Secondary Glaucomas and Normal Tension Glaucoma (F)

Question 1

What are a group of ocular diseases with various causes that ultimately are associated with a progressive optic neuropathy leading to loss of visual function?

Answer 1

glaucoma

Question 2

What is the condition that has a liberation of pigment granules from the posterior pigmented epithelium of the back surface of the iris?

Answer 2

pigment dispersion syndrome (PDS)

Question 3

Do drance hemes usually occur before or after damage to the nerve has taken place?

Answer 3

before

Question 4

What is a variation of phacolytic glaucoma in which either trauma or surgery causes a disruption in the lens capsule that releases lens proteins that block the TM and induce a uveitic glaucoma as well?

Answer 4

Lens Particle Glaucoma

Question 5

What are some future possibilities being studied to enhance ONH bloodflow to treat normal tension glaucoma?

Answer 5

 Topical CAIs may improve peripapillary blood flow
 Calcium channel blockers
 Gingko Biloba
 Naftidrofuryl (a serotonin antagonist) that ↑ VF in one NTG study

Question 6

What are the possibilities of things that can cause an increase in IOP for secondary glaucoma?

Answer 6

1. another ocular condition
2. systemic condition
3. use of medications
   4, trauma

Question 7

What were proven to not be risk factors for progression of normal tension glaucoma (according to CNTGS)?

Answer 7

 Baseline IOP
 Age
 FHx
 Hypertension

Question 8

What are characteristics that help differentiate anomalous optic nerve (large physiological cupping, malinserted disc, optic nerve pit) from normal tension glaucoma?

Answer 8

No progression

Question 9

What are the common characteristics of normal tension glaucoma?

Answer 9

1. Saucer like cupping (Temporal rim thinning ans hallow)
2. Visual field loss: Deeper, steeper, Dense isolated paracentral scotoma, Closer to fixation (b/c temporal thinning), Generalized depression
3. Drance hemorrhage (Prevalence of 25% in NTG vs. 8% in POAG)

Question 10

What are the vascular risk factors of normal tension glaucoma?

Answer 10

 Drance Heme
 Vasospastic Disease (Migraine or Raynaud’s phenomenon)
 Sleep Apnea (stop breathing, nocturnal hypotension, #1 refer glaucoma specialists make to see if have)
 Nocturnal Hypotension
 Hemodynamic Crisis (large volumetric blood loss)

Question 11

What are aspects that can rule out normal tension glaucoma?

Answer 11

Age

Question 12

What are the risk factors for progression of normal tension glaucoma (according to CNTGS)?

Answer 12

1. Disc Heme (2.72 greater risk)
2. Migraine (2.58 greater risk)
3. Female gender (1.85 greater risk)
4. African ancestry (sort of)

Question 13

Why should pilocarpine be effective in pigmentary glaucoma? 1. What is the problem? 2

Answer 13

1. increases outflow while decreasing concave configuration of iris and decrease mechanics that cause pigment liberation
2. side effects that are hard to deal with in younger patients and increase risk of RD

Question 14

What is the development of ONH damage associated with pigment dispersion syndrome (PDS) called?

Answer 14

pigmentary glaucoma

Question 15

How should new drance hemes found on the nerve be managed?

Answer 15

1. update fundus photo

2. get new baseline VF