Glaucoma

Question 1

normal IOP

Answer 1

13-21 mmHg

Question 2

high IOP

Answer 2

> 21 mmHg

Question 3

NT glaucoma is characterized by

Answer 3

+ glaucomatous changes
normal IOP

Question 4

glaucoma is characterized by

Answer 4

+ glaucomatous changes
elevated IOP

Question 5

ocular HTN is characterized by

Answer 5

• glaucomatous changes
  elevated IOP

Question 6

risk factors for glaucoma

Answer 6

-high iop
-age
-FH
-race/ethnicity
-inc. cup to disc ration
-thin central cornea thickness
-ocular perfusion pressure
-T2DM
-myopia

Question 7

who needs to be treated for glaucoma

Answer 7

all with elevated IOP AND confirmed disc changes/field defects

Question 8

what is the treatment goal for IOP

Answer 8

lower IOP 25% or more below pretreatment levels

Question 9

1st line options for glaucoma (2)

Answer 9

prostaglandin analogs > beta blockers

Question 10

2nd line for glaucoma

Answer 10

brimonidine (combo w/ timolol) > dorzolamide (combo w/ timolol) > solo CAIs > netarsudil/omidenepeg

Question 11

examples of prostaglandin analogs

Answer 11

bimatoprost
latanoprost
lanatnoprostene bunod
tafluprost
travoprost
unoprostone

Question 12

side effects of PG analogs

Answer 12

conjunctival hyperemia, hypertrichosis, iris pigmentation changes
systemic- infection, headache

Question 13

contraindications to PG analogs

Answer 13

existing ocular inflammation (keratitis, iritis, uveitis, macular edema)

Question 14

which PG analogs (2) have highest efficacy?
which has least AEs?

Answer 14

high eff- bimatoprost, latanoprostene bunod
least AE- omidenepeg

Question 15

examples of beta blockers

Answer 15

betaxolol
carteolol
levobunolol
metipranolol
timolol

Question 16

side effects of beta blockers

Answer 16

local irritation, tachyphylaxis
systemic- cardiac, pulmonary, CNS

Question 17

contraindications to beta blockers

Answer 17

sinus bradycardia, heart block, heart failure, pulmonary

Question 18

example of alpha agonist

Answer 18

brimonidine

Question 19

side effects of brimonidine

Answer 19

conjunctival hyperemia, irritation, allergic reactions, tachyphylaxis
systemic- drowsiness, xerostomia

Question 20

what is available in combo with brimonidine?

Answer 20

timolol

Question 21

examples of carbonic anhydrase inhibitors

Answer 21

brinzolamide & dorzolamide (topical)
acetazolamide & methazolamide (PO)

Question 22

what is available in combination with dorzolamide?

Answer 22

timolol

Question 23

when to treat ocular HTN

Answer 23

those with OH AND risk factors such as ethnicity, FH, thin central cornea, large cup to disc, and IOP >25 mmHg

Question 24

when to treat normal tension glaucoma

Answer 24

those with NTG AND documented progression of visual field loss

Question 25

wild iop fluctuations, rapid vision damage, unilateral, signaled by prodrome

Answer 25

infrequent AACC (angle closure)

Question 26

risk factors for angle closure

Answer 26

shallow anterior chamber depth (eastern Asian), FH, hyperopia, age

Question 27

drugs to lower IOP for AACC initial treatment

Answer 27

IV or PO CAI (acetazolamide) topical beta blocker topical alpha agonist (apraclonidine)

Question 28

agent used in initial treatment for AACC to fix the angle

Answer 28

topical pilocarpine

Question 29

side effects of pilocarpine

Answer 29

spasms, headache, brow ache, lid twitch

Question 30

secondary agents given PRN for AACC for additional IOP lowering if initial agents have no effect on IOP after 1 hour

Answer 30

hyperosmotics (PO glycerin or isosorbide, IV mannitol)

Question 31

chronic PACG treatment

Answer 31

same as PAOG