DIS - Glaucoma Management II - Week 7 Flashcards

1
Q

What percentage of low tension glaucoma patients will not progress after 6 years? What does this mean for treatment?

A

55% do not progress after 6 years

May not always need to treat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the major component of low tension glaucoma and how does this affect the use of beta blockers as treatment?

A

Major vascular component

Beta blockers should be avoided due to a decrease in systemic blood pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the target IOP for low tension glaucoma?

A

-30% or ≤12mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Compared to other forms of glaucoma, do PGAs generally have a greater or lesser effect on IOP in low tension glaucoma? What does this mean for reaching target IOP? Keeping this in mind, are they commonly used?

A

PGAs are commonly used, but have less effect in low tension glaucoma
Harder to get to target IOP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What percentage of low tension glaucoma patients stop responding to latanoprost after 3 months?

A

43%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What percentage of low tension glaucoma patients will reach their target IOP on PGA monotherapy? What percentage will need 2 drugs?

A

50% with monotherapy

50% will need 2 drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

If a patient requires 2 drugs for low tension glaucoma, what should be considered for the second drug (2), assuming the first is a PGA? What should this choice be based on?

A

Consider a vasomodifier
-CAI
-alpha agonist
Based on ON/VF loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Is timolol ideal to use alone for low tension glaucoma? Explain.

A

No, do not use timolol alone

It is ok in a combo if IOP is >15

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Does timolol give good IOP control? What about its night effect? Does it have any effect on systemic blood pressure? Explain.

A

Can give good IOP control but lacks night effect

Decreases systemic blood pressure, decreasing ocular perfusion pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Is progression of glaucoma higher or lower in eyes treated with timolol at 4 years after diagnosis?

A

3 times higher

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is a good single drug choice for low tension glaucoma? What about a combination therapy?

A

Tafluprost
Simbrinza
-CAI + alpha agonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How should cases of low tension glaucoma with IOP ≥15mmHg?

A

Prescribe as usual with target IOP at -30% or ≤12mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What syndrome is considered a risk factor for low tension glaucoma?

A

Reynaud’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Is migraine considered a risk factor for or protective against low tension glaucoma?

A

Risk factor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What CDR is a risk factor for low tension glaucoma?

A

<0.8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which gender has a higher risk of low tension glaucoma?

A

Female

17
Q

How should cases of low tension glaucoma with IOP <15mmHg? Explain all approaches and why they are viable (2).

A

Not prescribing for IOP <15mmHg is a viable option
-untreated average rate of loss of VF is 0.33dB/year after 5 years
Treat all moderate+ VF loss
-PGA like tafluprost
-consider vasomodifiers as first call (CAI or alpha agonist) - based on ON/VF loss

18
Q

Consider a case of low tension glaucoma with <15mmHg IOP, early VF defect, and no foveal threat. How should this be managed? Include review schedule and what to do if it worsens.

A

Discuss with the patient
-explain 55% show no progression
Offer no treatment but must review if changes occur
Or offer to treat with a modified target (i.e. -10%)
Monitor 4/12 for progression for 2 years, then 12/12
If VF/ON/NFL worsens, establish -30% or <12mmHg target

19
Q

Consider a case of low tension glaucoma with advanced loss (MD < -12dB or foveal threat). What is the management (give an exmaple of a good Rx), what is the target IOP, is it easy to reach, and what is the review schedule? What should be done if it worsens?

A

Prescribe two drugs - not a combination therapy - one being vasoactive drug (CAI or alpha)
Tafluprost + simbrinza
Target -30% or <12mmHg
-hard to achieve
Monitor NFL/ON/VF 4/12 for progression
If no changes after 2 years, then review 6/12 or 12/12
If it worsens, set target to -50% or <10mmHg
-consider referral for surgical intervention

20
Q

Consider a case of low tension glaucoma with advanced loss (MD < -12dB or foveal threat). What is the management if there is fast progression, less than 1-2 years (4)?

A

DFE for retinal masquerades
Rule out primary angle closure glaucoma
Rule out retinal cause or ON/pathway compression (tumour) - scans
Refer for second opinion/surgery

21
Q

What is the surgical intervention for acute angle closure glaucoma?

A

Urgent bilateral paeripheral laser iridectomy

22
Q

What are four other cases for surgical intervention aside from an ocular emergency?

A

Poor/limited adherence (low dexterity/poor motivation etc)
Max meds fail to stabilise progression
Adverse effects to drugs
Failing to achieve target IOP
-do not rush, can take up to 18 months to reach target IOP before deciding for surgery

23
Q

In what three cases is surgery for glaucoma generally not needed?

A

If there is no progression
If only one eye is affected
Older age (80+)

24
Q

Is surgery common or uncommon for glaucoma in australia?

A

Not

25
Q

Does treatment stop glaucoma?

A

No

26
Q

What is expected to happen if glaucoma drops are deprescribed?

A

IOP will rise to pre-treatment levels
-is asymptomatic and may not be vision-threatening for people with mild glaucoma
Generally done for patients over 80

27
Q

List 5 factors against deprescribing glaucoma medication.

A

Advanced disc cupping
Advanced visual field loss
Visual field defect involving fovea
Loss of vision in one eye due to glaucoma
Known very high pre-treatment IOP (>35mmHg)

28
Q

Consider the point system for estimating 5-year risk of developing primary open angle glaucoma. At what percentage risk should you begin treatment? what is it only valid for?

A

Treat when risk is >15%

Only valid for ocular hypertension

29
Q

What is a better indicator of everyday capacity, integrated vidual fields, or binocular fields?

A

Integrated visual fields

30
Q

Describe the categories for QoL and driving based on MD of VF testing (3). Include cutoff MD for each category and whether they are ok to drive.

A
0 to -7dB
-ok to drive and have high QoL
-7 to -10dB - moderate deficit
-some QoL limitations, may be unfit to drive (must do BF to check)
-10 to -14dB - severe deficit
-most likely unfit to drive, must  do BF, expect majority to fail
Worse than -14dB - unfit to drive
-do IVF but expect majority to fail