Primary Open Angle Galucoma

Question 1

What is glaucoma?

Answer 1

Raised intraocular pressure causing optic nerve damage and gradual visual loss

Question 2

What are the main features of primary open angle glaucoma?

Answer 2

Peripheral visual field loss (nasal scotomas progressing to tunnel vision)
Decreased visual acuity
Optic disc cupping

NB the increased ocular pressure is slow rising so is symptomless for a long time
Typically presents at routine optometry appointment

Question 3

Describe what you may see on fundoscopy in primary open angle glaucoma

Answer 3

Optic disc cupping (cup to disc ration >0.7- optic disc widens and deepens)
Optic disc pallor- indicates optic atrophy
Bayonetting of vessels- vessels have breaks as they disappear into the deep cup and reappear at the base
Additional features include cup notching, disc haemorrhage

Question 4

What are the management options for primary open angle glaucoma?

Answer 4

1st line prostaglandin analogue eye dropper (to reduce IOP preventing progressive loss of visual field)
2nd line beta blocker, carbonic anhydrase inhibitor or sympathomimetic eyedrop
In more advanced disease: surgery or laser treatment

NB to reassess IOP regularly particularly if poorly controlled or high risk of progression

Question 5

Give an example of a prostaglandin analogue eyedrop

Answer 5

Lantanoprost

Question 6

What is the mode of action of a prostaglandin analogue eye from such as latanoprost?

Answer 6

Increases uveoscleral outflow decreasing IOP

Question 7

What are some S/E of latanoprost?

Answer 7

Brown pigmentation of the iris, increased eyelash length

Question 8

How do beta blockers work in primary open angle glaucoma and give 2 examples

Answer 8

Timolol, betaxolol

Reduces aqueous production

NB avoid in asthmatics and patients with heart block

Question 9

How do synpathomimetics work in primary open angle glaucoma and give an example

Answer 9

Brimonidine

Reduces aqueous production and increases outflow

Question 10

Give an example of a carbonic anhydrase inhibitor used in primary open angle glaucoma

Answer 10

Dorzolamide

Acetazolamide

Question 11

What can you offer to patients with refractory primary open angle glaucoma?

Answer 11

Surgery- trabeculectomy

Question 12

If you have a family Hx of glaucoma when should I out commence annual screening?

Answer 12

From 40yrs of age

Question 13

Is primary open angle glaucoma associated with hypermetropia or myopia?

Answer 13

Myopia (nearsightedness)