Primary Open Angle Glaucoma Overview

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Questions and Answers

Which of the following is NOT a risk factor for primary angle-closure glaucoma (PACG)?

Family history

Gender

Eye Injury (correct)

Age

Most patients with angle-closure glaucoma are symptomatic.

False

Which of the following is NOT a characteristic of Primary Open Angle Glaucoma (POAG)?

Open, normal-appearing anterior chamber angle

Elevated intraocular pressure

Bilateral disease of adult onset

IOP consistently ≤21 mmHg (correct)

Age is a risk factor for both Primary Open Angle Glaucoma (POAG) and Normal Tension Glaucoma (NTG).

True Signup and view all the answers

What is the primary treatment for Acute Primary Angle Closure (APAC)?

Laser iridotomy Signup and view all the answers

What is the primary goal of treatment for Primary Open Angle Glaucoma?

To prevent functional impairment of vision. Signup and view all the answers

PXG is more common in ______ and older populations.

women Signup and view all the answers

Match the following types of glaucoma with their characteristics:

Primary Angle Closure Suspect (PACS) = Laser iridotomy recommended Primary Angle Closure (PAC) = Similar management to PACS Primary Angle-Closure Glaucoma (PACG) = Lower thresholds for intervention Pseudoexfoliation Glaucoma (PXG) = Higher failure rate in treatment options Signup and view all the answers

The only proven method to lower the intraocular pressure (IOP) in glaucoma patients is __________.

lowering IOP Signup and view all the answers

Which mechanism is NOT involved in angle-closure?

Retrospective occlusion Signup and view all the answers

Which of the following is a method used for investigating Primary Open Angle Glaucoma?

Pachymetry for Central Corneal Thickness Signup and view all the answers

Match the following glaucoma types with their characteristics:

Primary Open Angle Glaucoma = IOP >21 mmHg and optic nerve damage Normal Tension Glaucoma = IOP consistently ≤21 mmHg with optic nerve damage Both = Characteristic visual field loss Signup and view all the answers

A shallow anterior chamber with aqueous flare is a classic symptom of primary angle-closure glaucoma.

True Signup and view all the answers

Which of the following is a common treatment method for controlling IOP in glaucoma patients?

Laser trabeculoplasty Signup and view all the answers

What type of testing is essential for monitoring Pseudoexfoliation Glaucoma?

Gonioscopy Signup and view all the answers

List one risk factor specifically associated with Normal Tension Glaucoma.

Obstructive sleep apnea syndrome Signup and view all the answers

Study Notes

Primary Open Angle Glaucoma (POAG)

Defined by an open, normal anterior chamber angle and elevated intraocular pressure (IOP) without secondary causes.
Typically bilateral and occurs in adults, with IOP often exceeding 21 mmHg.
Characteristic visual field loss and optic nerve damage associated with disease progression.
Risk factors include: increased IOP, age, race (higher prevalence in certain populations), diabetes mellitus, family history, myopia, contraceptive pill usage, and vascular diseases.
Screening history should encompass visual symptoms, previous ophthalmic history, family history, past medical history, current medications, social history, and allergies.
Investigations include pachymetry for central corneal thickness (CCT), perimetry, and optical coherence tomography (OCT) for optic disc imaging.
Early visual field defects may show asymmetry in eye responses, small paracentral depressions, nasal step, temporal wedge, arcuate defects, or ring scotoma.
Management focuses on preventing vision impairment by slowing ganglion cell loss, primarily through IOP reduction.
Treatment goals are to achieve and maintain target IOP, with necessary adjustments based on treatment response.
Medical therapy requires regular review, perimetry, gonioscopy, examination, and serial imaging.
Laser trabeculoplasty (SLT) is a viable initial treatment option, with trabeculectomy performed as needed.

Normal Tension Glaucoma (NTG)

Variant of POAG with IOP consistently at or below 21 mmHg coupled with characteristic optic nerve damage and visual field loss.
Risk factors include age, gender (more common in women), race, family history, CCT, systemic hypertension, and vasoregulation abnormalities.
Clinical features may involve migraine history, Raynaud's phenomenon, and previous shock episodes or injuries to the head or eye.
Treatment options comprise medical management, laser trabeculoplasty, surgical options, and systemic vascular disease control.

Primary Angle-Closure Glaucoma (PACG)

Characterized by obstruction of the trabecular meshwork by the peripheral iris, hindering aqueous outflow.
Classified into phases: primary angle closure suspect (PACS), primary angle closure (PAC), and primary angle-closure glaucoma (PACG).
Mechanisms can include relative pupillary block, non-pupillary block, lens-induced angle closure, retrolenticular mechanisms, and reduced aqueous outflow.
Most patients remain asymptomatic until advanced, but signs may include shallow anterior chambers, unresponsive mid-dilated pupils, and intermittent IOP elevations.
Investigation methods involve anterior segment OCT, measuring anterior chamber depth, and posterior segment ultrasonography.
Treatment for PACS includes laser iridotomy, with similar management strategies for PAC and PACG at lower intervention thresholds.

Pseudoexfoliation or Pseudoexfoliative Glaucoma (PXG)

A systemic condition marked by deposition of protein-like material in the anterior segment of the eye, more prevalent in older women.
Treatment aligns with that of POAG but may present a higher failure rate.
Common treatment options encompass medical therapy, laser trabeculoplasty, phacoemulsification, and filtration surgery.
Regular gonioscopy is crucial for monitoring due to often incidental diagnosis post-vision loss from advanced glaucoma.

Pigment Dispersion or Pigmentary Glaucoma (PG)

Characterized by heavy pigmentation and abnormal behavior of pigment granules, leading to potential intraocular pressure issues.

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Description

This quiz covers the essential aspects of Primary Open Angle Glaucoma (POAG), including its definition, characteristics, and risk factors. Test your understanding of this common type of glaucoma and its implications on eye health. Learn about its diagnosis criteria and visual field loss associated with the condition.