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

Early glaucomatous damage typically manifests as localized thinning of the retinal nerve fiber layer, most commonly in the inferotemporal and superotemporal arcuate bundles. This damage respects the horizontal raphe. Diffuse thinning is less specific and can be seen in other conditions or advanced disease. Crossing the midline is not a typical pattern for early glaucoma. Increased signal strength is a measure of scan quality, not a sign of pathology.

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

This patient is experiencing an acute angle-closure glaucoma attack. The definitive treatment to relieve pupillary block and prevent recurrence is a laser peripheral iridotomy (LPI). This procedure creates a new channel for aqueous humor to flow from the posterior to the anterior chamber. Prostaglandin analogs are generally used for open-angle glaucoma. SLT is used for open-angle glaucoma and is not effective for angle-closure. Trabeculectomy is a surgical option for more advanced or uncontrolled glaucoma, not the initial definitive procedure for acute angle-closure.

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

Prostaglandin analogs (e.g., latanoprost, travoprost, bimatoprost) are a first-line treatment for open-angle glaucoma and lower intraocular pressure primarily by increasing the outflow of aqueous humor through the uveoscleral pathway. Beta-blockers and carbonic anhydrase inhibitors decrease aqueous production, while alpha-adrenergic agonists both decrease production and increase trabecular outflow.

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

The Collaborative Normal Tension Glaucoma Study (CNTGS) demonstrated that lowering the IOP by at least 30% significantly slowed the rate of visual field progression in patients with NTG. Even though the initial pressure is within the 'normal' range, reducing it further is the only proven treatment to slow disease progression. Observation is only appropriate if there is no evidence of progression. A 10% reduction is less than the target established by the CNTGS, and surgery is typically reserved for cases that progress despite medical or laser therapy.

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

Early glaucomatous visual field defects typically correspond to the pattern of nerve fiber layer loss. A nasal step, which is a scotoma just above or below the horizontal midline in the nasal field, is a classic early sign. This occurs due to damage to the arcuate nerve fibers. A central scotoma is more typical of macular disease or advanced glaucoma. Bitemporal hemianopsia suggests a chiasmal lesion. An enlarged blind spot can be seen in glaucoma but is less specific than a nasal step.

ABO - American Board of Ophthalmology Practice Test

ABO - American Board of Ophthalmology Practice Test

FREE ABO Glaucoma Diagnosis and Management Questions and Answers