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Disease/glaucoma Dr. Davey 2016 > Lecture 6 POAG > Flashcards

Lecture 6 POAG Flashcards

1
Q

(T/F) Secondary open angle glaucoma is more aggressive than primary open angle glaucoma

A

true

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2
Q

Your pt had a c/d ratio in the OD of 0.90 and the c/d ratio in OS is 0.70. Is this significant enough to call it asymmetric?

A

yes. a 0.20 or more difference is considered asymmetric.

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3
Q

Which one of the following is NOT associated with POAG?

a) IOP is often over 21 mmHg
b) POAG is an idiopathic condition
c) POAG is chronic, bilateral, and often asymmetric
d) POAG has a higher rate of prevalence and incidence among chinese

A

d) POAG has a higher rate of prevalence and incidence among chinese. (false, it is highest among african americans)

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4
Q

Which of the following is NOT a goal regarding treatment of POAG?

a) document status of nerve structure and function
b) develop a target pressure and maintain IOP below that target pressure
c) minimize side effects by giving the least amount of drug necessary to stop progression and if you see progression, reset target pressure.
d) educate and engage pt in POAG management to enhance compliance.
e) all of the above are POAG treatment goals

A

e) all of the above are POAG treatment goals

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5
Q

Which one of the following is not a risk factor of POAG?

a) age, race, family history
b) IOP, optic nerve, vascular disease
c) peripheral corneal thickness
d) myopia
e) low diastolic perfusion pressure

A

c) peripheral corneal thickness (false, central corneal thickness)

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6
Q

(T/F) Only 10% of OHT (ocular hypertension) pts develop glaucoma in 5 years.

A

true. and in 10 years, 15-40% of OHT pts develop glaucoma

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7
Q

(T/F) Only 1/10th of pts with elevated IOP have vision loss

A

true

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8
Q

(T/F) Only 1/6th pts with disc and field damage have IOP less than 21mmHg

A

true

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9
Q

(T/F) Lowering IOP is really the only parameter we have the ability to change for glaucoma pts.

A

true and the more the IOP is reduced, the more likely it is that progression of glaucomatous optic nerve damage will be retarded.

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10
Q

How many times greater is the risk of POAG for african americans compared with caucasians?

a) 2x
b) 4x
c) 6x
d) 8x

A

b) 4x

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11
Q

Blindness due to glaucoma is how many times greater in an african american when compared to a caucasian?

a) 2x
b) 4x
c) 6x
d) 8x

A

d) 8x

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12
Q

(T/F) Measuring IOP is a poor screening method for POAG because most people with high pressures do not have or never develop POAG

A

true (sensitivity 47.1%, specificity 92.4%)

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13
Q

Which of the following statement is NOT true regarding POAG screening?

a) screening can be made more efficient by including ONH and RNFL assessment
b) screening can be more efficient if targeted to specific groups: older population, African Americans, and relatives of glaucoma pts.
c) frequency doubling technology shows promise as a screening tool.
d) standard visual field is quick and easy

A

d) standard visual field is quick and easy (false, it is time consuming)

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14
Q

What is the target pressure calculation?

A

target pressure=max IOP-max IOP%-Z

*max IOP% can be approx. 20 or 30% of max IOP value, can be 40% or more for severe glaucoma

Z=optic nerve damage
0=normal disc and visual field
1=abnormal disc and normal visual field
2=visual field loss not threatening fixation
3=visual field loss threatening or involving fixation

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15
Q

You have a max IOP of 30 mmHg and a Z score of 1, what is the target IOP?

A

30% of 30 is 10 so 30-10-1=19…..19 is the target pressure. You know 20% would not work since IOP would still be above 21 (target pressure=max IOP-max IOP%-Z)

*max IOP can be 20% or 30% of max IOP value or 40% for more severe glaucoma.

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16
Q

(T/F) Regarding imaging, stereophotography is the gold standard

A

true

17
Q

(T/F) If the target pressure is not achieved and/or there is progression of damage, the time to follow up, recheck VF, and review ONH is much less than if target pressure is achieved and there is no progression of damage

A

true (please refer to slides 41,42,43 in lecture 6 for exact times for all scenarios)

18
Q

(T/F) Visual field changes must correlate well with disc changes. If it doesn’t correlate well it warrants further investigation

A

true

19
Q

Which one of the following is NOT evidence of glaucoma?

a) focal thinning (notching) of NRR (neuroretinal rim)
b) optic disc hemorrhage
c) symmetrical damage between the right and left eye
d) acquired change in disc rim or RNFL appearance

A

c) symmetrical damage between the right and left eye (glaucoma is asymmetrical)

20
Q

Which one of the following is NOT true regarding the prognosis of POAG?

a) most POAG pts will retain useful vision for their entire life
b) incidence of blindness is 27% and 9% (unilateral vs bilateral) at 20 years following diagnosis
c) prevalence of bilateral blindness is 8% in Caucasians and 4% in African Americans
d) lowering IOP has shown to significantly reduce progression and possibly halt it

A

c) prevalence of bilateral blindness is 8% in Caucasians and 4% in African Americans (false-8% for African americans and 4%for Caucasians)

21
Q

Which one of the following is NOT true?

a) optic disc hemorrhages are most commonly located infero and supero-temporally
b) a true wedge defect is followed to a notch in the NRR
c) glaucomatous damage is only indicated by an ONH that doesnt follow the ISNT rule 70% of the time
d) a small cup to disc ratio is a sign of glaucomatous damage

A

d) a small cup to disc ratio is a sign of glaucomatous damage (a large cup to disc ratio is indicative of glaucoma)

22
Q

Which of the following was NOT an outcome of the CNTGS (collaborative normal tension glaucoma study)?

a) cataracts were greater for surgical groups vs meds or laser
b) Lowering IOP does not retard progression of VF loss since IOP in NTG pts is not above 21mmHg
c) the effects of treatment was only apparent after cataracts were removed
d) some pt’s progressed despite IOP reduction indicating they may have an IOP independent disease

A

b) Lowering IOP does not retard progression of VF loss since IOP in NTG pts is not above 21mmHg (false-lowering IOP does help slow progression compared with untreated eyes)

(CNTGS) compared treatment vs. non treatment in OAG pts with normal IOP. Progression was lower and cataracts were higher in treated groups. It is better to start IOP lowering treatment in pt’s with NTG

23
Q

Which of the following was NOT an outcome of the EMGT (early manifest glaucoma trial)?

a) Risk of progression decreased with higher baseline IOP compared to lower baseline IOP
b) differentiating OHT from early POAG may be difficult
c) VF identified progressors more readily than optic disc evaluation
d) visual fields were performed twice as many times as optic disc evaluation which is biased
e) A post-hoc analysis shows that a thin CCT is a risk factor in POAG and low blood pressure is a risk factor for NTG (but these were not the intention of the study)

A

a) Risk of progression decreased with higher baseline IOP compared to lower baseline IOP (false–change decreased to increased)

(EMGT) compared treatment vs. non treatment in newly diagnosed OAG pts. Progression was lower and cataracts were higher in treated groups. It is better to start treatment in early OAG pts

24
Q

Which of the following was NOT an outcome of the OHTS (ocular hypertension treatment study)?

a) Most of the untreated group did not deteriorate after a 5 year follow up
b) the weakest association was CCT
c) disc hemorrhage increased risk of POAG development
d) some predictors of POAG onset were: older age, greater PSD, higher IOP, and larger vertical or horizontal CD ratio
e) 55% of subjects had only optic disc changes, 35% had only VF changes, 10% had both.

A

b) the weakest association was CCT (false–it was the strongest association, a 40 micron decrease in corneal thickness increased risk of developing POAG by 70%)

** (OHTS) compared treatment vs. non treatment in newly diagnosed OHT pts. Progression was lower and cataracts were higher in treated groups. It is better to start treatment in OHT pts because OHT can lead to POAG if untreated**

25
Q

Which of the following was NOT true regarding the EGPS (European glaucoma prevention study)?

a) This study failed to detect a statistical significance between chosen treatment and placebo in either lowering IOP effect or rate of conversion from OHT to POAG.
b) similar to OHTS, the EGPS studied efficacy of Dorzolamide in preventing or delaying POAG in OHT pts.
c) 120 out of 1081 OHT pt’s converted to POAG pt’s
d) all of these are true

A

d) all of these are true

(EGPS) results were inconclusive in comparing Dorzolamide (a CAI) to placebo in OHT pt conversion to POAG studies

26
Q

Which of the following was NOT true regarding the SGT (Scottish glaucoma trial)?

a) It compared new POAG pt’s in medical vs surgery therapies
b) IOP lowering medication reduced IOP better than the trabeculectomy.
c) treated group showed greater deterioration in VF when compared to trabeculectomy group.
d) drops were beta blockers, not prostaglandins and did not lower IOP better than trabeculectomy

A

b) IOP lowering medication reduced IOP better than the trabeculectomy. (false–the trabeculectomy reduced IOP better than medication)

(SGT) Surgery reduces IOP better in new POAG’s than beta blockers

27
Q

Which of the following was NOT true regarding the MPTT (Moorfields primary treatment trial)?

a) It compared new POAG pt’s in medical vs laser vs surgery therapies
b) trabeculectomy (surgery) was better at lowering IOP than trabeculoplasty (laser) and medicine
c) VF deterioration was less in trabeculectomy (surgery) than in trabeculoplasty (laser) and medicine
d) all of the above are true

A

d) all of the above are true

(MPTT) surgery lowers IOP and stops progression of visual field loss better than laser and medical treatments in new POAG pts

28
Q

Which of the following was NOT true regarding the GLT (Glaucoma laser trial)?

a) It compared new POAG pt’s in medical vs laser therapies
b) laser trabeculoplasty is at least as effective as medicine (timolol maleate)
c) If pt is not compliant with meds then laser trabeculoplasty is a good treatment option
d) all of the above are true

A

d) all of the above are true

(GLT) laser trabeculoplasty is at least as effective as beta blockers in lowering IOP in new POAG pts

29
Q

Which of the following was NOT true regarding the AGIS (Advanced glaucoma intervention study)?

a) It compared laser trabeculoplasty vs surgical trabeculectomy in POAG pts who failed with medical treatment
b) Black pts had less progression with laser trabeculoplasty
c) caucasians had less VF loss with trabeculectomy surgery
d) all of the above are true

A

d) all of the above are true

(AGIS) laser works better to lower IOP in POAG pts (who failed medical treatment) with darker pigment, surgery is better for caucasians

30
Q

Which of the following was NOT true regarding the CIGTS (collaborative initial glaucoma study)?

a) compared new POAG pts in medical vs trabeculectomy surgery
b) surgical group had slightly more ocular symptoms early in the study
c) outcomes were similar to other similar studies
d) all of the above are true

A

d) all of the above are true

(CIGTS) is similar to (SGT)–Surgery reduces IOP better in new POAG’s than meds

31
Q

In regards to classifying your pt as a glaucoma suspect, you are looking for which one of the following conditions in at least one eye?

a) ONH or NFL defect suggestive of glaucoma
b) VF consistent with glaucoma
c) elevated IOP consistently greater than 22mmHg
d) enlarged CD ratio/notching/NRR thinning/optic disc hemorrhage
e) you are looking for one of any of the above in at least 1 eye

A

e) you are looking for one of any of the above in at least 1 eye

32
Q

Which of the following is NOT true regarding the overall picture of all the glaucoma studies?

a) all forms of treatment increase risk of cataract
b) IOP lowering treatment may not benefit pts that have blood flow issues
c) large IOP reduction 40-50% may be required in pts at risk of vision loss that threatens quality of life
d) Lower IOP means better protection but greater IOP reduction may not benefit all pts
e) the lower the pressure, the harder it is to further lower it
f) central corneal thickness measurements in OHT and POAG pts must be done
g) all of the above are true

A

g) all of the above are true

33
Q

Match the followingstudies to the following outcomes:

1) CNGTS 2) EMGT
3) OHTS 4) EGPS
5) SGT and CIGTS 6) MPTT
7) GLT 8) AGIS

a) laser trabeculoplasty is at least as effective as beta blockers in lowering IOP in new POAG pts
b) surgery lowers IOP and stops progression of visual field loss better than laser and medical treatments in new POAG pts
c) Surgery reduces IOP better in new POAG’s than meds
d) laser works better to lower IOP in POAG pts (who failed medical treatment) with darker pigment, surgery is better for caucasians
e) It is better to start IOP lowering treatment in pt’s with NTG
f) It is better to start treatment in OHT pts because OHT can lead to POAG if untreated
g) results were inconclusive in comparing Dorzolamide (a CAI) to placebo in OHT pt conversion to POAG studies
h) It is better to start treatment in early OAG pts

A

1) CNGTS–e) It is better to start IOP lowering treatment in pt’s with NTG
2) EMGT–h) It is better to start treatment in early OAG pts
3) OHTS–f) It is better to start treatment in OHT pts because OHT can lead to POAG if untreated
4) EGPS–g) results were inconclusive in comparing Dorzolamide (a CAI) to placebo in OHT pt conversion to POAG studies
5) SGT and CIGTS–c) Surgery reduces IOP better in new POAG’s than meds**
6) MPTT– b) surgery lowers IOP and stops progression of visual field loss better than laser and medical treatments in new POAG pts
7) GLT–a) laser trabeculoplasty is at least as effective as beta blockers in lowering IOP in new POAG pts
8) AGIS–d) laser works better to lower IOP in POAG pts (who failed medical treatment) with darker pigment, surgery is better for caucasians

Disease/glaucoma Dr. Davey 2016 (13 decks)

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