Lecture 1. Epidemiology Flashcards

1
Q

What is the definition of glaucoma?

A

Ocular tissue damage at least partially related to IOP

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2
Q

What are the 2 major types of glaucoma? and which one is most common?

A

Open and closed angle. Open angle is most common

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3
Q

Between primary and secondary angle closure, which defines a known cause and which defines an unknown cause?

A

Primary=unknown, secondary=known (glaucoma secondary to…)

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4
Q

What do you call a pt who has elevated pressure, reduced visual fields and/or glaucomatous damage in their optic nerve but you have only seen them 1 time?

A

A “glaucoma suspect”. in order to diagnose a pt with glaucoma you must observe progression. Make sure to follow up with pt in 3 months.

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5
Q

Name the 3 types of open angle glaucoma and their usual IOP

A

1) PAOG (primary open angle) greater than 21 w/ damage/vf loss.
2) OHT (ocular hypertension) gretaer than 21 w/o damage/vf loss.
3) NTG (normal tension glaucoma) less than 21 w/ damage/vf loss

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6
Q

Name the 3 types of closed angle glaucoma

A

Primary and secondary closed angle glaucoma and congenital glaucoma.

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7
Q

What is the prevalence of glaucoma in Caucasian populations over 40 yrs. old?

A

2%

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8
Q

*Prevalence of POAG in African Americans/African Caribbeans is _____ times higher than in Caucasians?

A

4x (4x 2%=8%) **POAG affects African Americans the most

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9
Q

(T/F) Angle closure is more prevalent in women

A

True

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10
Q

(T/F) POAG is more common in women

A

False (no obvious correlation in increased incidence in men or women) only in closed angle glaucoma do we see a difference

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11
Q

At what age for caucasians and African Americans do we find an increased risk of glaucoma?

A

Caucasians=40 yrs. old, African Americans=35 yrs. old, Hispanics=40 and are similar to Caucasians at first but then progress more rapidly than African Americans later on

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12
Q

(T/F) according to the Beaver Dam study, 25% of POAG’s had IOPS of less than 21mmHG?

A

True (depending on what time of day, possible fluctuations)

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13
Q

What is the prevalence of OHT in Caucasians?

A

3%

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14
Q

(T/F) Caucasians are more likely to have POAG rather than closed angle?

A

True. Caucasians have wide angles and large anterior chambers. African Americans also have a lower prevalence of closed angle as well due to wide angles.

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15
Q

(T/F) An elderly Chinese woman has the lowest risk of closed angle glaucoma?

A

False, chinese people and women have the highest risk and prevalence increases with age.

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16
Q

*Japanese people are at the highest risk of which type of glaucoma?

A

NTG (normal tension)

17
Q

What is the prevalence of angle closure in the Japanese population?

A

0.31% very low

18
Q

*The Chinese population has a ____ times higher risk of developing angle closure glaucoma than POAG

A

3x Chinese are highest for risk of angle closure.

19
Q

*Would hyperopes have a higher tendency for closed or open angle glaucoma?

A

Closed

20
Q

IOP is a major risk factor for glaucoma. As IOP increases, how does your risk for glaucoma increase?

A

Pressures @ 26mmHg=30% chance of glaucoma, @27mmHg=70% chance of glaucoma, @30mmHg=80% chance of glaucoma. The risk greatly increases after 26mmHg.

21
Q

What are the 3 components of the glaucoma triad?

A

Optic nerve damage, visual field deficit, and elevated IOP.. This is “old thinking”, we know now that some forms of glaucoma, such as NTG, do not need high IOP’s to cause damage. There are also unknown factors of glaucoma.

22
Q

Most doctors treat pt’s when their pressures are above what?

A

Above 28mmHG, but some may treat at 26mmHg

23
Q

As IOP increases, the prevalence of glaucoma in African Americans _____ Caucasians

a) is less than
b) is the same as
c) is greater than

A

C. The prevalence of POAG at higher IOP increases exponentially (for African Americans) as IOP increases. For example @ 34mmHg, Caucasians have a prevalence of 7% and African Americans have a prevalence of 32% at the same IOP. Much lower pressures show similar prevalence rates between African Americans and Caucasians.

24
Q

What retinal cell is damaged in glaucoma? how many of them are we born with?

a) bipolar cells, 750,000
b) horizontal cells, 1.5 million
c) ganglion cells, 1 million
d) rods only, 15 million

A

c) Ganglion cells, 1 million. We lose approx 4,000 ganglion cells per year naturally.

25
Q

Data shows that myopes may have a higher prevalence of POAG, why is this?

A

This is a false association because myopes also happen to get more eye exams, increasing their frequency of being diagnosed.

26
Q

(T/F) According to the consensus guidelines, Diabetic pt’s and pt’s with diabetic eye disease are at risk for glaucoma and should be screened.

A

True. however the Baltimore eye study showed a protective effect and this could be due to increased blood flow in early diabetes. hard to say, but for boards, the answer is yes, they are correlated.

27
Q
  • Your pt’s blood pressure is 120/80, what is the mean pressure?
    a) 40
    b) 60
    c) 100
    d) 200
A

C) 100

28
Q

*Ocular Profusion Pressure=____-____

A

OPP=BP-IOP

29
Q
As diastolic perfusion pressure increases, prevalence of POAG \_\_\_\_\_\_:
A) increases
B) decreases
C) stays the same
D) is completely eliminated
A

B) decreases. This is because of 2 main hypothesis of what cause glaucoma: 1) elevated BP 2) blood flow to the eye (if blood flow to the eye is not good—>higher risk of glaucoma)

30
Q

Genetic factors and glaucoma:
Siblings=____ times risk
Parents=____times risk
Children=____times risk

A

Siblings=3.69x
Parents=2.67x
Children=1.12x

31
Q

(T/F) Hypertension in the short term (as it relates to risk of glaucoma) may be beneficial because higher pressure means more blood flow to the eye?

A

True. However chronic HTN narrows vessels over time leading to dramatic worsening in the long term. Low BP is also not good, organs can suffer.

32
Q

What percentage of pt’s over 70 have glaucoma?

a) 2%
b) 3%
c) 8%
d) 12%

A

C) 8% (remember 2% over 40 yrs old have glaucoma)

33
Q

(T/F) smoking and alcohol consumption has an unknown correlation with glaucoma.

A

True. Some studies say yes, some say no, nothing conclusive

34
Q

What is the 3rd major cause of blindness in the USA?

a) BB guns
b) Diabetic Retinopathy
c) Macular Degeneration
d) Glaucoma

A

d) Glaucoma

35
Q

What is the zipcode effect?

a) When you can determine the overall chances of glaucoma prevalence based on certain zip codes
b) When you can recommend that your pt move to a different zip code and their glaucoma improves.

A

a) When you can determine the overall chances of glaucoma prevalence based on certain zip codes

36
Q

(T/F) the most common cause of blindness among African Americans is glaucoma

A

True. Rate of blindness in African Americans is 6-8 times more than in Caucasians.

37
Q

What is the cure for glaucoma?

A

There is no cure, only management. The doctor wants to start treatment early but not too early. Once treatment starts, you are on treatment for life