Chronic Glaucoma

Question 1

What is Glaucoma?

Answer 1

a group of eye diseases which cause progressive optic neuropathy commonly associated with raised intraocular pressure

Question 2

What is the most common condition associated with open anterior chamber angle of the eye?

Answer 2

Primary open-angle glaucoma (POAG)

Question 3

Describe the pathophysiology of primary open angle glaucoma:

Answer 3

1. Although the anterior chamber angle is open, there is resistance to the outflow of aqueous humour through the trabecular meshwork into the canal of Schlemm
2. This causes increased intraocular pressure which can cause retinal ganglion death and permanent visual loss

Question 4

Give 6 risk factors of primary open angle glaucoma:

Answer 4

1. Increasing age (65+)
   2 Afro-Caribbean ethnic origin
   3.T2 diabetes
2. Family history
3. Cardiovascular disease
4. Myopia

Question 5

What is myopia?

Answer 5

Short-sightedness

Question 6

is primary open-angle glaucoma (POAG) chronic or acute?

Answer 6

Chronic

Question 7

Does primary open-angle glaucoma often affect one or both eyes?

Answer 7

both

Question 8

True or false: most cases of primary open angle glaucoma are asymptomatic

Answer 8

true

Question 9

Describe the sequence of peripheral vision loss seen in primary open angle glaucoma:

Answer 9

the superior visual field is lost first, followed by the inferior visual field

Question 10

What classic fundoscopy finding is associated with primary open angle glaucoma?

Answer 10

cupped optic disc

Question 11

When does central vision loss occur in POAG?

Answer 11

Central vision loss occurs at the end stage of POAG

Question 12

Name 5 specialist investigations used to assess primary open angle glaucoma:

Answer 12

1) tonometry
2) fundoscopy
3) visual field assessment
4) gonioscopy
5) central corneal thickness measurement

Question 13

What ratio is used to assess the health of the optic disc in glaucoma fundoscopy?

Answer 13

optic-cap-to-disc ratio

Question 14

What is a normal optic-cap-to-disc ratio?

Answer 14

less than 0.5

Question 15

What does a pale optic disc indicate?

Answer 15

primary optic nerve atrophy.

Question 16

Why is central corneal thickness measured when assessing primary open angle glaucoma?

Answer 16

intraocular pressure measurement scan be affected by central corneal thickness and so this is done so allowances can be made

Question 17

What is the IOP threshold for primary open angle glaucoma treatment?

Answer 17

> 24

Question 18

What is the name of the laser management for primary open angle glaucoma treatment?

Answer 18

360 degrees selective laser trabeculoplasty

Question 19

What does 360 degree selective laser trabeculoplasty involve?

Answer 19

using short pulses of low energy light to target particular cells in the eye, triggering the eye to build a meshwork that will function effectively to drain aqueous humour

Question 20

What is the first line eye drop medication used to treat primary open angle glaucoma?

Answer 20

generic prostaglandin analogue such as latanoprost

Question 21

Other than latanoprost, give 3 other eye drops that are used to treat primary open angle glaucoma:

Answer 21

1) beta blockers (timolol)
2) carbonic anhydrase inhibitors (acetazolamide)
3) parasympathomimetics (pilocarpine)

Question 22

What are the side effects of latanoprost?

Answer 22

Brown pigmentation of iris/lids/lashes

Question 23

What surgery is used to treat advanced cases of primary open angle glaucoma?

Answer 23

trabeculectomy

Question 24

How does trabeculectomy surgery treat primary open angle glaucoma?

Answer 24

creating a channel in the sclera for aqueous humour to drain

Question 25

What drug is given alongside trabeculectomy surgery to prevent post-operative scarring?

Answer 25

mitomycin C

Question 26

What is mitomycin-C?

Answer 26

an antimetabolite used during the initial stages of trabeculectomy to prevent excessive postoperative scarring and therefore reduce the risk of failure.

Question 27

What is the main complication of untreated Glaucoma?

Answer 27

irreversible loss of vision

Question 28

What is the DVLA policy on driving with glaucoma?

Answer 28

DVLA requires patients to inform them of a new diagnosis of glaucoma if it affects both eyes (group 1 drivers) or one eye for group 2 commercial drivers