Term
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Definition
| a group of ocular dz with various causes that ultimately cause progressive optic neuropathy leading to loss of vision fxn |
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Term
| What are the primary s/sx of glaucoma? |
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Definition
optic nerve head atrophy
visual field loss |
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Term
| Is IOP a definitive sign of glaucoma? |
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Definition
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Term
| What is the only significant risk factor for glaucoma that we can influence? |
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Definition
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Term
| What are risk factors for glaucoma? |
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Definition
Age
Gender
Race
F HX
Vascular conditions
Inflammatory conditions
Corticosteroids
Trauma
Surgery
Refractive Status
Increased IOP
AC angle configuration
Anterior Segment appearance
Appearance of ONH
Nerve Fiber Layer appearance |
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Term
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Definition
| Random clinical trial that looked at ocular hypertension and how it relates to POAG development in treated and untreated pt's |
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Term
| What baseline factors did OHTS follow? |
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Definition
age
race
gender
Vertical C/D
Horizontal C/D
IOP
F Hx
VF
Myopia
Heart Dz
HTN
low BP
oral CCB use
oral beta blocker use
CVA
DM
Migrain
Pachymetry |
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Term
| What % of pt's >62yo have glaucoma? |
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Definition
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Term
| What is the hardest part of glaucoma management? |
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Definition
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Term
| May you treat glaucoma before they have measurable s/sx? |
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Definition
| yes, if they have lots of risk factors and are highly likely to convert to glaucoma in the future |
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Term
| Does the type of glaucoma determine how we treat it? |
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Definition
| yes, target IOP's, timeline for surgery, TOC, drug regimen change depending on type |
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Term
| Do we set the same target IOP for all glaucoma pts? |
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Definition
| No, the baseline they are starting from influences the target |
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Term
| At what level of IOP, do most optometrists decide to treat if there are NO other s/sx? |
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Definition
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Term
What condition has been 'controversial' as to whether it can cause glaucoma?
*controversial in that it has been ruled in, then out, and back in repeatedly |
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Definition
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Term
| Is any one instrument reliable in definitively diagnosing glaucoma? |
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Definition
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Term
| What is one reason why OCT/HRT/GDX may be misleading for glaucoma dx? |
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Definition
| The baseline database has small sample size, narrow age range, and too uniform of a racial component. |
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Term
| Which gender is at a higher risk of POAG? |
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Definition
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Term
| Which gender is at a higher risk of narrow angle glaucoma? |
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Definition
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Term
| How does race affect glaucoma? |
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Definition
| african descent --> higher risk |
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Term
| What % of pt's who have glaucoma have a +FHx? |
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Definition
| 16-80% (highly variable, but definitely a factor) |
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Term
| What condition can cause a 50% risk of comorbid glaucoma? |
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Definition
| Fuch's hereditary iridocyclitis |
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Term
| What kind of surgery can induce glaucoma? |
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Definition
Non-ocular surgery due to blood flow during surgery impacting ONH
Lasik when a vacuum is used to immobilize the eye |
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Term
| What do refractive errors do to glaucoma risk? |
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Definition
Hyperopia --> increased angle closure risk
Mypia --> POAG |
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Term
| What were the IOP cutoffs for the OHTS study? |
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Definition
| Minimum of 24 in one eye, no one less than 21 in the other eye and no one above 32 |
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Term
| Can inference for pt's over ten years be made from the OHTS study? |
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Definition
| No, as the study only looked at a 5 year lead time |
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Term
| Why were both oral CCB's and oral beta blockers included in the OHTS study? |
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Definition
| They impact the vascular system. CCB --> relax arterioles; BB --> vasoconstriction peripherally |
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Term
| What is multivariant vs univariant risk factors? |
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Definition
Multivariant is when we have to isolate one variable by filtering out other variables
Univariant is when we just look at the absolute prevalence without filtering for other variables |
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Term
| Are multivariant or univariant studies more accurate? |
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Definition
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Term
| What was the age group in the OHTS study? |
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Definition
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Term
| Per OHTS, what were the most important multivariant risk factors for glaucoma? |
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Definition
age
vertical C/D
horizontal C/D
IOP
PSD on VF
CCT |
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Term
| Per OHTS, what were the most important univariant risk factors for glaucoma development |
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Definition
gender (male)
Race (African)
HD |
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Term
| What risks were not supported by OHTS? |
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Definition
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Term
| Why were multivariant race not a risk for glaucoma? |
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Definition
| They removed the physical characteristics that cause the actual increase of glaucoma. So if you had an African pt who had no physical traits of increased glaucoma risk, they would have no higher risk of glaucoma than a similar caucasian |
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Term
| Why was the OHTS studies F Hx risk factor nil? |
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Definition
| The FHx's were self-reported by the pt, so the data from OHTS on FHx is not reliable |
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Term
| What % of POAG will have a + FHx? |
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Definition
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Term
| What is more important for POAG: maternal or paternal history? |
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Definition
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Term
| Is parental or sibling FHx more important for POAG? |
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Definition
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Term
| What did OHTS say about POAG and DM? |
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Definition
| There was no correlation, BUT anyone with diabetic retinopathy was excluded from the study. |
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Term
| Why does low blood pressure increase NTG risk? |
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Definition
| Low blood pressure reduces the blood's ability to deliver nutrients to the ONH |
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Term
| What low blood pressure related sign is correlated with glaucoma? |
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Definition
| avascularity of nailfold capillary bed (low perfusion) and nailbed hemes |
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Term
| Why was myopia not found to be a risk factor in OHTS? |
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Definition
| There were not a representative number of high myopes. Avg refractive error was quite low. |
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Term
| What are the overall caveats for OHTS? |
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Definition
IOP 24-32
no glaucomatous damage yet |
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Term
| What is EGPS and how does it compare to OHTS? |
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Definition
| European Glaucoma Prevention Study that matched well with OHTS, supporting its results. |
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Term
| How does BMI impact glaucoma in females? |
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Definition
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Term
| How does ED affect glaucoma? |
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Definition
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Term
| How does iron and calcium supplementation impact glaucoma risk? |
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Definition
| >18mg iron and >800mg calcium leads to increased risk due to vasoconstriction |
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Term
| What dietary mineral may be useful for treating glaucoma? |
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Definition
| magnesium to counteract calcium induced vasoconstriction |
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Term
| What does easily getting 'ice cream HA', being slow to respond to thirst, or having poor circulation indicate for glaucoma? |
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Definition
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Term
| What tests MUST be done on all glaucoma suspects and pts? |
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Definition
pupils
SLE
VF
CCT
IOP
Gonio
ONH evaluation
NFL evaluation
fundus photography |
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Term
| How do beta blockers impact VF results? |
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Definition
| Beta blockers --> increased cataracts which can reduce VF performance |
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Term
| What are goals of testing for glaucoma? |
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Definition
| We want tests with high specificity/sensitivity to either not treat someone unnecessarily, or to prevent missing tx for someone who has glaucoma |
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Term
| Compare repeatable vs valid as it pertains to testing results |
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Definition
| repeatable just means it can be reproduced. However, if there is a flaw in the test, it may not be a valid result |
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