in the TM which increases outflow resistance.

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21
Q

Why is there a link between hyperthyroidism and POAG?

A
  1. Enlarged EOMs compromising venous outflow, elevating episcleral venous pressure
  2. Fibrotic EOMs indent the globe. IR pushing on globe when patients look up
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22
Q

What is the link between Raynaud’s syndrome/migraines and POAG?

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A

vasoconstriction may lead to decreased vascular perfusion to the optic nerve

23
Q

What is the link between carotid artery disease and IOP?

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A

decreases IOP due to decreased perfusion pressure

24
Q

What is the link between corticosteroids and POAG? Who takes corticosteroids?

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A

increase IOP in 5-6% of normals after 4-6 weeks. Increases TM cell size. Increase in glucoaminoglycans in TM, suppression of endothelial phagocytosis of aqueous debris, steroid particles obstruct outflow
RA, asthma, COPD

25
What substances can lower IOP?
Alcohol, nitro, digitalis, beta blockers, Ca channel blockers, marijuana (for 3 hours)
26
Why does corneal edema happen more in angular closure glaucoma vs POAG?
angle closure - rise in IOP much more rapid than POAG
27
What percent damage is required to present an RAPD in glaucoma?
30% more damage in one eye than the other
28
Color vision usually presents what defect in Glaucoma?
blue/yellow
29
Are myopes or hyperopes more prone to glaucoma?
Myopes. May be due to the fact that myopes go to the eye doctor more.
30
Angle closure glaucoma happens more in hyperopes with what eye characteristics?
short axial length, shallow anterior chamber, anterior placed lens
31
To diagnose POAG, what must you perform?
Gonioscopy
32
What percent of newly diagnosed POAG patients have an IOP of 21 or less?
40%
33
True/false. Majority of patients with high IOP never develop glaucoma
True
34
IOP is _____ in thick cornes, and ____ in thin corneas
Overestimated in thick corneas Underestimated in thin corneas (thick corneas resist tonometry more?)
35
What did the 24 hour anaylsis of IOP and glaucoma reveal? (3)
In glaucoma: 1. Diurnal variation in IOP is higher 2. Day to night variation in IOP is lower 3. Posture-independent IOP different in glaucoma patients
36
Aqueous production is highest at what time of day? Lowest when?
highest - morning lower - afternoon half the morning rate during sleep
37
Ganglion cells make up __% of the tissue of the ONH while __% make up vasculature
90% ganglion cells | 10% capillaries, astrocytes, glial cells
38
What are the three theories of why the ONH changes with POAG?
1. Ischemic 1 - IOP reduces blood supply to ONH and lamina crushes axons 2. Ischemic 2 - Perfusion pressure inadequate to support adequate blood flow to ONH. Glaucoma patients lack good autoregulatory control with IOP increases 3. Lamina distortion - IOP compresses lamina which compresses arteries which kills axons and NFL
39
What is the axonic flow blockage theory?
Axonal trasnport at the lamina is stopped due to elevated IOP for long enough that NFL death occurs. Probably secondary to nutrition deficit. Mechanical compression of axonal bundles
40
How is Neurotrophin and Glutamate toxicity releated to glaucoma?
Neurotrophin - peptide involved in development of ganglion cells. Obstruction of neurotrophin results in RCG apoptosis Glutamate toxicity - accumulation of glutamate to toxic levels increases calcium ions and nitrous production
41
How could cup size be a definite sign of glaucoma?
document enlargement of the cup. a c/d above 0.6 always suggestive of possible glaucoma
42
What is barring of circumlinear vessels?
When the circumlinear vessel that usually outlines the cup is now inside the margins
43
What is bean pot enlargement?
When the retinal blood vessels diappear as they vollow the lateral excavation of the optic cup and reappaear the tbottom of the cup
44
What is vertical elongation?
When the c/d ration is longer by 0.2 vertically than horizontally
45
What is notching
Focal loss of ganglion cell axons | usually superior or inferior (most often inferior)
46
Bjerrum's area usually extends from central __ - __ degrees of the visual field
5 - 20 degrees of the visual field
47
how is symmetry in rim tissue important?
more likely to have glaucoma if there is a differnece in rim tissue between eyes
48
What is temporal unfolding?
enlargment of the cup resulting in the loss of temporal rim
49
how are distorted lamina dots important?
Oval lamina dots may indicate moderate glaucomatous damage
50
What is nerve fiber layer dropout?
Change in appearance of normal striated pattern of NFL around nerve head
51
What type of hemorrhage occurs at the ONH?
Drance Hemes. flame shaped. corresponding to shape of NFL. May appear round when hemorrhage is deeper in cup.
52
What is an acquired optic pit?
specific localized tissue loss in optic disc
53
What is peripapillary atrophy?
Acquired peripapillary atrophy can be focal or 360 around ONH. Soft sign of glaucoma

Etiology (3 decks)

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