Chronic Glaucoma

Question 1

What is Chronic Glaucoma

Answer 1

Primary Open Angle Glaucoma
Raised IOP

Question 2

Risk Factors Chronic Glaucoma

Answer 2

increasing age
affects < 1’5 in individuals under 55 years of age
but up to 10% over the age of 80 years
genetics
first degree relatives of an open-angle glaucoma patient have a 16% chance of developing the disease
Afro Caribbean ethnicity
myopia
hypertension
diabetes mellitus
corticosteroids

Question 3

Chronic Glaucoma Present

Answer 3

peripheral visual field loss - nasal scotomas progressing to ‘tunnel vision’
decreased visual acuity
optic disc cupping

Question 4

Primary Open Angle Glaucoma Present on Fundoscopy

Answer 4

1. Optic disc cupping - cup-to-disc ratio >0.7 (normal = 0.4-0.7), occurs as loss of disc substance makes optic cup widen and deepen
2. Optic disc pallor - indicating optic atrophy
3. Bayonetting of vessels - vessels have breaks as they disappear into the deep cup and re-appear at the base
4. Additional features - Cup notching (usually inferior where vessels enter disc), Disc haemorrhages

Question 5

Investigations for POAG

Answer 5

automated perimetry to assess visual field
slit lamp examination with pupil dilatation to assess optic nerve and fundus for a baseline
applanation tonometry to measure IOP
central corneal thickness measurement
gonioscopy to assess peripheral anterior chamber configuration and depth
Assess risk of future visual impairment, using risk factors such as IOP, central corneal thickness (CCT), family history, life expectancy