POAG

Question 1

Principal site of insult in POAG

Answer 1

Laminar region of ONH

Question 2

What diurnal variation is common in POAG?

Answer 2

> 5 mmHg

Question 3

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

Answer 3

TRUE

Question 4

How much asymmetry is common in GLC?

Answer 4

≥ 3 mmHg

Question 5

Primary cause of elevated IOP in GLC

Answer 5

Reduced outflow facility

Question 6

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

Answer 6

Juxtacanicular region of TM

Question 7

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

Answer 7

Increased (>555 mmHg)

Question 8

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

Answer 8

Decreased (<555µm)

Question 9

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

Answer 9

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

Question 10

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

Answer 10

ONH appearance

Question 11

Floor Effect

Answer 11

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

Question 12

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

Answer 12

Loss of macular and peripapillary capillaries

visible on OCT angiography but not widely used in practice

Question 13

Most common meridian for RNFL defects

Answer 13

Inf Temp

Question 14

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

Answer 14

30º

Question 15

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

Answer 15

Thinner; myopia

Question 16

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

Answer 16

Low

Question 17

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

Answer 17

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

Question 18

SVP pulsation occurs in tandem with the ___ pulse

Answer 18

CSF

(Collapses during CSFP diastole, expands during systole)

Question 19

SVP is ___ (less/more) common in GLC

Answer 19

LESS

Question 20

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

Answer 20

RF

Question 21

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

Answer 21

1. LC stiffens
2. Post mvmt of LC

Via integrin receptors

Question 22

Other than VF loss, what other visual dysfunction?

Answer 22

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

Question 23

How many test locations in a 30-2?

Answer 23

76

Question 24

How many test locations in a 24-2?

Answer 24

54

Question 25

Clinical use of 10-2?

Answer 25

Advanced GLC, macular involvement

Question 26

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

Answer 26

VEP latency

Question 27

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

Answer 27

Abnormal pattern/flicker w/ VF progression

Question 28

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

Answer 28

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

Question 29

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

Answer 29

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

Question 30

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

Answer 30

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

Question 31

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

Answer 31

36% in white 58% in black 50% overall

Question 32

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

Answer 32

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

Question 33

TX for Low-Risk

Answer 33

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

Question 34

TX for Medium-Risk

Answer 34

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

Question 35

TX for High-Risk

Answer 35

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

Question 36

NTG suspect might exhibit:

Answer 36

1. Cupping 2. RNFL loss 3. VF defects But normal IOP

Question 37

What IOP is normal for NTG?

Answer 37

High end of normal (18-20 mmHg)

Question 38

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

Answer 38

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

Question 39

Case HX that may indicate NTG in suspect

Answer 39

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

Question 40

Central scotomas suggest

Answer 40

ON compression

Question 41

Why is a peripheral retina exam important in GLC eval?

Answer 41

Scars/lesions may produce VF defects

Question 42

Pathognomonic sign for GLC

Answer 42

Does not exist

Question 43

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

Answer 43

FALSE; “time is on your side”

Question 44

T/F: POAG is diagnosed independent of IOP

Answer 44

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

Question 45

___% of adults in US have vCDR < 0.6

Answer 45

98%

Question 46

98% of adult pop in US has vCDR asymmetry < ___ Each ___ increase in vCDRE asymmetry increases odds of GLC by ___x

Answer 46

0.2 0.1; 2.5x

Question 47

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

Answer 47

TRUE; 5-10% of gen pop

Question 48

T/F: Cirrus = RNFL + GC + IPL

Answer 48

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

Question 49

Rim area < ___ is **always** suspicious

Answer 49

< 1.0 mm^2

Question 50

Fovea lies about ___º below ONH

Answer 50

10º

Question 51

5 steps to manage GLC

Answer 51

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

Question 52

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

Answer 52

TRUE