FREE Board Certified Ophthalmologist Glaucoma Diagnosis and Management Questions and Answers

Question 1

A 68-year-old male with a history of primary open-angle glaucoma (POAG) presents for a follow-up visit.
His intraocular pressure (IOP) is 18 mmHg in both eyes on a prostaglandin analog.
Optical Coherence Tomography (OCT) of the retinal nerve fiber layer (RNFL) shows progressive thinning in the inferotemporal quadrant of the right eye compared to the previous year.
Visual field testing remains reliable and full.
What is the most appropriate next step in management?

Accepted Answer

Add a second IOP-lowering agent.

Answer

Continue current therapy and repeat testing in one year.

Answer

Discontinue the prostaglandin analog and switch to a beta-blocker.

Answer

Perform a laser peripheral iridotomy.

Question 2

A 55-year-old hyperopic female presents to the emergency department with severe right eye pain, headache, nausea, and blurred vision with halos around lights. On examination, her IOP is 52 mmHg, the cornea is hazy, the pupil is mid-dilated and nonreactive, and the anterior chamber is shallow. Gonioscopy of the fellow eye reveals a narrow, occludable angle. What is the definitive treatment for this condition?

Accepted Answer

Laser peripheral iridotomy

Answer

Topical prostaglandin analog therapy

Answer

Intravenous acetazolamide followed by oral therapy

Answer

Selective laser trabeculoplasty (SLT)

Question 3

Which of the following findings is most characteristic of Normal-Tension Glaucoma (NTG)?

Accepted Answer

Optic disc hemorrhages.

Answer

Intraocular pressures consistently above 25 mmHg.

Answer

A deep, centrally located visual field defect.

Answer

Peripheral anterior synechiae on gonioscopy.

Question 4

When interpreting a Humphrey Visual Field (HVF) 24-2 test for glaucoma, which of the following indices is most useful for identifying localized, focal defects characteristic of early glaucomatous damage?

Accepted Answer

Pattern Standard Deviation (PSD)

Answer

Mean Deviation (MD)

Answer

Visual Field Index (VFI)

Answer

Fixation Losses

Question 5

A 72-year-old patient with moderate primary open-angle glaucoma is being monitored for progression. Which combination of tests provides the most comprehensive information to assess for glaucomatous progression?

Accepted Answer

Stereoscopic optic disc photography/OCT and automated perimetry

Answer

Tonometry and gonioscopy

Answer

Corneal pachymetry and fundus photography

Answer

Serial tonometry and family history review

Question 6

According to the American Academy of Ophthalmology (AAO) Preferred Practice Pattern for Primary Open-Angle Glaucoma, what is a reasonable initial target for intraocular pressure (IOP) reduction in a newly diagnosed patient?

Accepted Answer

A reduction of 20-30% from baseline

Answer

A reduction of 5-10% from baseline

Answer

A target IOP below 15 mmHg for all patients

Answer

A target IOP equal to the population mean of 16 mmHg