Term
| Why are uniocular trials a bad idea in Dr Lingel's opinion? |
|
Definition
Systemic circulation will carry plenty of medication to opposite eye, so not a true uniocular trial
Pt compliance is difficult, very confusing |
|
|
Term
| How should you ensure the pt understand proper drop instillation technique? |
|
Definition
| Have pt perform drop instillation in front of you |
|
|
Term
| What is the follw-up schedule after Rx'ing medication? |
|
Definition
Every 2 weeks until target IOP is reached if mild or moderate
Weekly for severe |
|
|
Term
| Why is pre-appointing glaucoma follow-ups a good idea? |
|
Definition
| Only 30% of pts return for first follow-up. Scheduling all visits at same time increase compliance |
|
|
Term
| What special tests should be performed on glaucoma follow-ups if a beta blocker or adrenergic agonist has been rx'd? |
|
Definition
| BP, pulse, and lung capacty (PEFR) |
|
|
Term
| Relative to a pt's med schedule, when should followup IOP's be taken? |
|
Definition
| As long as possible after previous med instillation |
|
|
Term
| What is the typical drift for IOP after the 'honeymoon' period for IOP meds? |
|
Definition
|
|
Term
| What is the schedule for VF's to be performed for a glaucoma pt after initial dx? |
|
Definition
2-3 VF in first few months to establish a baseline for all then:
Annual for mild glaucoma or glc suspect
6-12 months for moderate
4-8 months for severe
Every 4-6 weeks if very unstable |
|
|
Term
| When and what kind of VF's should be performed if VF's are very unstable? |
|
Definition
| Every 4-6 weeks; do not do a 30-2 or 24-2 if pt has advanced peripheral loss as pt may only have a central 10* (for example) |
|
|
Term
| If you are using a GDX for NFL evaluation, what mitigating factors should be controlled for? |
|
Definition
use the same instrument year to year
same ambient light level
undilated |
|
|
Term
| What are the four types of VF changes that indicate current medication is not working? |
|
Definition
new defect in prev. normal area
deepening of existing defect
expansion of multiplae pre-existing scotomas joining into a single defect
generalized depression |
|
|
Term
| When does MD indicate progression may be occuring? Definitely occurring? |
|
Definition
m = -0.50 --> be suspicious
m = -1.00 --> definitely progressing |
|
|
Term
| What is the basic premise of when a new defect can be counted as significant on a VF? |
|
Definition
Either a cluster of non-edge points must progress 5dB or more
OR
A single non-edge point must progress 10dB or more |
|
|
Term
| What is the basic premise for when an existing VF defect has deepened? |
|
Definition
3 or more clustered non-edge pts deepen 10dB or more
OR
3 non-edge points in the same defect decline 5 dB but are at P<5% compared to baseline |
|
|
Term
| What is the basic premise for the expansion of discrete scotomas into one scotoma? |
|
Definition
| 10dB or more drop OR P<5% progression for 2 or more points inside 15* (3 if outside of 15*) |
|
|
Term
| What is the criteria for confirming a generalized depression? |
|
Definition
CPSD trending over 5 or more VF
Decline of 3dB or more at ALL points on two consecutive VF
MD decline at the P<1% level and not due to cataract/media opacity/senile miosis |
|
|
Term
| Why do we assess endocrine systems before rx'ing glc meds? |
|
Definition
| beta blockers mask hypoglycemia (dangerous for DM1, lesser so for DM2) |
|
|
Term
| If the initial IOP med is ineffective, should we avoid other drugs with same mechanism of action? |
|
Definition
| No, you can try same category. |
|
|
Term
| If PG's or BB's don't work, what should be tried next? |
|
Definition
| Combo of the two mechanisms |
|
|
Term
| If combo meds fail to control IOP, what is the next step? |
|
Definition
|
|
Term
| What are the reservations regarding glc surgery? |
|
Definition
| laser therapy can diminish effectiveness of future meds |
|
|
Term
| When should VF be performed in mild, moderate, severe and unstable glaucoma? |
|
Definition
mild: yearly
moderate: 6-12 months
severe 4-8 months
4-6 weeks until new baseline |
|
|
Term
| What is the thickness variation from test to test of a GDX? |
|
Definition
|
|
Term
| What constitutes a good score for NFI? A bad score? |
|
Definition
| The higher the NFI is, the more NFL loss. 1 = good score, 99 = bad score |
|
|
Term
| What is the most useful single metric (according to Lonsberry) that a GDX printout provides? |
|
Definition
|
|
Term
| What is the range for a normal NVI score? Borderline? Abnormal? |
|
Definition
Normal: 1-30
Borderline: 31-50
Suspicious: 50-70
Abnormal: >70 |
|
|
Term
| What is modulation with regards to a GDX score? What is a good value? A bad value? |
|
Definition
| Modulation is the delta between peak and trough on the TSNIT graph. A high score is good/normal, a low score is bad/abnormal |
|
|
Term
| What is the inter-eye symmetry score on a GDX measuring? |
|
Definition
| Compares OD to OS and checks how congruous they are. Symmetric will be values of close to 1, asymmetric will be closer to 0. |
|
|
Term
| What is the spectrum of image detail between OCT machines? |
|
Definition
| Time doman such as Stratus (older) or Cirrus (newer) will have lower detail than Fourier domain (RTVue) |
|
|
Term
| When using a Cirrus OCT, what age range of pt's should be evaluated cautiously and why? |
|
Definition
| Over 70 has low sample size for normative database, no database for those under 19 |
|
|
