Glaucoma 3

Question 1

What are the three phases of POAG? Briefly explain them.

Answer 1

Latency Phase: ON damage -> Threshold testing detection
Detectable Preclinical Phase: Detection -> Symptoms
Clinical Phase: Symptoms onward

Question 2

What percent of axons must be affected before a detectable threshold occurs?

Answer 2

40%, this equates to ~400,000 fibers.

Question 3

Which two methods of testing may be able to detect changes earlier?

Answer 3

SWAP: Short Wavelength Automated Perimetry
(Blue stimulus, yellow background)
FDT: Frequency Doubling Technique
(M-pathway)

Question 4

What percent of the time is IOP above 21mmHg in POAG?

Answer 4

50%

Question 5

What is the typical “categorization” of POAG?

Answer 5

POAG is characterized by any of the following in AT LEAST 1 eye.

1. IOP consistently above 21mmHg
2. Open-angle with no abnormalities
3. Adult-onset
4. Glaucomatous optic nerve damage
5. Visual field damage consistent with glaucoma

Question 6

What are some risk factors for POAG?

1. Ocular
2. Non-ocular

Answer 6

1. Ocular: 
CD asymmetry of 0.2 or greater between eyes 
NFL damage 
ONH changes
Elevated IOP
2. Systemic: 
FHx
Age
Race
Smoking

Question 7

What are the steps to managing POAG?

Answer 7

Accurate baseline data
Set target pressure
Obtain target pressure
Modify treatment based on patient response to treatment