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Z. Glaucoma — Class Final > POAG > Flashcards

POAG Flashcards

1
Q

Principal site of insult in POAG

A

Laminar region of ONH

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2
Q

What diurnal variation is common in POAG?

A

> 5 mmHg

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3
Q

T/F: IOP asymmetry is more common in secondary GLC compared to primary GLC

A

TRUE

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4
Q

How much asymmetry is common in GLC?

A

≥ 3 mmHg

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5
Q

Primary cause of elevated IOP in GLC

A

Reduced outflow facility

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6
Q

Fundamental cause for the increased resistance to outflow in POAG is not known, but is believed to be a consequence of alterations in…

A

Juxtacanicular region of TM

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7
Q

OHT is associated with higher incidence of ___ (inc/dec) CCT

A

Increased (>555 mmHg)

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8
Q

NTG is associated with higher incidence of ___ (inc/dec) CCT

A

Decreased (<555µm)

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9
Q

POAG is diagnosed if angles are open/normal; however Gonio should still be performed on these pts. Why? And especially if they are…

A

May develop angle closure due to lens changes, esp in HYPEROPES

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10
Q

What is the single most important clinical feature to establish Dx of POAG?

A

ONH appearance

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11
Q

Floor Effect

A

RNFL thinning stops (“Reaches its floor”) at 60µm despite progression

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12
Q

OCT features of POAG:
1. RNFL defects
2. Thinning of GCs
3. Decrease in NRR
4. ???

A

Loss of macular and peripapillary capillaries

visible on OCT angiography but not widely used in practice

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13
Q

Most common meridian for RNFL defects

A

Inf Temp

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14
Q

What is the difference between local and diffuse RNFL defect in RNFL?

A

30º

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15
Q

Trans-laminar cribosa pressure gradient becomes higher when the lamina is ___, as in the case of high ___

A

Thinner; myopia

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16
Q

Low blood pressure is associated with ___ (hi/lo) CSFP

A

Low

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17
Q

How can a benign tumor in the chiasmal region produce GLC-like optic discs:

A

Obstructs ON/CSF canal —> Inc TLPD —> thin NRR + large PPA

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18
Q

SVP pulsation occurs in tandem with the ___ pulse

A

CSF

(Collapses during CSFP diastole, expands during systole)

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19
Q

SVP is ___ (less/more) common in GLC

A

LESS

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20
Q

Absence of SVP may be ___ (protective/RF) of GLC

A

RF

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21
Q

Strain in Lamin Cribosa triggers what CT remodeling? Via Via what receptors?

A
  1. LC stiffens
  2. Post mvmt of LC

Via integrin receptors

22
Q

Other than VF loss, what other visual dysfunction?

A

Decreased CS, color, and motion perception in early stages
VA affected later stages

23
Q

How many test locations in a 30-2?

A

76

24
Q

How many test locations in a 24-2?

A

54

25
Q

Clinical use of 10-2?

A

Advanced GLC, macular involvement

26
Q

What results would you expect in a VEP of a GLC pt?

A

VEP latency

27
Q

What results would you expect in a ERG of a GLC pt?

A

Abnormal pattern/flicker w/ VF progression

28
Q

What results would you expect in a PhNR ERG of a GLC pt?

A

< 50% b-wave amplitude —> suggest GC abnormality

29
Q

T/F: VF is a requirement for the Dx of GLC

A

FALSE; not all pts are able to provide reliable fields (electrophysiology may be used in its place)

30
Q

According to OHTS, 3 RFs that significantly increase risk of conversion from OHT to GLC

A
  1. Higher baseline IOP (<25 mmHg)
  2. Thinner CCT (< 555 µm)
  3. Larger VCDR (>0.5)
31
Q

According to OHTS study, 20% reduction in IOP reduces risk of GLC by ___ in whites, ___ in blacks, and overall: ___.

A

36% in white
58% in black
50% overall

32
Q

OHTS: High risk suspects have any of the following… + a ___% risk of conversion

A
  1. IOP > 30 mmHg
  2. CCT < 555 [+IOP > 25 or VCD > 0.5]
  3. RNFL defect on OCT
  4. VF defect, consistent w/ GLC

> 20% conversion

33
Q

TX for Low-Risk

A

No Tx
Pt edu
F/u: 6-12 mo
RTC x 1 yr CEE + OCT/VF

34
Q

TX for Medium-Risk

A

No Tx (if OCT/VF reliable)
Maybe Tx trial (if unreliable)
F/u: every 6 months

35
Q

TX for High-Risk

A

Tx rec’d — 15% reduction
Consider: life expectancy, expense, or risk of tx
F/u: every 6 months

36
Q

NTG suspect might exhibit:

A
  1. Cupping
  2. RNFL loss
  3. VF defects

But normal IOP

37
Q

What IOP is normal for NTG?

A

High end of normal (18-20 mmHg)

38
Q

T/F: Decreased VA in a NTG suspect is indicative of progression to GLC

A

FALSE; suspicious for non-GLC disease bc dec VA not expected until late stage GLC

39
Q

Case HX that may indicate NTG in suspect

A
  1. Hypotension
  2. Prior IOP elevation
  3. Vasospasms (Migraines, Raynaud’s)
  4. FOHX of GLC
40
Q

Central scotomas suggest

A

ON compression

41
Q

Why is a peripheral retina exam important in GLC eval?

A

Scars/lesions may produce VF defects

42
Q

Pathognomonic sign for GLC

A

Does not exist

43
Q

T/F: GLC Dx is urgent and requires immediate TX

A

FALSE; “time is on your side”

44
Q

T/F: POAG is diagnosed independent of IOP

A

FALSE; IOP must be > 21 mmHg
Otherwise, consider NTG

45
Q

___% of adults in US have vCDR < 0.6

A

98%

46
Q

98% of adult pop in US has vCDR asymmetry < ___

Each ___ increase in vCDRE asymmetry increases odds of GLC by ___x

A

0.2

0.1; 2.5x

47
Q

T/F: (-) ISNT can be found in non-GLC pt

A

TRUE; 5-10% of gen pop

48
Q

T/F: Cirrus = RNFL + GC + IPL

A

FALSE

GCC = RNFL + GC + IPL
Cirrus = GC + IPL

49
Q

Rim area < ___ is always suspicious

A

< 1.0 mm^2

50
Q

Fovea lies about ___º below ONH

A

10º

51
Q

5 steps to manage GLC

A
  1. Establish baseline
  2. Set IOP target
  3. Lowe pressure
  4. Long term f/u
  5. Modify as needed
52
Q

T/F: IOP lowered below threshold shows no add’l benefit, once threshold already met

A

TRUE

Z. Glaucoma — Class Final (8 decks)

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