Glaucoma 1 - Introduction

Question 1

Definition of Glaucoma:

Answer 1

• Group of disorders
•Characteristic optic neuropathy
•Visual field defect with characteristic patterns
- Consist with loss of the nerve fibre layer ganglion cells
•Intraocular pressure is often a factor

Question 2

Epidemiology : Incidence

Answer 2

• 20 cases of POAG per 100,000 persons per year at age 50
• 200 cases per 100,000 per year at age 80
•2nd commonest cause of visual impairment in the UK
•Accounts for 10% of blind registrations in the uk

Question 3

Epidemiology : Prevalence

Answer 3

• 2% of population over 40 has glaucoma
• 5% over age of 70
~300,000 + known sufferers of glaucoma in UK

Question 4

Genetics of Glaucoma:

Answer 4

• Glaucoma associated with systemic/ocular syndromes
•Family History
- 6 fold increase risk of developing POAG if 1st degree relative with glaucoma (studies vary 3-8x risk)
• Racial Factors
- POAG- African descent
- ACG- Asians, Chinese

Question 5

Risk factors for Glaucoma: Ocular/systemic

Answer 5

Ocular risk factors:
• IOP
• Age
•Family history
• Rx
• Central corneal thickness
• Pseudoexfoliation/
• Pigment dispersion
•Shallow AC

Other systemic factors:
•Drug Hx
•Migraine
•Raynauds
•Vascular history

Question 6

Classification of Glaucoma

Answer 6

• Primary
- Primary open angle glaucoma
- Primary angle closure glaucoma

• Secondary
- Secondary open angle glaucoma
- Secondary closed angle glaucoma

• Congenital/Developmental

Question 7

What are the types of open angle Glaucoma associated with pressure?

Answer 7

•Ocular Hypertension
- Risk factor for POAG (22mmhg+)
•Open angle Glaucoma
- High pressure (POAG)
- Normal pressure (NTG)

Question 8

Primary Angle Closure Glaucoma types:

Answer 8

•Acute angle closure Glaucoma
•Intermittent angle closure glaucoma
•Chronic angle closure glaucoma (mixed mechanism)
•Plateau iris syndrome

Question 9

Primary Angle Closure Glaucoma classification: Anatomical/IOP

Answer 9

• PACS - Primary Angle Closure Suspect
- 3 quadrants + of Iridotrabecular Contact (ITC) but no peripheral anterior synechae (PAS), normal IOP, disc and field

• PAC - Primary Angle Closure
- ITC as above but with raised IOP and/or PAS but normal disc and field

• PACG - Primary Angle Closure Glaucoma
- 3 quadrants + of ITC with raised IOP and Disc/Field damage

Question 10

Secondary Open Angle Glaucoma causes/examples:

Answer 10

• Pseudoexfoliation syndrome/glaucoma
• Pigment dispersion syndrome/pigmentary glaucoma
• Steroid induced glaucoma (topical, creams, systemic)
• Phacolytic glaucoma
• Ghost cell glaucoma/Hyphaema
• Uveitis
•Trauma
•Raised episcleral venous pressure (Sturge-Weber Syndrome, Dysthyroid Eye Disease)

Question 11

Secondary Closed Angle Glaucomas : Examples

Answer 11

• Phacomorphic
• Post-vitreoretinal or post-corneal graft surgery
• Ectopia lentis (Marfans, Ehlers Danlos , trauma)
• Post segment tumours
• Aniridia
• Aqueous misdirection syndrome
•Uveitis
•Rubeosis Iridis

Question 12

Congenital Glaucoma : Classification

Answer 12

•Juvenile or developmental
•Anterior segment dysgenesis
• Axenfeld/Reigers, ICE syndrome, Posterior polymorphous dystrophy