Board Certified Ophthalmologist Board Certified Ophthalmologist Glaucoma Diagnosis and Management Questions and Answers 2

Question 1

A 58-year-old patient presents with an intraocular pressure of 34 mmHg, a cup-to-disc ratio of 0.8, and nasal step visual field defect. Which initial medical therapy is most appropriate?

Accepted Answer

Topical prostaglandin analog

Answer

Topical prostaglandin analogs such as latanoprost are first-line therapy for primary open-angle glaucoma due to their efficacy and once-daily dosing.

Question 2

Which diagnostic finding on optical coherence tomography (OCT) is most characteristic of early glaucomatous damage?

Accepted Answer

Thinning of the retinal nerve fiber layer in the inferior temporal sector

Answer

Early glaucomatous damage typically manifests as RNFL thinning, most commonly in the inferior temporal sector corresponding to the arcuate nerve fiber bundles.

Question 3

A patient with pseudoexfoliation syndrome is found to have unilateral elevated IOP of 28 mmHg. What mechanism most likely accounts for the pressure elevation?

Accepted Answer

Trabecular meshwork obstruction by exfoliative material

Answer

Pseudoexfoliative material accumulates in the trabecular meshwork, reducing aqueous outflow and causing elevated intraocular pressure.

Question 4

During gonioscopy of a patient with acute angle-closure glaucoma, which Shaffer grading would you expect to see in the affected eye?

Accepted Answer

Grade 0 (closed angle)

Answer

Acute angle-closure glaucoma presents with a Shaffer grade 0, indicating complete iridotrabecular contact and closure of the drainage angle.

Question 5

Which visual field test pattern is most specific for moderate glaucomatous progression beyond early disease?

Accepted Answer

Arcuate scotoma connecting to the blind spot

Answer

An arcuate scotoma that connects to the physiologic blind spot follows the retinal nerve fiber layer pattern and is highly characteristic of moderate glaucomatous damage.

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Board Certified Ophthalmologist Board Certified Ophthalmologist Glaucoma Diagnosis and Management Questions and Answers 2