Glaucoma

Question 1

What is glaucoma?

Answer 1

A disease of the optic nerve.

A chronic, progressive (it never stops!) optic neuropathy.

Question 2

What is characteristically seen in glaucoma?

Answer 2

Cupping, atrophy of the optic disc, and corresponding HVF patterns

Question 3

True or false:

In most cases, glaucoma spares the macular until the end.

Answer 3

True.

Question 4

True or false:

You can have a patient with advanced glaucoma seeing 20/20.

Answer 4

True.

This is because the macula is spared until the end.

Question 5

What portions of the optic nerve does glaucoma affect first?

Answer 5

Superior and inferior arcuate bundles of the optic nerve.

Question 6

What portion of the optic nerve does glaucoma tend to affect last?

Answer 6

The papillomacular bundle.

Question 7

Is the onset of glaucoma fast?

Answer 7

No. It is a progressive disease. There are small incremental changes. Vision is lost peripherally first, and it works its way in.

Question 8

True or False: According to WHO, glaucoma is the leading cause of blindness.

Answer 8

False.

Glaucoma is the 2nd leading cause of blindness in the world. Cataracts would be the leading cause.

Question 9

Define glaucoma

Answer 9

It is the most common cause of optic atrophy that leads to loss of retinal ganglion cell axons, manifesting as increased C/D ratio.

Question 10

When we lose a part of the optic nerve, what layer of the retina do we see a loss of?

Answer 10

The retinal nerve fiber layer (RNFL).

Question 11

True or False:

Atrophy of inferior-temporal optic nerve would lead to loss of corresponding RNFL?

Answer 11

True.

Question 12

Is it possible that glaucoma can affect the superior arcuate bundle and leave the inferior arcuate bundle unaffected?

Answer 12

Yes.

Vice versa could also occur.

Question 13

If a fundus photo shows darkening of the superior arcuate bundle in OD, what will the patient describe they’re experiencing?

Answer 13

Loss of vision inferiorly

Question 14

How do we evaluate structural changes with glaucoma?

Answer 14

• Look/take photos of the optic nerve

* Take an OCT measurement of the nerve fiber layers

Question 15

How do we evaluate functional changes with glaucoma?

Answer 15

Perform a visual field.

Question 16

What two items are important for diagnosing and looking at the rate of progression of glaucoma?

Answer 16

Structure and function

Question 17

Is the following observed in the early or late/advanced stages of glaucoma:

Structural change occurs without functional vision loss

Answer 17

Early in glaucoma

There is a functional latency period.

Question 18

Early in glaucoma, will there be more change in an OCT or HVF?

Answer 18

Because structural change occurs early without functional vision loss, we will see more change in OCT than HVF.

Question 19

In late/advanced stage glaucoma, will we expect to see more change in an OCT or HVF?

Answer 19

In late/advanced stage glaucoma, functional vision loss changes at a greater rate than structural damage.

More change in HVF than in OCT.

Question 20

If a superior-temporal defect was seen on the retina:

1. What quadrant would this correspond to in an OCT?
2. What defect would show in an HVF?

Answer 20

1. Superior-temporal defect would be seen in OCT

2. An inferior-nasal defect would be seen in HVF

Question 21

True or False:

All patients with glaucoma have elevated IOPs.

Answer 21

False!

In most cases, though, IOP is elevated

Question 22

What is the only known treatment for glaucoma?

Answer 22

To reduce IOPs.

Even if a patient with glaucoma presents with IOPs of 16 (within normal range), we would have to reduce still.

Question 23

To reduce IOPs, what treatments are available?

Answer 23

Medical (eyedrops) and surgical (laser, incisional) treatments

Question 24

Is there a way to reverse or cure glaucoma?

Answer 24

No, but we can slow the progression of optic nerve damage from the disease.

Question 25

What is the most common type of glaucoma?

Answer 25

Primary open angle glaucoma

Question 26

What are other types of glaucoma?

Answer 26

1. Primary closed angle glaucoma
2. Secondary open angle glaucoma
3. Secondary closed angle glaucoma

Question 27

What change do we see in the optic nerve with glaucoma?

Answer 27

Cupping and atrophy of the optic disc

Question 28

What happens to the RNFL with glaucoma?

Answer 28

When a part of the optic nerve is lost, we see loss of corresponding RNFL.

For example, atrophy of the inferior-temporal optic nerve AND corresponding RNFL.

Question 29

What is meant by structure-function?

Answer 29

Structure: what does the optic nerve look like? Take photos of and OCT of optic nerve.

Function: How is the patient’s visual performance changing? Perform HVF.

Question 30

What part of the visual field is affected in early glaucoma?

Answer 30

Neither. There is a functional latency period. Structural change occurs early without functional vision loss. There is more change in OCT than HVF.

Question 31

What kind of HVF do we use in glaucoma?

Answer 31

The most common test to do is a 24-2 HVF which covers 24 degrees (incl. the superior and inferior arcuate bundles).

Another is 10-2 HVF which covers 10 degrees and is important to do in early glaucoma since the papillomacular bundle is affected.

Another VF test is called the Goldmann VF.