Clinic: Glaucoma Workup Flashcards
Provide a suggested sequence for a Glaucoma workup (8)
(VA) –> SL–> IOP –> Gonio –> pachymetry –> VF (dilation as doing) –> OCT –> Fundus lens –> Repeat IOP
NB: subject to change based on supervisor/patient. It’s variable. Could also include red cap perhaps?
Do you always have to do refraction on a glaucoma patient? Why/why not?
No. If we do refraction, we might not fit everything in. You need to prioritize based on patient’s needs/wants
How long after diagnosing glaucoma does the patient typically see an ophthalmologist? Does this vary?
4 months. But it’s up to the patient. Some patients are happy to just keep seeing the optom
How should you evaluate the RNFL in fundus examination for glaucoma? (3)
Look for:
superior + inferior dropout (loss of ISNT
Slit or wedge defects + assoc. notches in NRR
BDB presence/distribution (check with red free filter if needed)
List 7 reasons for glaucoma suspicion on fundus examination
Vertical notching
Loss of ISNT
increase in CD size over time
Deepening of cup
CD asymmetry of > 0.2
Drance Haemorrhages
Baring of circumlinear vessels
What Visual field test options are there for glaucoma (3)
Humphrey 30-2 SITA standard
Humphrey 24-2 SITA standard
Medmond Fast Threshold
How should the patient be set up for visual field testing?
with near correction + px properly positioned and watched
What is the most important aspect to measure for OCT in a glaucoma patient?
Change over time
What OCT test should you perform on a glaucoma patient?
Mac Vertical (= Glaucoma TSNIT) (whereas mac horizontal is a more general scan and can be used for other conditions like AMD)
How many IOP measurements should you make, at minimum, when measuring IOP?
2 measurements per eye
What IOP value should we consider very seriously even in the absence of other findings?
Any IOP of 26mmHg or over
What CCT values are considered a risk factor for glaucoma?
<555 microns
When should you perform gonio on a glaucoma patient?
1st review and regularly thereafter. Measure deepest angle in all 4 quadrants + level of pigmentation if present.
How often do we generally review glaucoma patients?
Typically 6 or 12 monthly, depending on risk. Sometimes we’ll have 1 month reviews (e.g. if wanting to monitor the use of new drops)
What differential should we ensure we aren’t missing when assessing glaucoma?
Neurological problems
What should you consider in history for a glaucoma assessment? (3)
FOH: which relative, age of onset, type/duration, tx, effect on vision
Other Risk Factors: age>50yo, race (african), CV disease, DM, Migraines, Sleep apnoea, Myopia, Smoking
Relevant Meds: b-blockers, steroids, etc, any side effects of glaucoma meds such as breathing, sore eyes, cardiovascular
