Term
| Is a bright, striated appearance to the NFL with a whitish haze over the top of the retina a normal or abnormal appearance? |
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Definition
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Term
| Where should the NFL appear brighter, where should it look dimmer, and what kind of asymmetry is worrisome? |
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Definition
| Superior and inferior arcades should have thick NFL overlying and be brighter compared to temporal or nasal NFL layer. Assymmetry between arcades in one eye or between opposite eyes is abnormal. |
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Term
| What impact does pigment have on the appearance of the NFL? |
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Definition
| The more pigmented the fundus, the more prominent the NFL should appear |
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Term
| What are slit defects? Are they pathognomonic for dz? |
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Definition
| arteriole sized ganglion cell degeneration that causes a missing slit in the NFL. 10% of normals have these, so it does not guarantee dz |
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Term
| Where is the NFL most prominent relative to the ONH? |
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Definition
| At the superior/inferior portions within 1-2DD of ONH |
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Term
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Definition
| expanded sectorial loss of ganglion cells |
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Term
| What are wedge defects often seen with? |
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Definition
| VF defects and an associated optic nerve notch |
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Term
| What is the easiest to see yet least common NFL damage pattern? |
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Definition
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Term
| What is the most common NFL damage pattern? |
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Definition
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Term
| What dz is diffuse atrophy associated with? |
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Definition
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Term
| What is NFL reversal also known as? |
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Definition
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Term
| What appearance does diffuse atrophy take? |
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Definition
| the arcades appear dimmest while the papillomacular bundle appears brightest in the NFL. This is opposite of normal. |
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Term
| If you see diffuse atrophy, what other signs are often associated with it? |
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Definition
neuroretinal rim thinning
NFL reversal
more prominent blood vessels |
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Term
| What are symptoms of diffuse atrophy? |
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Definition
| Diffuse depression or constriction of corresponding visual field |
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Term
| Should IOP's be reduced in NTG? |
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Definition
| Yes, even if 'normal' their IOP is still sufficient to cause damage |
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Term
| According to the collaborative NTG study, what IOP target shows slowed progression to no progression for NTG? |
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Definition
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Term
| According to the collaborative NTG study, what percentage of control eyes vs what percentage of treated eyes progressed with nerve damage? |
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Definition
| 35% of controls, 12% of treated |
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Term
| What did Hattenhauer determine from retrospectively analyzing glaucoma pt charts? |
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Definition
27% went on to be legally blind in one eye
9% went on to be legally blind in both eyes
So even with tx, no guarantees |
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Term
| What is the defintion of legal blindness? |
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Definition
<20/200 BVCA
or
VF <20 degrees |
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Term
| What did the ocular HTN Tx study determine about glaucomatous changes? |
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Definition
| ONH change or usually the first indication, VF loss second, concurrent ONH and VF last |
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Term
| What did the AGIS study determine was the cutoff to maintain stable VF? |
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Definition
<18 IOP at 100% of visits over 6 years had stable VF
IOP <18 mmHg for only 50% of visits had marked worsening of VF |
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Term
| What was the mean IOP in the AGIS study? |
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Definition
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Term
| Is VF loss proportional to IOP elevation? |
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Definition
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Term
| According to the EMGT study, what was the general relationship between IOP control and glaucoma progression? |
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Definition
| For every 1 mmHg drop in IOP --> 10% reduction in risk of glaucoma progression |
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Term
| What are theories for why glaucoma progresses, often even with tx ? |
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Definition
undetected IOP spikes (IOP appears controlled, but is not)
premature apoptosis due to poor axoplasmic flow
increased glutamate and nitric oxide in retina/vitreous |
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Term
| When do we code for high or low risk of glaucoma? What are the codes? |
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Definition
Low risk is 1-2 risk factors; Code 365.01
High risk is 3 or more risk factors; Code 365.05 |
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Term
| What are the 5 general rules for initiating glaucoma treatment? |
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Definition
IOP >30 mmHg
Changes in ONH, NFL or VF
Pt requests it
Vascular changes (Drance heme or occlusion)
Risk factors outweight equivocal findings |
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Term
| What is the general rule for when to treat when using the risk factor tool? |
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Definition
| Tx initiated > or = 7 points |
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Term
| What are the findings for the optic nerve in mild POAG according to AOA stage guidelines? |
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Definition
Disc hemorrhage
asymmetry
concentric or localed mild thinning of neuroretinal rim |
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Term
| What are the findings for the nerve fiber layer in mild POAG according to AOA stage guidelines? |
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Definition
less bright reflex
fine striations
large BV's clear
med BV's blurred
small BV's blurred |
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Term
| What are the findings for the visual field in mild POAG according to AOA stage guidelines? |
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Definition
| isolated paracentral scotomas partial arcute or nasal step damage limited to one hemifield w/ <25% of points involved mean deviation of 6 dB |
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Term
| What are the findings for the optic nerve in moderate POAG according to AOA stage guidelines? |
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Definition
central disc pallor
focal notching
vessel undermining
loss of neuroretinal rim in one quadrant |
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Term
| What are the findings for the nerve fiber layer in moderate POAG according to AOA stage guidelines? |
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Definition
minimal reflex brightness
all vessels clear
VF has partial or full arcuate scotoma in one hemifield. Damage may involve both hemifields but no fixation
mean deviation of between -6 and -12 dB |
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Term
| What are the findings for the optic nerve in severe POAG according to AOA stage guidelines? |
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Definition
complete absence of neuroretinal rim in 3 quadrants
vessell bayonetting (unreliable)
central disc pallor |
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Term
| What are the findings for the nerve fiber layer in severe POAG according to AOA stage guidelines? |
|
Definition
dark reflex, all vessels clear, no texture
VF with advanced loss in both hemifields, 5-10* central islan of vision and MD worse than -12dB, fixation may be involved |
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Term
| What is is the code 365.71 for? |
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Definition
Mild glaucoma
ONH abnormalies consistent with glaucoma w/o VF loss |
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Term
| What is the code 365.72 for? |
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Definition
Moderate glaucoma
ONH abnormalities consistent with glaucoma with VF loss in one hemifield but not within 5* of fixation |
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Term
| What is the code 365.73 for? |
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Definition
Severe glaucoma
ONH abnormalities consistent with glaucoma and VF loss withing 5* of fixation and/or VF abnormalities in both hemifields |
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Term
| What is the general rule for reducing IOP? |
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Definition
| 20-50% reduction is the target |
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Term
| For ocular HTN, how much should IOP be reduced? |
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Definition
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Term
| For VF loss or ONH notching, how much should IOP be reduced? |
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Definition
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Term
| For extreme VF loss or cupping, how much should we reduce IOP? |
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Definition
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Term
| What are the numbers for Z, the optic nerve damage severity factor in Jampels method? |
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Definition
0 = normal ONH, VF
1 = abnormal ONH, normal VF
2 = VF loss in periphery
3 = VF loss threatening fixation |
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Term
| What are the AAO guidelines for IOP target in OHT? |
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Definition
| 20% lower than baseline, lower than 20 mm Hg |
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Term
| What are the AAO guidelines for IOP target in mild glaucoma? |
|
Definition
| 20-30% lower than baseline |
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Term
| What are the AAO guidelines for IOP target in advanced glaucoma? |
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Definition
| 40% lower than baseline, lower than 15 mmHg |
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Term
| What are the AAO guidelines for IOP target in NTG? |
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Definition
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Term
| What glaucoma IOP guideline is considered the minimum and doesn't consider the severity of damage or risk factors? |
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Definition
| Cole/Lewis' Review of Optometry article |
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Term
| What is the equation for the Jampel method for IOP targeting? |
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Definition
| Target IOP = Maximum IOP - Maximum IOP% - Z (optic nerve damage severity factor) |
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Term
| How are Hartelben target IOP's calculated? |
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Definition
| Target IOP = IOP - IOP% - MD (VF mean deviation) |
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Term
| What are the caveats for Hartelben target IOP's? |
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Definition
| Most extreme IOP target, so carefully evaluate diurnal variation, damage, life expectancy, FHx, IOP at dx |
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