Board Certified Ophthalmologist Glaucoma Diagnosis and Management 5 — Questions and Answers
Question 1: Indentation gonioscopy showing a 'double hump' sign is characteristic of:
- Pupillary block angle closure
- Plateau iris configuration (Correct answer)
- Angle recession
- Iridoschisis
Correct answer: Plateau iris configuration
The double hump reflects the peripheral iris draped over anteriorly positioned ciliary processes, typical of plateau iris.
Question 2: The definitive initial procedure for acute primary angle closure due to pupillary block, once the cornea clears, is:
- Selective laser trabeculoplasty
- Laser peripheral iridotomy (Correct answer)
- Cyclophotocoagulation
- Goniotomy
Correct answer: Laser peripheral iridotomy
LPI equalizes pressure between the posterior and anterior chambers, relieving pupillary block.
Question 3: The EAGLE trial found that, in PAC with IOP ≥30 mmHg or PACG, clear lens extraction compared with LPI was:
- Less effective and less cost-effective
- More effective and cost-effective (Correct answer)
- Equivalent in IOP control
- Associated with more vision loss
Correct answer: More effective and cost-effective
EAGLE showed clear lens extraction yielded better IOP control, quality of life, and cost-effectiveness than LPI.
Question 4: In the Ocular Hypertension Treatment Study, which baseline factor was a strong independent predictor of conversion to POAG?
- Thicker central corneal thickness
- Thinner central corneal thickness (Correct answer)
- Myopia
- Female sex
Correct answer: Thinner central corneal thickness
OHTS identified thinner CCT, along with older age, higher IOP, larger cup-to-disc ratio, and higher PSD, as predictive.
Question 5: Which patient is at highest risk for hypotony maculopathy after trabeculectomy with mitomycin C?
- Elderly hyperopic woman
- Young myopic man (Correct answer)
- Patient with prior LPI
- Pseudophakic elderly patient
Correct answer: Young myopic man
Young age, male sex, and myopia (thinner, less rigid sclera) increase risk of hypotony maculopathy.
Question 6: A 6-month-old with epiphora, photophobia, enlarged corneas, and horizontal Descemet breaks most likely requires which first-line treatment?
- Long-term topical timolol alone
- Angle surgery (goniotomy or trabeculotomy) (Correct answer)
- Laser peripheral iridotomy
- Cyclophotocoagulation
Correct answer: Angle surgery (goniotomy or trabeculotomy)
Primary congenital glaucoma is surgical, with angle surgery as first-line therapy.
Question 7: The Early Manifest Glaucoma Trial found that each 1 mmHg of IOP reduction from baseline reduced the risk of progression by approximately:
- 1%
- 10% (Correct answer)
- 25%
- 50%
Correct answer: 10%
EMGT showed roughly a 10% reduction in progression risk per mmHg of IOP lowering.
