Case 1 - Glaucoma

Question 1

hallmarks

Answer 1

1. Loss of retinal ganglia
2. Thinning of retinal layers
3. Cupping of optic disc
   * Cup-to-disc ratio > 0.8.
4. IOP > 35 mm Hg is not diagnostic of glaucoma, but can be associated with glaucoma
   * Almost all patients with this IOP level need IOP-lowering interventions.

Question 2

loss of retinal ganglia and thinning of retinal layers

Answer 2

• Glaucoma is an optic neuropathy in which the optic nerve axons are damaged, resulting in death of retinal ganglion cells (RGCs).
• The primary region of damage is thought to be the optic nerve head (ONH), with the lateral geniculate nucleus (LGN) and optic radiations to the visual cortex and the V1 itself being secondarily affected.
• Neurotrophin (BDNF) deprivation resulting from optic nerve injury is thought to cause RGCs to die by apoptosis by inhibition of cell survival pathways.

Question 3

cupping of disc

Answer 3

• ISNT rule in normal eyes
• RGCs are to undergo cell death by apoptosis after axonal injury
• This cell death and simultaneous loss of RGC axons is thought to be the cause of the excavated appearance of the ONH in glaucoma

Question 4

symptoms

Answer 4

mainly tunnel vision
painful eyes
red eyes
blurred vision

Question 5

biomarkers

Answer 5

• Intraocular pressure (IOP)
• When glaucoma is diagnosed using IOP, the level of retinal ganglion cell death usually amounts to 30–40%
• Cup disc ratio –> imaging
• 458 molecules are altered in concentration in glaucoma –> potential fluid biomarkers

Question 6

eye-brain

Answer 6

• Retina is part of CNS
• Eye shares vasculature
• BBB is similar to B-retina-B
• Several neurodegenerative disorders start by manifesting retinal problems
• Plaques, tangles, lewy bodies can be found in the retina

Question 7

genetics

Answer 7

myocilin –> mutations lead to higher IOP
optineurin –> mutation leads to increased RGCs apoptosis