Glaucoma

• Using ophthalmoscopic techniques, what should be evaluated of the ONH (in Glaucoma)?

  1. Optic disc size
  2. CDR
  3. Loss of rim tissue
  4. Disc hemorrage
  5. Peripapillary atrophy
  6. RNFL atrophy
• To appropriately estimate disc size using slit beam, the correction factor for a 60D lens is x 1
• To appropriately estimate disc size using slit beam, the correction factor for a 90D lens is x 1.2
• Use of color and other monocular cues tends to (under/over) under estimate cup size
• The best cues to locate cup margins are contour and vessel deflections
• TRUE/FALSE: ISNT Rule violations is a significant predictor of GLC TRUE
• Splinter hemorrhages also known as drance hemorrhages cross the disc margin and is a common feature of GLC damage.
• TRUE/FALSE: splinter hemorrhages are pathognomonic for GLC. FALSE
• TRUE/FALSE: splinter hemorrhages are detected more with fundus photography than in ophthalmoscopy. TRUE
• TRUE/FALSE: Disc hemorrhages are often subtle and frequently overlooked. TRUE
• Scleral rings are indicative of peripapillary atrophy
• TRUE/FALSE: scleral rings should be considered in CDR. FALSE
• Scleral ring: thin, even, white rim that marks the disc margin, usually for the full 360 degrees is seen clinically in some eyes
• Disc hemorrhage

  
• Zone (A/B) B PPA is more strongly associated with GLC.
• Peripapillary atrophy is greater in eyes with glaucoma, and may be a risk factor for the conversion of OHT to POAG, but is nonspecific
• TRUE/FALSE: NFL defects are specific to GLC FALSE
• The white arrows are pointing to Zone (A/B) B PPA.

  
• The black arrows are pointing to the Zone (A/B) A PPA.

  
• TRUE/FALSE: GLC is multifactorial. TRUE
• What must be present to make a diagnosis of GLC?

  Optic neuropathy
• NFL is most visible in (less/more) more pigmented eyes.
• NFL defects appear as dark stripes or wedge-shaped in the peripapillary area
• In assessing NFL, ophthalmoscopy should be conducted with a bright light and red-free filter.
• Normal IOP: 15.5 mmHg, with a SD of 3 mmHg.
• Upper limit of normal IOP: 22 mmHg.
• What is the most important risk factor for GLC?

  IOP
• TRUE/FALSE: IOP < 22 mmHg is considered safe from GLC. FALSE
• TRUE/FALSE: GLC is the leading cause of irreversible blindness. TRUE
• TRUE/FALSE: Glaucoma is the leading cause of blindness worldwide FALSE
• GLC is responsible for 15 % of the blindness worldwide
• 50 % of GLC pts are unaware they have GLC
• 75 % of GLC is OAG
• OAG prevalence is highest among African Americans
• ACG prevalence is highest among Chinese people
• 87% of Asians with GLC have ACG
• (Women/Men) women are at higher risk of GLC
• GLC prevalence increases with age: 3-8 x higher among persons in their 70s compared to persons in their 40s