Glaucoma Flashcards
What is glaucoma?
A disease of the optic nerve.
A chronic, progressive (it never stops!) optic neuropathy.
What is characteristically seen in glaucoma?
Cupping, atrophy of the optic disc, and corresponding HVF patterns
True or false:
In most cases, glaucoma spares the macular until the end.
True.
True or false:
You can have a patient with advanced glaucoma seeing 20/20.
True.
This is because the macula is spared until the end.
What portions of the optic nerve does glaucoma affect first?
Superior and inferior arcuate bundles of the optic nerve.
What portion of the optic nerve does glaucoma tend to affect last?
The papillomacular bundle.
Is the onset of glaucoma fast?
No. It is a progressive disease. There are small incremental changes. Vision is lost peripherally first, and it works its way in.
True or False: According to WHO, glaucoma is the leading cause of blindness.
False.
Glaucoma is the 2nd leading cause of blindness in the world. Cataracts would be the leading cause.
Define glaucoma
It is the most common cause of optic atrophy that leads to loss of retinal ganglion cell axons, manifesting as increased C/D ratio.
When we lose a part of the optic nerve, what layer of the retina do we see a loss of?
The retinal nerve fiber layer (RNFL).
True or False:
Atrophy of inferior-temporal optic nerve would lead to loss of corresponding RNFL?
True.
Is it possible that glaucoma can affect the superior arcuate bundle and leave the inferior arcuate bundle unaffected?
Yes.
Vice versa could also occur.
If a fundus photo shows darkening of the superior arcuate bundle in OD, what will the patient describe they’re experiencing?
Loss of vision inferiorly
How do we evaluate structural changes with glaucoma?
- Look/take photos of the optic nerve
* Take an OCT measurement of the nerve fiber layers
How do we evaluate functional changes with glaucoma?
Perform a visual field.
What two items are important for diagnosing and looking at the rate of progression of glaucoma?
Structure and function
Is the following observed in the early or late/advanced stages of glaucoma:
Structural change occurs without functional vision loss
Early in glaucoma
There is a functional latency period.
Early in glaucoma, will there be more change in an OCT or HVF?
Because structural change occurs early without functional vision loss, we will see more change in OCT than HVF.
In late/advanced stage glaucoma, will we expect to see more change in an OCT or HVF?
In late/advanced stage glaucoma, functional vision loss changes at a greater rate than structural damage.
More change in HVF than in OCT.
If a superior-temporal defect was seen on the retina:
- What quadrant would this correspond to in an OCT?
- What defect would show in an HVF?
- Superior-temporal defect would be seen in OCT
2. An inferior-nasal defect would be seen in HVF
True or False:
All patients with glaucoma have elevated IOPs.
False!
In most cases, though, IOP is elevated
What is the only known treatment for glaucoma?
To reduce IOPs.
Even if a patient with glaucoma presents with IOPs of 16 (within normal range), we would have to reduce still.
To reduce IOPs, what treatments are available?
Medical (eyedrops) and surgical (laser, incisional) treatments
Is there a way to reverse or cure glaucoma?
No, but we can slow the progression of optic nerve damage from the disease.
