FREE ABO Glaucoma Diagnosis and Management Questions and Answers

Question 1

A 68-year-old male with primary open-angle glaucoma is being monitored for progression.
His intraocular pressure is stable on a prostaglandin analog.
Which finding on spectral-domain optical coherence tomography (SD-OCT) of the retinal nerve fiber layer (RNFL) is most indicative of early glaucomatous progression?

Accepted Answer

Localized thinning of the inferotemporal or superotemporal quadrant that respects the horizontal midline

Answer

Diffuse thinning of the entire RNFL

Answer

Focal thinning of the inferotemporal quadrant that crosses the horizontal midline

Answer

An increase in the overall signal strength of the scan

Question 2

A 55-year-old female presents with sudden, severe right eye pain, blurred vision, and nausea. On examination, her intraocular pressure (IOP) is 58 mmHg, the cornea is hazy, and the pupil is mid-dilated and nonreactive. Gonioscopy of the left eye reveals a narrow, occludable angle. What is the most appropriate definitive initial treatment for the affected right eye after the acute attack is medically controlled?

Accepted Answer

Laser peripheral iridotomy (LPI)

Answer

Topical prostaglandin analog therapy

Answer

Selective laser trabeculoplasty (SLT)

Answer

Trabeculectomy

Question 3

Which of the following classes of topical glaucoma medications primarily works by increasing the uveoscleral outflow of aqueous humor?

Accepted Answer

Prostaglandin analogs

Answer

Beta-blockers

Answer

Alpha-adrenergic agonists

Answer

Carbonic anhydrase inhibitors

Question 4

A 62-year-old patient is diagnosed with normal-tension glaucoma (NTG). Their intraocular pressures are consistently 15-17 mmHg in both eyes. Humphrey Visual Field testing shows a dense superior arcuate scotoma in the right eye. According to the Collaborative Normal Tension Glaucoma Study (CNTGS), what is the recommended management approach?

Accepted Answer

Lowering the intraocular pressure by at least 30% from baseline.

Answer

Observation without treatment, as the IOP is within the normal range.

Answer

Initiation of a topical beta-blocker to lower IOP by 10%.

Answer

Surgical intervention with trabeculectomy as the first-line treatment.

Question 5

When interpreting a Humphrey Visual Field (HVF) 24-2 test for a glaucoma suspect, which of the following patterns is most characteristic of early glaucomatous damage?

Accepted Answer

A nasal step respecting the horizontal midline

Answer

A central scotoma

Answer

A bitemporal hemianopsia

Answer

An enlarged blind spot

Question 6

A 70-year-old patient with pseudoexfoliation glaucoma has an intraocular pressure of 28 mmHg in the right eye despite maximal tolerated medical therapy with a prostaglandin analog, a beta-blocker, and a carbonic anhydrase inhibitor. Which of the following is the most appropriate next step in management?

Accepted Answer

Perform selective laser trabeculoplasty (SLT).

Answer

Add a fourth medication, such as a miotic.

Answer

Switch the prostaglandin analog to a different brand.

Answer

Continue to monitor the patient on the current regimen.