Board Certified Ophthalmologist Glaucoma Diagnosis and Management 2 — Questions and Answers
Question 1: Goldmann applanation tonometry is most likely to OVERESTIMATE true IOP in which situation?
- Thin cornea after LASIK
- Thick central cornea (Correct answer)
- Corneal edema with reduced rigidity
- Keratoconus
Correct answer: Thick central cornea
A thick central cornea resists applanation, so the reading comes out falsely high.
Question 2: Which peripapillary RNFL quadrant/sector most commonly shows the earliest glaucomatous thinning on OCT?
- Nasal
- Temporal
- Inferotemporal (Correct answer)
- Superonasal
Correct answer: Inferotemporal
The inferotemporal arcuate bundles are most vulnerable early, consistent with the ISNT rule being violated inferiorly.
Question 3: The Glaucoma Hemifield Test on Humphrey perimetry primarily evaluates:
- Overall diffuse sensitivity loss
- Asymmetry between mirror-image superior and inferior sectors (Correct answer)
- Fixation losses and reliability
- Central 10-degree threshold sensitivity
Correct answer: Asymmetry between mirror-image superior and inferior sectors
GHT compares five mirror-image sector pairs across the horizontal meridian to detect glaucomatous asymmetry.
Question 4: On gonioscopy, a scalloped pigment line anterior to Schwalbe line (Sampaolesi line) is most characteristic of:
- Pseudoexfoliation syndrome (Correct answer)
- Plateau iris
- Primary congenital glaucoma
- Angle recession
Correct answer: Pseudoexfoliation syndrome
Sampaolesi line is classic for pseudoexfoliation, though it can also appear in pigment dispersion.
Question 5: A patient with a dense superior paracentral scotoma near fixation on 24-2 testing should additionally undergo which test for better characterization?
- 30-2 SITA Standard
- 10-2 visual field (Correct answer)
- Goldmann kinetic perimetry with V4e
- Frequency doubling screening
Correct answer: 10-2 visual field
The 10-2 has 2-degree spacing that better detects and monitors central/paracentral glaucomatous damage.
Question 6: Low corneal hysteresis measured by the Ocular Response Analyzer is associated with:
- Lower risk of glaucoma progression
- Higher risk of visual field progression (Correct answer)
- Falsely elevated GAT readings only
- Angle-closure risk
Correct answer: Higher risk of visual field progression
Lower corneal hysteresis is an independent risk factor for glaucoma progression.
Question 7: A -9.00 D myope has OCT RNFL flagged red temporally-superiorly but has a normal visual field and healthy-appearing disc. The most likely explanation is:
- Early normal-tension glaucoma
- Compressive optic neuropathy
- Myopic shift of RNFL peaks causing a normative database artifact (Correct answer)
- Ischemic optic neuropathy
Correct answer: Myopic shift of RNFL peaks causing a normative database artifact
In high myopia the RNFL bundles shift temporally and the normative database is inappropriate, producing 'red disease' false positives.
