Glaucoma Management and IOP Assessment
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Questions and Answers

What is the primary benefit of home self-tonometry as mentioned?

  • It eliminates the need for any in-office visits.
  • It provides data that supplements in-clinic tonometry. (correct)
  • It requires no training for patients.
  • It guarantees accurate IOP readings every time.

What is one potential challenge of home self-tonometry devices?

  • They can be used at any time without restrictions.
  • They are extremely affordable for all patients.
  • Some patients may find it difficult to perform. (correct)
  • They provide continuous 24-hour IOP monitoring.

What is a noted occurrence regarding IOP in glaucoma patients?

  • IOP is consistently high during office hours.
  • IOP remains stable without fluctuations throughout the day.
  • IOP spikes often occur during routine check-ups.
  • 66% to 69% of patients experience peaks outside of office hours. (correct)

What percentage of patients had different daily IOP patterns on different days, according to Querat et al.?

<p>63% (D)</p> Signup and view all the answers

Which statement regarding continuous IOP monitoring technology is true?

<p>It is designed to be fast, safe, and painless. (D)</p> Signup and view all the answers

In which scenario is home tonometry typically recommended?

<p>For young patients with suspected occult IOP elevation. (C)</p> Signup and view all the answers

What does a successful measurement on home tonometry devices indicate?

<p>The measurement sequence was completed successfully. (B)</p> Signup and view all the answers

What is a future possibility for IOP monitoring mentioned in the content?

<p>Developing a non-contact IOP measurement method. (B)</p> Signup and view all the answers

Which type of artifact accounts for the highest percentage of OCT B-Scan segmentation failures?

<p>De-centration (B)</p> Signup and view all the answers

What should be the initial step in interpreting an OCT scan report?

<p>Determine if segmentation failure or image artifact is present (D)</p> Signup and view all the answers

What is a significant problem with topical medications for glaucoma patients?

<p>They result in patient variability over time (D)</p> Signup and view all the answers

Which OCT segmentation failure is caused by the presence of high myopia?

<p>High Myopia (related error) (C)</p> Signup and view all the answers

What is the purpose of the Travoprost Implant Clinical Trial?

<p>To evaluate the effectiveness of a microdose delivery system (A)</p> Signup and view all the answers

What percentage of OCT scans experience segmentation failure due to poor signal?

<p>5% (B)</p> Signup and view all the answers

Which technique is categorized under Minimally Invasive Glaucoma Surgery (MIGS)?

<p>Direct selective laser trabeculoplasty (D)</p> Signup and view all the answers

Which statement is true regarding the efficacy period of the Bitmatoprost SR implant?

<p>It provides drug release for about 4 months (A)</p> Signup and view all the answers

What is the primary indication for initiating therapy in patients with ocular hypertension?

<p>Presence of multiple significant risk factors with risk calculation over 15% (A)</p> Signup and view all the answers

Which factor is NOT true concerning the variability of intraocular pressure (IOP) readings?

<p>A single IOP reading is definitive for diagnosis. (A)</p> Signup and view all the answers

What role does the OHTS Risk Calculator play in glaucoma management?

<p>It aids in assessing risk factors and guiding treatment decisions. (B)</p> Signup and view all the answers

In the context of tonometry for glaucoma suspects, which statement is true?

<p>Multiple readings on different days are essential. (C)</p> Signup and view all the answers

What characteristic of a glaucoma suspect's health history would raise concern for potential future glaucoma?

<p>History of ocular hypertension with IOP in the mid/high 20's (A)</p> Signup and view all the answers

Which of the following statements reflects a common misconception about intraocular pressure?

<p>A single exact number can define IOP. (C)</p> Signup and view all the answers

When considering the management of ocular hypertension, which outcome is represented by a central corneal thickness measurement of 588 µm?

<p>Low risk of developing primary open angle glaucoma (D)</p> Signup and view all the answers

What is a key educational element to discuss with patients identified as glaucoma suspects?

<p>The risk of future glaucoma must be explained and discussed. (B)</p> Signup and view all the answers

What is a polygenic risk score used for?

<p>To compare a person's genetic disease risk to others in the population (B)</p> Signup and view all the answers

What is one of the first steps to take when interpreting an OCT scan report?

<p>Check for segmentation failure or image artifacts (D)</p> Signup and view all the answers

Why is low signal strength in an OCT scan problematic?

<p>It can cause inaccurate measurement of RNFL thickness (C)</p> Signup and view all the answers

What aspects should be evaluated when looking at a retinal nerve fiber layer (RNFL) thickness map?

<p>The quality of the scan and visual fields correlation (B)</p> Signup and view all the answers

Which of the following is NOT a recommended tip for improving OCT scan quality?

<p>Allowing eye movement to gauge reaction (B)</p> Signup and view all the answers

What are the consequences of segmentation failure in an OCT scan?

<p>It can result in missed diagnosis of glaucoma (D)</p> Signup and view all the answers

Which of the following steps is crucial before interpreting OCT scan results?

<p>Assessing the scan quality and looking for artifacts (B)</p> Signup and view all the answers

What does RNFL stand for in the context of OCT imaging?

<p>Retinal Nerve Fiber Layer (D)</p> Signup and view all the answers

What is the primary purpose of MIGS during cataract surgery?

<p>To help a glaucoma patient by implanting a trabecular bypass stent (B)</p> Signup and view all the answers

Which of the following statements is true regarding the use of iStents in glaucoma treatment?

<p>Two iStents might provide enhanced outcomes compared to one. (B)</p> Signup and view all the answers

What percentage decrease in intraocular pressure (IOP) was observed in the study after MIGS treatment?

<p>15.6% (B)</p> Signup and view all the answers

What is the function of the Kahook Dual Blade (KDB) in performing goniotomy?

<p>To manually cut and remove the trabecular meshwork (B)</p> Signup and view all the answers

Which of the following is NOT a characteristic of canaloplasty?

<p>It involves removing the trabecular meshwork. (B)</p> Signup and view all the answers

What is the mechanism of action (MOA) of the microstent used in ab-interno canal-based MIGS?

<p>It scaffolds and holds the canal open at 90 degrees. (D)</p> Signup and view all the answers

What is a key innovation in glaucoma treatment mentioned in the content?

<p>Standalone micro-invasive implantable devices. (D)</p> Signup and view all the answers

How does the effectiveness of multiple stents compare to a single stent in treating glaucoma?

<p>Using multiple stents could improve outcomes. (C)</p> Signup and view all the answers

Flashcards

Glaucoma Suspects

Individuals showing signs of potential glaucoma, but not yet diagnosed with the disease.

Ocular Hypertension (OHTN)

Elevated intraocular pressure (IOP) without evidence of optic nerve damage or visual field loss.

Central Corneal Thickness (CCT)

Measurement of the thickness of the cornea at the center.

IOP Risk Calculator

A tool to estimate the risk of developing glaucoma based on various risk factors.

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Multiple IOP Readings

Taking IOP measurements on different days and at different times to get a more accurate picture of the patient's IOP.

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IOP Spikes

Significant and sudden increases in intraocular pressure.

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Glaucoma Danger Zone

15% risk of developing glaucoma, based on the risk calculator, suggests the individual is more vulnerable to progressing to glaucoma.

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Tonometry

Technique used to measure intraocular pressure (IOP).

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Glaucoma Treatment

Decisions on starting glaucoma treatment are based on risk assessment and factors like central corneal thickness and IOP to ascertain if an individual's risk for glaucoma development requires intervention.

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Expert Panel Recommendations

Suggested guidelines for glaucoma management, emphasizing careful consideration for each patient's unique characteristics.

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Polygenic Risk Score

An estimate of disease risk calculated by combining the risks from many genetic variants.

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Genetic Variants

Variations in our DNA that make each person unique. Some increase disease risk.

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OCT Scan Quality

The quality of an Optical Coherence Tomography (OCT) scan, crucial for accurate interpretation.

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OCT Segmentation Failure

An error in the process of analyzing an OCT scan that can lead to inaccurate results.

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RNFL Thinning

A reduction in the thickness of the retinal nerve fiber layer (RNFL), a sign of glaucoma.

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Visual Field Defect

An area of reduced vision, indicating potential damage to the optic nerve pathways.

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Signal Strength (OCT)

The intensity of the light reflected back to the OCT machine during scanning. Affects image quality.

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Image Centration

Proper placement of the structures of the eye in an OCT scan frame.

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Goldmann tonometry

The standard method for measuring intraocular pressure (IOP).

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Implantable intraocular sensors

Devices for continuous 24/7 IOP monitoring.

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IOP spikes

Sudden increases in intraocular pressure, often outside of clinic hours.

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Daily IOP patterns

Variation in intraocular pressure throughout the day.

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Sporadic IOP measurements

Taking IOP measurements infrequently, often only during office visits.

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Self-tonometry

Patients measuring their own IOP at home.

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Home tonometry

Use of a home device to measure IOP by the patient.

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24-hour IOP monitoring

Continuous IOP measurement over a 24-hour period, usually outside clinical setting.

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Low in-office IOP

Intraocular pressure readings during office visits that are lower than expected.

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Home IOP monitoring

Using home tonometry devices to actively monitor IOP over time.

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Polygenic risk score

A score calculated based on genetic variants associated with a specific trait (in this case, glaucoma).

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AI-based IOP measurement

A method for measuring IOP that utilizes AI technology instead of physical contacts.

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Implantable device for IOP measure

A device that can be implanted to continuously monitor IOP for extended periods of time.

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TM Bypass

Surgical procedure to improve aqueous outflow by creating a pathway for fluid drainage.

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Canaloplasty

Surgical procedure to clean and improve the drainage canal in the eye.

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Goniotomy

Surgical procedure to remove trabecular meshwork (TM) to improve flow.

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MIGS

Micro-invasive glaucoma surgery; small surgical procedures to treat glaucoma.

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Cataract surgery (CE)

Surgical procedure to remove cataracts and increase IOP outflow.

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Trabecular Bypass Stent

Implantable device placed to help improve drainage of aqueous humor.

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Mild to Moderate glaucoma

Glaucoma with moderate or less severe symptoms.

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Moderate to severe (refractory) glaucoma

Glaucoma resistant or unresponsive to existing treatments.

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Collector Channels

Channels in the eye that drain aqueous humor.

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iStent

Subtype of MIGS stent used to improve drainage.

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Two iStents

Implants two stents to increase outflow.

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Ab-interno Canal-based MIGS stent

A tiny scaffold inserted into the main drainage channel of the eye

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Kahook Dual Blade

Disposable knife for manually cutting and removing TM.

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IOP

Intraocular pressure (the pressure inside the eye)

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OCT Scan Quality

The quality of an Optical Coherence Tomography scan, essential for accurate interpretation.

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Segmentation Failure (OCT)

An error in analyzing an OCT scan, leading to inaccurate results.

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Image Artifact (OCT)

Distortions or anomalies in an OCT scan that mask true data.

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B Scan Centration

Proper positioning of the eye's structures within an OCT scan's frame.

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De-centration (OCT)

A common OCT B-scan segmentation failure where the eye isn't properly centered.

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Posterior Vitreous Detachment (OCT)

An error in OCT segmentation associated with the detachment of the vitreous humor.

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Posterior RNFL Misidentification

An OCT error in which the retinal nerve fiber layer is misidentified in the scan's posterior area.

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Poor OCT Signal

Insufficient light reflection in an OCT scan, affecting image quality.

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High Myopia

Severe nearsightedness; a factor that sometimes impairs usable OCT scans.

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Peripapillary Atrophy

Associated errors in OCT scans (rare)

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Incomplete Segmentation

An OCT error where the process of analyzing the scan is not fully performed.

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Motion Artifact (OCT)

OCT error due to eye movement during the scan affecting image quality.

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RNFL and GCC thickness maps (OCT)

OCT measures specific layers of the optic nerve (RNFL) and ganglion cell complex (GCC).

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Image centered (OCT)

The structure of the eye is in the right position in the OCT scan, impacting the accuracy.

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Eye Movement (OCT)

Any movement of the eye during an OCT scan that degrades image quality.

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Segmentation accuracy

The correctness of segmenting (dividing) an image in an OCT, directly impacting diagnosis.

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Study Notes

Glaucoma is Coming to Your Practice!

  • Glaucoma is expected to double by 2050.
  • Glaucoma suspects are broadly categorized into two groups: ocular hypertensive subjects with risk factors, and those with questionable glaucomatous findings.
  • Subjects with questionable findings are assessed using OHTS data to determine if treatment is needed.
  • A 64-year-old white male with a history of ocular hypertension was evaluated.
  • Baseline findings included IOP of 25/23 OD/OS.
  • Percentage of subjects who developed POAG (primary open-angle glaucoma) was determined by central corneal thickness and baseline IOP.
  • Therapy is indicated when there are multiple significant risk factors, such as CCT under 555 microns, family history, disc hemorrhage, vertical CD ratio, and low ocular perfusion pressure.

Tonometry and IOP

  • IOP varies throughout the day and across different days.
  • IOP spikes are a significant risk factor for disease progression.
  • Multiple IOP readings over time are essential for diagnosis and treatment.
  • Goldmann tonometry is the standard, but other methods (iCare, Tono-Pen) may be used.
  • Monitoring IOP outside of office hours is important since many spikes occur outside of office hours.
  • There is a high probability of missing important IOP spikes when performing infrequent IOP measurements.
  • Self-tonometry is a helpful technique for patients to monitor their IOP at home.

OCT Interpretation

  • OCT can aid in diagnosing glaucoma earlier.
  • Key highlights to consider when evaluating OCT scan reports are segmentation failure, image artifacts, and checking scan quality.
  • If there is segmentation failure or other image artifacts present, don't waste time- evaluate other areas for issues.
  • Identify how to confidently identify glaucomatous changes in RNFL and GCA.
  • If you are unsure what you are looking at, use a second reader or seek consultation from an expert.

Errors in OCT

  • Errors associated with posterior vitreous detachment (14%) and posterior RNFL misidentification (8%) are frequent findings.
  • Poor signal strength, and high myopia and peripapillary atrophy are other areas to note.
  • OCT imaging artifacts occur in 15.2% - 36.1% of scans and could be misdiagnosed as glaucoma.
  • Visual field deficits may not be as apparent, as macular changes often precede deficits in the visual field.

Topical Medications, MIGS, and Canaloplasty

  • Delivery of topical medications can be problematic, especially in patients with glaucoma.
  • MIGS procedures, such as iStent and Canaloplasty, can potentially reduce IOP and improve glaucoma management.
  • The ROMEO study demonstrated average IOP reduction of 6.2mm Hg.
  • 38% of patients in the ROMEO study were medication free at 12 months after the procedure.

Other Key Concepts

  • Polygenic risk scores are used to compare a person's risk of developing glaucoma to others in a population.
  • Diagnostic Genetic Testing is still under development.
  • Ocular Hypertensive subjects are patients with risk factors for future development of glaucoma.

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Related Documents

Glaucoma Update PDF

Description

This quiz covers essential concepts in glaucoma management, including risk factors, assessment methods, and treatment indications. Learn about the classifications of glaucoma suspects and the significance of intraocular pressure readings for disease progression. Ideal for practitioners looking to enhance their understanding of ocular hypertension and glaucoma care.

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