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Questions and Answers
What is the classification of glaucoma that occurs due to maldevelopment of the angle of the anterior chamber?
What is the classification of glaucoma that occurs due to maldevelopment of the angle of the anterior chamber?
What is the term for the glaucoma that occurs in association with a hypermature cataract?
What is the term for the glaucoma that occurs in association with a hypermature cataract?
What is the term for the blockage of the flow of aqueous humor through the pupil, leading to angle-closure glaucoma?
What is the term for the blockage of the flow of aqueous humor through the pupil, leading to angle-closure glaucoma?
What is the term for the glaucoma that occurs due to an intumescent cataractous lens?
What is the term for the glaucoma that occurs due to an intumescent cataractous lens?
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What is the percentage of Primary Congenital Glaucoma cases that affect boys?
What is the percentage of Primary Congenital Glaucoma cases that affect boys?
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What is the term for the breaks in Descemet's membrane that occur in Primary Congenital Glaucoma?
What is the term for the breaks in Descemet's membrane that occur in Primary Congenital Glaucoma?
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What is the primary method of measuring intraocular pressure?
What is the primary method of measuring intraocular pressure?
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What is the term for the large eyes that result from the elevated intraocular pressure in Primary Congenital Glaucoma?
What is the term for the large eyes that result from the elevated intraocular pressure in Primary Congenital Glaucoma?
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What is the purpose of gonioscopy in glaucoma diagnosis?
What is the purpose of gonioscopy in glaucoma diagnosis?
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What is the term for the granulomatous uveitis that occurs due to sensitization to own lens proteins?
What is the term for the granulomatous uveitis that occurs due to sensitization to own lens proteins?
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What is the name of the test that maps the visual field?
What is the name of the test that maps the visual field?
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What is the name of the ratio that indicates the thickness of the neuroretinal rim?
What is the name of the ratio that indicates the thickness of the neuroretinal rim?
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What is the term for the tissue between the outer edge of the cup and disc margin?
What is the term for the tissue between the outer edge of the cup and disc margin?
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What is the classification of glaucoma based on the mechanism of aqueous outflow impairment?
What is the classification of glaucoma based on the mechanism of aqueous outflow impairment?
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What is the name of the device used to measure intraocular pressure using the principle of total internal reflection?
What is the name of the device used to measure intraocular pressure using the principle of total internal reflection?
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What is the name of the test that uses a flash of light to measure intraocular pressure?
What is the name of the test that uses a flash of light to measure intraocular pressure?
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What is the normal position of the Central Retinal Artery in relation to the vein?
What is the normal position of the Central Retinal Artery in relation to the vein?
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What is the purpose of measuring the cup-disc ratio in glaucoma diagnosis?
What is the purpose of measuring the cup-disc ratio in glaucoma diagnosis?
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What is the definition of ocular hypertension?
What is the definition of ocular hypertension?
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What is the typical pattern of visual field defect in Primary Open-Angle Glaucoma?
What is the typical pattern of visual field defect in Primary Open-Angle Glaucoma?
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What is the most common type of glaucoma classification?
What is the most common type of glaucoma classification?
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What is the anatomical feature of the optic nerve head that can appear as a small dimple or a punch-out deep central cup?
What is the anatomical feature of the optic nerve head that can appear as a small dimple or a punch-out deep central cup?
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What is a risk factor for Primary Open-Angle Glaucoma?
What is a risk factor for Primary Open-Angle Glaucoma?
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What is the characteristic of the cupping of the optic nerve head in Primary Open-Angle Glaucoma?
What is the characteristic of the cupping of the optic nerve head in Primary Open-Angle Glaucoma?
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Study Notes
Classification of Glaucoma
- Angle-closure with pupil block
- Angle-closure without pupil block
- Open angle
- Posner-Schlossman syndrome
Lens-related Glaucoma
- Phacolytic glaucoma: open-angle glaucoma occurring in association with hypermature cataract
- Phacomorphic glaucoma: acute secondary angle-closure glaucoma precipitated by an intumescent cataractous lens
- Phacoanaphylaxis glaucoma: rare, occurs after penetrating trauma/surgery, sensitization to own lens proteins resulting in granulomatous uveitis
Pupillary Block Glaucoma
- Aqueous fluid flows forward through the pupil to the angle of the anterior chamber
- The lens seals against the iris and blocks the flow of aqueous humor through the pupil
- Form of an angle closure glaucoma
Primary Congenital Glaucoma
- Impaired aqueous outflow is caused by maldevelopment of the angle of anterior chamber
- 65% are boys, OU affected, and 75% of cases are asymmetrical
- Two classifications: True Congenital (40%) and Infantile glaucoma (55%), and Juvenile glaucoma (least common)
Changes with Primary Congenital Glaucoma
- Corneal Haze: often the first sign noticed by parents
- Buphthalmos: large eyes result of stretching due to the elevated IOP prior to age 3 yrs
- Breaks in Descemet’s membrane: secondary to IOP stretching may be associated with a sudden influx of aqueous into the corneal stroma
- Optic disc cupping: in infants may regress once the IOP is normalized
Overview of Glaucoma
- Potentially progressive and characteristic optic neuropathy associated with visual field loss
- Intraocular pressure is usually a key modifying factor
- Affects up to 2% of those over the age of 40 years globally, and up to 10% over the age of 80; 50% may be undiagnosed
Classification of Glaucoma
- Congenital (developmental) or acquired
- Open-angle and angle-closure types based on the mechanism by which aqueous outflow is impaired
- Primary and secondary glaucoma
Diagnostic Tests for Glaucoma
- IOP (intraocular pressure)
- Gonioscopy
- Optic nerve head appearance
- Visual field appearance
- Optic nerve head imaging
Methods of Checking IOP
- Goldmann tonometry
- Tonopen
- Schiotz tonometry
- Puff tonometry
- Rebound tonometry
Visual Field Tests
- Static perimetry – Humfrey VF (commonly used)
- Kinetic perimetry – Goldmann
Optic Nerve Head Imaging
- Stereo photographs
- Optical coherence tomography
- Heidenberg retinal tomograph
Optic Nerve Head Appearance
- Normal optic nerve head:
- Neuroretinal rim
- Rim-disc ratio
- Cup
- Cup disc ratio
Structures Affected/Changes in Glaucoma
- Optic nerve head:
- A. Neuroretinal rim: follows the ISNT rule
- B. Rim-disc ratio: indicates the thickness of the rim in four quadrants expressed as a fraction of the diameter of the disc
- C. Cup: may have one of three main appearances
- D. Cup-disc ratio: indicates the diameter of the cup expressed as a fraction of the diameter of the disc
- E. Blood Vessels: BV from within the optic nerve enter the disc centrally and then course nasally from the edge of the cup
Ocular Hypertension
- Population over 40 yrs have IOP’s greater than 21mmhg without detectable glaucomatous damage on standard clinical tests
- These individuals are referred to as ocular hypertensives or glaucoma suspects
Signs of POAG
- IOP greater than 21mmhg
- Wide open angle
- Thinning of NFL
- Changes on cupping (ONH)
Risk of POAG
- Age: after age 65 y/o
- Race: more severe in blacks than whites
- Family history
- Diabetes mellitus
- Myopia
- Retinal disease: CRVO, RD, and RP
Changes of POAG in the VF
- Paracentrally scotoma: supero nasal
- Nasal: below horizontal midline in the nasal field
- Arcuate shaped: coalescence of paracentral scotomas
- Temporal wedge: due to damage to adjacent fibres
Management for POAG
- No information provided
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Description
This quiz covers the different types of glaucoma, including angle-closure with and without pupil block, open-angle, and lens-related glaucoma such as phacolytic, phacomorphic, and phacoanaphylaxis glaucoma.
