Term
| 2 most important factors in diagnosis of glaucoma |
|
Definition
1. Risk Factors
2. Appearance of nerve head |
|
|
Term
| Name 1 common risk factor present in all participants in the OHTS study |
|
Definition
| All had ocular hypertension |
|
|
Term
| Why was the use of oral calcium channel blockers considered in the OHTS study |
|
Definition
| Calcium channel blockers can cause dilation of blood vessels in the periphery and are thought to be protective in glaucoma |
|
|
Term
| Investigation of what risk factor was added later in the OHTS study |
|
Definition
| Central Corneal Thickness |
|
|
Term
| Name 4 multivariant risk factors found to be significant according to the OHTS study |
|
Definition
Age (per decade)
Vertical cup to disc ratio
IOP
Pattern Standard Deviation |
|
|
Term
| Name 3 univariant risk factors found to be signficant according to the OHTS study |
|
Definition
Gender (Male)
Self-identified race
Heart disease |
|
|
Term
| Is myopia a risk factor for glaucoma supported by the OHTS study |
|
Definition
| No, it is not supported by the OHTS study |
|
|
Term
Which of the following is a supported risk factor for glaucoma according to the OHTS study
Migraine
Blood Pressure
Vertical CD
Diabetes |
|
Definition
|
|
Term
Family history was shown to be a risk factor in glaucoma, order the following relation from greatest to least risk
Maternal, Sibling, Paternal |
|
Definition
| Sibling>Maternal>Paternal |
|
|
Term
| Why may the OHTS study findings regarding the relation between POAG and DM differ from all other studies |
|
Definition
| Possibly because OHTS excluded patients with DR and the patient group was not representative of DM |
|
|
Term
| What 2 characteristics of a patients fingernails may increase their risk of glaucoma |
|
Definition
Hemorrhages underneath nails increases risk of glaucoma
Avascularity of nailfold capillary bed |
|
|
Term
| Low blood pressure is more likely to be related to which form of glaucoma |
|
Definition
|
|
Term
| 1 reason why the OHTS showed no correlation between glaucoma and myopia, unlike other studies have shown |
|
Definition
| OHTS participants had low average refractive errors, thus high myopes were not properly represented in the study |
|
|
Term
| The results of the OHTS study should only be applied to individuals with an IOP of: |
|
Definition
|
|
Term
| The results of the OHTS study should only be applied to individuals between the ages of ______________ |
|
Definition
|
|
Term
| Describe a specific subset of women who are more likely to develop the glauc! |
|
Definition
| Thin, Thirst (don't respond to thirst well) and Cold feet |
|
|
Term
| Name a condition that may be a vascular marker for glaucoma in men and is associated with a 3X risk of glc |
|
Definition
|
|
Term
| How may cataracts relate to the development of glaucoma |
|
Definition
| As the lens swells due to cataracts the angle becomes narrower, which can cause angle closure |
|
|
Term
| Tests that have low numbers of false positives have high ________________ (sensitivity or specificity) |
|
Definition
|
|
Term
| Tests that have low numbers of false negatives have high ________________ (sensitivity or specificity) |
|
Definition
|
|
Term
| 3 Goals of Testing for Glaucoma |
|
Definition
High Specificity
High Sensitivity
Repeatable and valid results |
|
|
Term
| Which test for glaucoma has the best specificity |
|
Definition
|
|
Term
| Which test for glaucoma has the lowest sensitivity |
|
Definition
| Tono IOP using the cutoff of 24mmHg |
|
|
Term
| How can we increase the sensitivity and specificity of testing for glaucoma |
|
Definition
| Increase the number of tests performed |
|
|
Term
| How do we designate a pt (suspect or confirmed case) who has high IOP, large cupping but not VF loss or ONH change |
|
Definition
|
|
Term
| What testing time indicates abnormal FDT |
|
Definition
| Longer than 90s on one eye |
|
|
Term
| In the central 5 locations on an FDt, what indicates an abnormal result |
|
Definition
| Any defect at all in the central 5 locations |
|
|
Term
| In the outer twelve locations on an FDT, what indicates an abnormal result |
|
Definition
| 2+ mild defects, 1+ moderate/severe defects |
|
|
Term
Fixation losses on Humphrey VF
What does upward line indicate? |
|
Definition
|
|
Term
Fixation losses on Humphrey VF
What does downward line indicate? |
|
Definition
| Blink or unable to track fixation |
|
|
Term
| _____% or less errors in blind spot testing on a visual field indicates a reliable field |
|
Definition
|
|
Term
| _____% or less false positives/negatives on a visual field indicates a reliable field |
|
Definition
|
|
Term
| Which part of the visual field print out compares corresponding data points above and below the horizontal midline |
|
Definition
|
|
Term
| Everything except _____________ on a visual field printout is adjusted for age matched norms |
|
Definition
|
|
Term
Single Field Printout Analysis
Area that illustrates difference between expected for age and achieved (- means less sensitive) |
|
Definition
|
|
Term
Single Field Printout Analysis
Plot that illustrates how likely the pattern deviation is due to chance or real |
|
Definition
| Probability plot of Pattern deviation |
|
|
Term
| Which part of the single field printout analysis for visual fields is most indicative of risk of glaucoma, according to OHTS |
|
Definition
|
|
Term
| 4 Most common types of early field loss in glaucoma |
|
Definition
Partial Arcuate
Paracentral
Nasal Step
Temporal wedge |
|
|
Term
| Most common location for paracentral scotoma to occur due to glaucoma |
|
Definition
|
|
Term
| 2 ways the appearance of the disc can be used to differentiate glaucoma from AION |
|
Definition
Pallor in AION, not as likely in glaucoma
Excavation in glaucoma, not AION |
|
|
Term
| Which glaucoma patients are more likely to have generalized VF depression (compared to localized defects), those with high IOP or low IOP |
|
Definition
| Those with generalized depression tend to have higher IOP than those with localized defects |
|
|
Term
| What CPSD value indicates the VF defects are significant? |
|
Definition
|
|
Term
| The thickness/stability of the cornea relates to the thickness/stability of the ___________ ____________since they have similar structural makeup |
|
Definition
|
|
Term
| Those with Ocular Hypertension tend to have ________________ corneas |
|
Definition
|
|
Term
| Those with Normotensive Glaucoma tend to have ______________ corneas |
|
Definition
|
|
Term
| Performing gonioscopy before tonometry can cause the measurements to be _______________ |
|
Definition
|
|
Term
| Performing a visual field may ______________ tonometry readings (if taken close together) |
|
Definition
|
|
Term
| Narrow anterior chamber angles tend to have ____________ iris approaches |
|
Definition
|
|
Term
| Name 4 nerve head characteristics that can influence whether or not it follows the ISNT rule |
|
Definition
Location of ONH
Tilting
Irregular shape
Drusen |
|
|
Term
| Normal size of an optic nerve head |
|
Definition
|
|
Term
| How many fibers in normal optic nerve head |
|
Definition
|
|
Term
| Ganglion cell axons are usually first to go from which areas of the disc |
|
Definition
| Superior and inferior, especially inf temp |
|
|
Term
| It is normal to have a slightly vertically elongated ________ but not normal to have a vertically elongated _______ |
|
Definition
| Normal for disc to be V>H, but not for cup (only 7% of normals have it) |
|
|
Term
| If using the size of major veins to judge the size of the nerve head, you should be able to 'fit' _____ into the nerve head |
|
Definition
|
|
Term
| Most common position of central retinal artery trunk |
|
Definition
|
|
Term
| Area in which we expect to first see rim tissue loss is furthest from____________ |
|
Definition
| Central Retinal Artery Trunk |
|
|
Term
| 3 aspects of vessel evaluation in glaucoma |
|
Definition
1. Position of CRA trunk
2. Diffuse arteriolar narrowing
3. Shift in vessel position |
|
|
Term
| Approximately how long for an optic disc hemorrhage to resolve |
|
Definition
|
|
Term
| What other evidence of progressing glaucoma is associated with rim notching |
|
Definition
|
|
Term
| 2 zones of peripapillary pigmentary atrophy, which is more concerning |
|
Definition
| Beta is more concerning, if alpha is present but alone there is not as much concern. |
|
|
Term
| Alpha and Beta atrophy- which is always closest to the disc and which is the leading edge? |
|
Definition
| Beta always closest to nerve head and alpha is the leading edge |
|
|
Term
| Beta zone peripapillary atrophy is atrophy of which layers |
|
Definition
|
|
Term
| What may be the first sign of glaucoma in a crowded nerve head where it is difficult to see nerve loss |
|
Definition
|
|
Term
| Describe alpha zone peripapillary atrophy |
|
Definition
| Mottled appearance of RPE around the disc, irregular hyper and hypo pigmentation |
|
|
Term
| ONH Pits are most common in which part of the disc |
|
Definition
| Inferior Temporal quadrant |
|
|
Term
| The brightness of the nerve fiber layer correlates to it's _____________ |
|
Definition
|
|
Term
| With advanced glaucoma, which region of the nerve fiber layer may appear to be brightest (reversed pattern) |
|
Definition
| Papillomacular area becomes brightest instead of near disc |
|
|
Term
| Which ethniticites have a higher rate of conversion from Ocular Hypertension to Glaucoma |
|
Definition
|
|
Term
| In the Ocular HTN Treatment study, what was found to be the most common first indication of glaucoma |
|
Definition
|
|
Term
| In the Ocular HTN Treatment study, what was found to be the second set of changes that indicate glaucoma |
|
Definition
|
|
Term
| Early Management Glaucoma Trial found what difference in treated vs. untreated groups |
|
Definition
Progression in 45% of treated and 62% of untreated
Faster progressionin untreated |
|
|
Term
| In the EMGT what was the most significant side effect in treated patients |
|
Definition
| Increased incidence of nuclear cataracts |
|
|
Term
| What did the AGIS study find in regards to stability of IOP and the relation to glaucoma progression |
|
Definition
Eyes <18 mmHg at all visits had almost completely stable VF
Eyes whose IOP fluctuated at 50% of visits had definite worsening of VF |
|
|
Term
| 5 recommendations for when to begin treating glaucoma |
|
Definition
IOP>30mmHg
Changes in ONH, NFL or VF consistent with glaucoma and each other
Patient request
Vascular disease changes (heme)
Risk factors outweigh equivocal findings |
|
|
Term
AOA Stages of POAG
Description of Optic Nerve in the MILD category |
|
Definition
Mild concentric narrowing of rim
Disc hemorrhage
Asymmetry |
|
|
Term
AOA Stages of POAG
Description of Optic Nerve in the MODERATE category |
|
Definition
Moderate concentric narrowing
Increased central pallor
Loss of rim in 1 quadrant
Focal notching
Vessel undermining |
|
|
Term
AOA Stages of POAG
Description of NFL in Mild vs. Moderate category |
|
Definition
Mild-less striations, large vessels clear, med and small bvs blurred
Moderate-no texture and all vessels clear |
|
|
Term
AOA Stages of POAG
Visual field changes in Mild vs. Moderate category |
|
Definition
MILD- Isolated paracentral scotomas, partial arcuate or nasal step
Damage in only 1 hemifield, <25% points involved
MD <6dB
MODERATE-Partial or FULL arcuate scotoma, damage may involved both hemifields but no fixation
MD-6 to -12 dB |
|
|
Term
| Description of Optic Nerve in SEVERE category |
|
Definition
Complete absence of rim in at least 3 quadrants
Bayonetting
Increased central disc pallor |
|
|
Term
AOA Stages of POAG
Description of NFL in Moderate vs. Severe category |
|
Definition
MODERATE-minimal brightness, no texture, all vessels clear
SEVERE-Dark reflex, no texture, all vessels clear |
|
|
Term
AOA Stages of POAG
Visual fields in SEVERE category |
|
Definition
Advanced loss in BOTH hemifields
MD<12dB, fixation may be involved. |
|
|
Term
| Mild Glaucoma Stage according to Medicare |
|
Definition
| ONH abnormalities consistent with glaucoma w/o VF loss |
|
|
Term
| Moderate Glaucoma stage according to Medicare |
|
Definition
| ONH abnormalities consistent with glaucoma w/ VF loss in 1 hemifield and not within 5 degrees of fixation |
|
|
Term
| Severe (ie. advanced or endstage) Glaucoma according to Medicare |
|
Definition
| ONH abnormalities consistent with glaucoma, VF loss in both hemifields and/or loss within 5 degrees of fixation |
|
|
Term
| According to evidence based studies, how much do you aim to decrease IOP by when they have Ocular HTN and risk factors present |
|
Definition
|
|
Term
| According to evidence based studies, how much do you aim to decrease IOP by when they have VF loss or ONH notching |
|
Definition
|
|
Term
| According to evidence based studies, how much do you aim to decrease IOP by when they have extreme VF loss and/or cupping |
|
Definition
|
|
Term
| According to AOA guidelines, how much do you aim to lower IOP by when they have Ocular HTN |
|
Definition
| 20% less than baseline and <20mmHg |
|
|
Term
| According to AOA guidelines, how much do you aim to lower IOP by when they have mild glaucoma |
|
Definition
| 20-30% less than baseline |
|
|
Term
| According to AOA guidelines, how much do you aim to lower IOP by when they have advanced glaucoma |
|
Definition
| 40% less than baseline and <15 mmHg |
|
|
Term
| According to AOA guidelines, how much do you aim to lower IOP by when they have normotensive glaucoma |
|
Definition
|
|
Term
| How much do you lower IOP by for any glaucoma patient according to Cole/Lewis |
|
Definition
| Decrease by the percentage equal to their initial IOP (ie. IOP =20mmHg, decrease by 20%) |
|
|
Term
| Formula for target IOP according to Jampel |
|
Definition
| Target=Max IOP-Max IOP% -Z |
|
|
Term
For Jampel Target IOP formula, Z= optic nerve damage severity factor
When does Z=0 |
|
Definition
|
|
Term
For Jampel Target IOP formula, Z= optic nerve damage severity factor
When does Z=1 |
|
Definition
| 1=Abnormal disc and normal VF |
|
|
Term
For Jampel Target IOP formula, Z= optic nerve damage severity factor
When does Z=2 |
|
Definition
| 2= VF loss NOT threatening fixation |
|
|
Term
For Jampel Target IOP formula, Z= optic nerve damage severity factor
when does Z=3 |
|
Definition
| 3= VF loss threatening or involving fixation |
|
|
Term
| Formula for target IOP according to Hartelben |
|
Definition
|
|
Term
| Which recommendation for target IOP represents the most aggressive 'calculation' |
|
Definition
| Hartelben, the one that subtracts MD |
|
|
Term
| No matter what target IOP you set, you will need to constantly ________________________ |
|
Definition
|
|
Term
| Who owns the technology for Stratus OCT |
|
Definition
| Zeiss-no other companies can make them |
|
|
Term
| Which company owns the SD-OCT |
|
Definition
| not owned by 1 company, is made by different manufacturers |
|
|
Term
| For Cirrus OCT database, what is the youngest age included in the normative database |
|
Definition
|
|
Term
| Name the parameters that the normative databases of the RNFL and Macula are adjusted for with the Cirrus OCT |
|
Definition
| Age only, no other parameters |
|
|
Term
| Name 3 parameters that normative database is adjusted for in the RTVue |
|
Definition
Age
Disc size
Signal strength |
|
|
Term
| For Cirrus OCT, which parameters are used when applying normative limits to ONH parameters |
|
Definition
|
|
Term
| What does the FAstrac technology do in the Cirrus OCT |
|
Definition
| It overlaps the BV each scan to ensure the exact same area is being analyzed each time,s othe comparisons are more reliable. |
|
|
Term
| What anatomic features does the Cirrus use to identify the end of the cup |
|
Definition
| Bruch's membrane termination |
|
|
Term
| How many baseline scans are needed for Cirrus OCT |
|
Definition
|
|
Term
| Approx how does the rate of glaucoma progression change when the pt presents with a Drance hemorrhage |
|
Definition
|
|
Term
| What layers of the retina make up the ganglion cell complex |
|
Definition
Nerve Fiber Layer (axons)
Ganglion Cell Layer (cell bodies)
Inner Plexiform Layer (dendrites) |
|
|
Term
| Where is the ganglion cell complex thickest |
|
Definition
|
|
Term
| Of the three layers within the GCC, which has normal variation between individuals, and which tends to be constant between normal individuals |
|
Definition
RNFL varies between individuals
NFL and IPL appears more similar b/w individuals |
|
|
Term
| Describe Ganglion Cell Analysis |
|
Definition
| It analyzes 2/3 layers of the GCC, it removes the RNFL from the equation since there is so much variability between individuals. |
|
|
Term
True or False
The Heidelberg Spectralis has eye tracking technology like the FAstrac on Cirrus |
|
Definition
|
|
Term
| Which instrument has the unique feature, Fovea to Disc Alignment |
|
Definition
Spectralis-which eliminates head tilt as a contaminating factor, therefore it accounts for both eye movement and head positioning.
Cirrus does not do this, only eye movement |
|
|
Term
| Which OCT makes a comparison between the 2 eyes as well as between superior and inferior in one eye |
|
Definition
| Spectralis-Posterior Pole Symmetry Index |
|
|
Term
| How many baseline scans are needed for Spectralis vs. Cirrus |
|
Definition
Cirrus=2 (may change now that they have Fastrac)
Spectralis=1 |
|
|
Term
| Which 2 types of perimetry are done by the Spectralis and it's HEP attachment |
|
Definition
Flicker Defined Form for early glaucoma
Standard Automated Perimetry for mod-severe progressive disease |
|
|
Term
| Which OCT has the best GCC analysis |
|
Definition
|
|
