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Glaucoma-2
Final info
37
Medical
Graduate
12/08/2013

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Cards

Term
Some assumptions made when supporting the notion of uni-ocular trials of glaucoma meds
Definition
Diurnal variation equal in both eyes
Each eye responds equally to med
No cross over effect
Patient compliance/confusion
Term
Name a critical component of EVERY glaucoma follow-up
Definition
Re-education
Term
How often do you follow up a new patient with mild glaucoma until target pressure is reached
Definition
Every 2 weeks
Term
How often do you follow up a new patient with SEVERE glaucoma until target pressure is reached
Definition
Weekly
Term
Once target pressure is reached, how often do you see a mild case of glaucoma to check 'recent control'?
Long term control?
Definition
1-3 months for recent
3-6 months for long term
Term
When seeing a glaucoma patient for follow-up who has been put on a beta blocker, name specific topics you should ask them about (in terms of changes they have experienced with the med)
Definition
Blood Pressure
Pulse
Lung capacity
Term
What is an important component of evaluating IOP stability, in terms of scheduling follow-ups
Definition
Make sure you check their IOP at different times of the day, eg. Check around the peak action time of med, just before 2nd drop etc.
Term
Describe Reverse uniocular trial
Definition
Take pt off drug in 1 eye only, to see how the pressure reacts to ensure no tachyphylaxis has occurred.
Term
During follow-up visits always evalute ___________ & ____________ together
Definition
always evaluate VF and optic nerve head together
Term
Approximately how often should you have your 'severe' glaucoma patient perform a visual field?
Definition
4-8 months
Term
Name the 4 categories of VF 'changes'
Definition
New defect
Deepening of pre-existing defect
Expansion of pre-existing defect
Generalized depression
Term
Name some ways to tell that your patient has not been compliant with their meds
Definition
Refill history
Expected side effects missing
Confusion regarding their schedule
Term
Name 2 drug types that are generally 1st choice for glaucoma treatment
Definition
Prostaglandin analogues or beta-blockers
Term
If normal tension glaucoma and you are starting them on a beta-blocker, which one should you use specifically
Definition
Betaxolol-because it is selective and does not cause vasoconstriction as much
Term
An option for changing treatment when pressure is not met but there are no troublesome side effects?
Definition
Increase concentration of existing med if possible
Term
2 options ot consider if neither prostaglandins or beta-blockers are working
Definition
Combination med or Brimonidine bid or qid
Term
If you've tried a beta blocker, a prostaglandin and a combination and they are still not working, what is a good next option
Definition
Laser Therapy
Term
Important consideration of additive therapy in terms of drug effectiveness
Definition
Additional drugs have less effect than the initial drug
Term
If wanting to add to a prostaglandin but beta-blockers are contraindicated, name some other options
Definition
brimonidine
Dorzolamide/brinzolamide
Term
4 indications for surgery
Definition
Noncompliance
Continued damage with maximum medical therapy
Cost concerns
Quality of life concerns
Term
What is the best 1st surgery for African American patients?
Definition
ALT
Term
What is the best 1st surgery for Causasians?
Definition
Trabeculectomy
Term
ALT vs SLT-which can be re-treated
Definition
SLT only
Term
ALT vs SLT
which has a smaller burn size
Definition
ALT=50um
SLt=400um
Term
ALT vs. SLT
Which causes more damage to surrounding tissue?
Definition
ALT causes more damage to surrounding tissue
Term
Laser Trabeculotplasty basically replaces _____ (#) glaucoma med(s)
Definition
Basically replaces just 1 med
Term
According to the study by Song, J et al, SLT only buys you about ____ _________
Definition
6 months
Term
Name a med used to prevent pressure spikes following laser trabeculoplasty
Definition
Use Iopidine (alpha agonist)
Term
Trabeculectomy connects which 2 anatomical structures
Definition
Connects anterior chamber to sub-Tenon's space
Term
What is the most common trabeculectomy procedure
Definition
Partial-thickness Trabeculectomy
Term
Difference between partial and full trabeculectomy
Definition
Partial- a scleral flap is made
Full-no scleral flap, only Tenon's and conjunctiva over sclerotomy
Term
What is the main risk of a full-thickness trabeculectomy
Definition
High risk of hypotony
Term
Describe a canaloplasty
Definition
Catheter is snaked through Schlemm's canal 360 degrees in an attempt to dilate it and remove blockages
Term
Which causes mor eof an IOP drop, trabeculectomy of canaloplasty
Definition
Trabeculectomy, won't get into single digit IOPs with canaloplasty
Term
What procedure is done in conjunction with partial thickness trabeculectomy
Definition
Peripheral iridectomy
Term
Name 3 advantages of filtration devices over trabeculectomies
Definition
Don't need PI
less risk of obstruction
Typically less hypotony (exit of aqueous is more controlled)
Term
Describe Trabectome surgery
Definition
Electrocautery is used to ablate a segment of the inner wall of Schlemm's
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