• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

Card Range To Study

through

image

Play button

image

Play button

image

Progress

1/230

Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

230 Cards in this Set

  • Front
  • Back
If a patient has elevated IOP with normal optic nerves, intact nerve fiber layer and normal threshold visual fields the diagnosis is
Ocular Hypertension
Currently, elevated IOP is conidered to be above _______ mmHg by Goldmann Tonometry
21
_________ is an optic neuropathy characterized by progressive damage to the optic nerve called cupping, damage to the retinal nerve fiber layer, and subsequent sensory damage to the visual field
POAG

Damage usually occurs in the presence of elevated IOP
COAG refes to
either primary or secondary open angle glaucoma
COAG is less specific than POAG and is appropiate when there exists confusion with respect to etiology
_________ glaucoma involves progressive optic nerve damage, damage to the RNFL, and subsequent loss of the visual field at normal or even low levels of IOP
Normal tension or Low tension Glaucoma
T/F Angle closure glaucoma results from the appositional closure of the anterior chamber angle by the PERIPHERAL iris
T

Closure can be either acute or chronic, primary or secondary, or even intermittent
This racial group is more prone to angle closure glaucoma
eastern and southeaster nasian people
Characterstics of Glaucoma:
SCAB
Slowly Progressive
Chronic in Nature
Asymmeetric
Bilateral
____ fibers connect the scleral spur to the limbus
longitudinal fibers
T/F Radial fibers connect longitudinal fibers to circular fibers
T
Where does the iris insert into the cilary body?
Anterior "short" side
Where is the aqueous humor produced?
anterior portion of the ciliary processes
What are the three sites of collateral anastomoses of the aterial blood supply?
1. Major Arterial Circle
2. Intramuscular Circle
3. Episcleral Circle
Complex processes are involved in forming aqueous, such as _______ and __________
ultrafiltration and diffusional exchange
______ facilitates fluid movement out of capillaries into the stroma
ultrafiltration
T/F Active transport/secretion of aqueous humor is energy-independent
FALSE

energy dependent.

Carbonic Anhydrase Inhibitors decrease both the rate of entry of bicarbonate into new aqeuous and the rate of H2O into the posterior chamber
_____ decrease both the rate of entry of bicarbonate into new aqeuous and the rate of H2O into the posterior chamber
CAIs
What borders the anterior chamber angle?
Anteriorly: scleral groove
Posteriorly: iris
T/F Schlemm's Canal can be directly observed during gonio
FALSE

cannot be observed UNLESS negative pressure is applied during gonio and blood is regurgitated into the canal
3 Portions of the Optic nerve include
Prelaminar- surrounded by outer retina choriocapilalris and choriod
Laminar- contained within the lamina cribrosa
Retrolaminar- MYELINATED posterior to te lamina cribrosa
T/F The Optic Nerve head is myelinated in the laminar portion
FALSE

Only in retrolaminar portion
2 Theories of Glaucoma are
Vasogenic
Mechanical
What are Quigley's 3 questions you need to ask in order to assess glaucoma?
1. What is the primary site of injury?
2. What factors contribue to axonal injury?
3. How do the ganglion cells die?
How do Ganglion cells die?
1. Glutamate is a neurotoxin usually seen as a result of ischemia.
2.Apoptosis- preprogramemd genetic mode for individual cellular suicide.
Definition of neuroprotection
It is protection of damaged cell bodies of axons. It is the protetion of adjacent axons from release of noxious agents (secondary damage)

The goal of Neuroprotection is to limit neuronal dysfunction/death after CNS injury and attempt to maintain the highest possible integrity of cellular interactions in the brain resulting in an undisturbed neural function
2 Potential Pre-NMDA agents that would be neuroprotective are
Riluzole and Lifarazine.

Both attentuates glutamate release(glutamate is used to kill ganglion cells by the body)
Potential NMDA receptor antagonists/blockers that could be neuroprotective are:
Felbamate- a gylcin binding-site antagonist
Magnesium- open channel blocker
memantine- open channel blocker
nitroglycerin- redox site
This can be used to measure narrow anterior chamber angles
A-scan ultrasonography- assesses risk of angle closure.

75% of angle closure glaucoma occurs in chambes < 1.5 mm
75% of angle closure glaucoma occurs in chambers < __ mm
1.5
The optic nerve blood supply:
central retinal arteries via the short posterior ciliary arteries
TIGR nucleic acid stands for
Trabecular Meshwork Induced Glucocorticoid Resposne
This barrier prevents movement of sbustances from plasma to aqeuous humor
blood-aqueous barrier.
Many mechanisms compromise this barrier, for instance, prostaglandins
When Schwalbe's line is pigmented it is known as
Sampoaleski's line.
What controls IOP by impeding outflow?
Trabecular meshowrk
What makes up the traecular meshwork?
Uveal-radial cords

Corneo-sceral-circumferential sheets covered y ENDOTHELIAL cells and poresb
The trabecular meshwork constains ________ that help control IOP
nucopolysccardies of hyaluronic acid
The junxtacanalicular tissue contains ________ which is responsible for the STICKINESS of the angle
amorpic material --> Hyaluronic acid.
___ vacuoles facilitate one way flow of aqueous out of Schlemm's Canal
Giant
________% of aqueous exits the eye via Schlemm's canal
90
T/F Prescribing Xalatan and Pilocarpine at the same time aids in the reduction of IOP
FALSE!!

Xalatan activates the uveoscleral pathway while pilocabine blocks this pathway to increase outflow through trabecular meshwork... these 2 drugs work against eachother.
_________ is the optic nerve's point of exit through the sclera
scleral lamina cribrosa.
--> 200-300 irregular perforation in the sclea form the optic canal.
T/F Arcuate bundles respect the horziontal raphe
T
Axons within the _______ bundle folow a direct path to the optic nerve
papillomacular
What is the "neighborhood effect"?
Axons die and as a result, all the surrounding die, probably due to break down products of the dad axons which are toxic to living axons.
Eary changes in the posterior segment resulting in glaucoma?
Compression of laminar pores, distortion of laminar bores, and blockage of axonal transport.
Bimonidine has been shown to have neuroprotecive effect
T/F Bimonidine has been shown to have neuroprotecive effect
T
If Pallor changes is greater than cupping, te problem may be
neurological
Loss of function seen in visual fields and contrast sensitivity is due to_________
nerve fiber layer dropout
Where is the primary site of injury to the optic nerve?
Sclera lamina!!!
This type of gonioscopy is useful for differentiating pupillary block in angle closure glaucoma and may help reduce IOP in angle closure glaucoma
Dynamic/Compression Gonio
Narrow anterior chamber angles may be measured using _________
A scan ultrasonography
___% of AOG occurs in chambers less than 1.5 mm
75%
75% of AOG occurs in chambers that are < ______ mm
1.5
T/F ACG is very rare in chambers > 2.5 mm
T
Average CCT among OHT patients were found to be _________ microns
570 microns
Damage to the optic nerve examples:
neuroretinal rim thinning
enlargement of cup
laminar dots
peripaillary atrophy
optic atrophy
RNFL drip outs
Drance Hemorrgages
Baring of cicumlinear veseels
bean-pot cupping
_________ is the thinning of the retina and retinal, pigment epithelium in the region immediately surrounding the optic nerve head.
Peripapillary atrophy
When the lamina cribrosa is visible with grey dots, it is known as
"lamellar dots"
Relative order of thickness of the rim is
Inferior > Superior > Nasal > Temporal
Defects to the Retrinal Nerve Fiber Layer Integrity is enhanced and domcumented with
red-free illumination
Bayoneting of the blood vessels, proudfound damage to the ONH architecture, end-stage gualoma are all characteristics of
BEAN-POT enlargement of the cup
A small disc hemorrhage, known as a splinter or _______hemorrhage, is commonly associated with normal tension glaucoma.
Drance

These hemorrhages typically appear blot-like when located on the disc, and more flame shaped if they are in close proximity to the disc.
Drance hemorrhages are commonly associated with this type of glaucoma
Normal tension
These hemorrhages typically appear blot-like when located on the disc, and more flame shaped if they are in close proximity to the disc.
Drance Hemmorhages
T/F Screening visual fields are commonly used with new fast threshold programs
FALSE
FDT measure
non-linear response to contract by My-type cells
This type of perimetry determines the extent of the damage quantitatively
THRESHOLD automated perimetry

data i digitalized, archived, and followed statistically over time.
remains the cornerstrone to detect, document, and follow fluacomatous damage over time
This test remains the cornerstrone to detect, document, and follow fluacomatous damage over time
Threshold automated perimetry
Common glaucomatous sivuel field losses include
arcuate field defects
nasal step
paracentral defects
temporal sector-shaped defects
T/F Diffuse visual field loss is non-specific for glaucoma
T
T/F Focal loss has not been well definied and is not specific for gluacoma
F

focal loss=glaucoma
Visual fields of glaucoma patients tend to show _______ defects 2:1 and ___ closer to fixation
Superior

Superior
This test may find defects 3-5 years sooner, and involves 2-color incremet threshold procedure
SWAP
This device uses a confocal scanning system to acquire 3-dimensional images of the optic nerve and retina. This data is used for retinal thickness measurements as well as topographic optic nerve head analysis.
Topographic Scanning System
The GDx looks at
RNFL and detects its retardation. MEasures thicnkess in an undilated pupil in < .7 sec
Advantages of using GDx for RNFL detection
no mag erro, no reference plane needed, defects can be found earlier.

HOWEVER, cornea can induce significant artifacts!!!
Color-coded Thickness maps:
___ colors show thicker areas and ____ colors show thinner areas.

_____ represents missing RNFL
BRIGHT (white, yellow)
Dark (red, blue)


Black
This test visualizes results where the whole column repesents the total optic nerve head area in a specific vector. It is divided into % rim area versus Cup Area
Moorfields regression analysis
The OCT measures
RNFL thickness in the peripapillary region using lser lights.
1. In glaucoma the retina nerve fiber layer and the optic nerve are________ damaged?
o Progressively
2. What are the 8 secondary glauccomas

U SHEEP IT
o Uveitic
o Steroid
o Hypoxic conditionso Episcleral Venous plexus elevation—unilateral IOP
o Exfoliant
o Pigmentary dispersion

o Inflammatory
o Traumatic
3. Progressive damage to the optive nerve in POAG is called? Which is a type of?
o Cupping
o Optic neuropathy
4. What is the Hallmark sign in POAG?
o Cupping
5. Low tension Glaucoma is usually seen in patients with this systemic disease?
o Vascular
6. What must the pressure be to be considered LTG?
o 21 or below
7. What is the main point about treating LTG
o Get the pressures low even though they are technically normal
8. How do u differential the etiology of OAG vs ACG?
o Gonioscopy
9. What demographic has the highest prevalence for OAG? How much higher
o AA
o 4 x,
10. OAG is the leading cause of blindness in what demographic?
o AA
11. What is the percentage of people over 70 with OcHTN?
o 25%
12. 4 things that characterize MOST glaucoma?
o Bilateral
o Slowly progressive
o Chronic
o Asymmetric
13. This is the site of aqueous production?
o Ciliary process eepithelial cells
14. Ciliary muscles are?
o Longitudinal
o Connect limbus to Scl spur
15. If one sees too much CB..think what?
o Trauma
16. What happens when IOPs jump to 40 or higher?
o The ciliary body becomes ischemic
17. What drug is contraindicated as the pressures reach above 40?
o Pilo
18. What class of drugs works DIRECTLY on active transport of aqueous production
o CAIs
19. IOP is highest at what time of day? This change in IOPs throughout the day is called
o Morning
o Diurnal Variation
20. What is a pigmented Schwalbes line called?
o Sampaolesi’s line
21. How does TM control IOP?
o Impedes outflow
22. what covers the endothelial cells of the TM?
o Corne-scleral circumferential sheets
23. This acid exists in the interTrabecular space? And it does what?
o Mucopolysaccharide hyaloruronic acid
o Control IOP
24. This acid exists in the Juxtacanalicular tissue and does what? What class of drug can greatly affect IOP at this point
o Amorphic material Hylorounic acid
o Stickiness
o Steriod
25. where does the majority of aqueous exit the eye?
o Schlemm’s
26. what two drugs counteract each other?
o Xalatan and Pilo
27. What drug is contraindicated as the pressures reach above 40?
o Pilo\
28. Prostaglandins work at what source of outflow?
o Uveoscleral
29. Prelaminar region of the ON consists of? Blood supply via?
o Outer retina
o Choriocapillaries
o Choroids
o Peripapillary choroidal arteries\
30. Blood supply of scleral laminar region?
o Short posterior ciliaries\
31. Optic nerve Blood supply?
o CRA and short posterior ciliary, yet it varies
32. which drug has been shown to have neuroprotective affect (namebrand/generic)
o Alphagan –P and brimondine
33. Pathological signs of ON changes?
o Cupping, pallor, NFL dropout
34. Primary site of injury?
o Sclera lamina
35. how do ganglion cells die?
o Glutamate
36. what is the first thing we do during an exam? Second? Throughout the exam?
o Take history
37. how does blood loss lead to glaucoma?
o Decreased profusion to the nerves
38. OHT are considered to be above?
o 21 mmhg
39. definitely treat when the IOP gets above?
o 30
40. Pseudoexfoliation disease is what type of disease?
o Basement membrane
41. how often should we check patients with PEX?
o 6 months
42. Radial slits in the mid peripheral iris is indicative of?
o Pigment dispersions syndrome
43. Patients with pigment dispersion will have this on the endothelium of the cornea?
o Krukenburg spindles
44. what Is the most common cause of enucleation?
o Neovascular Glaucoma
45. what do we look for in NVG?
o Diabetes, CRVO, malignant melanoma, ischemia, RD with Buckle
46. What drug is contraindicated as the pressures reach above 40 and with NVG?
o Pilo/miotics
47. What is the only direct gonioscopy?
o Koeppe
48. How do we use spaeth?
o ABCDE, E=40, angle degree, and RSQ
o R=reg
o S=steep
o Q=queer
49. in 75% of ACG what is the depth of their anterior chamber? Checked by what device?
o < 1.5mm
o A scan
50. ACG is very rare in anterior chambers greater than? With an exception for what?
o 2.5
o plateaued iris
51. Average K thickness in OHT?
o 570
52. what is Notching?
o A small area where there is no neural retinal rim and corresponds to VF damage
53. What is saucerization of the cup?
o Vessels disappearing under a shelf
54. What is shelving?
o Enlargement of the cup which eats away underneath the superior rim
55. Poor perfusion /compromised vasculature causes what?
o Peripapillary atrophy
56. what is a sign of progressive disease?
o Baring of the circumlinear vessels
57. what is a indication of endstage glaucoma? And what is the definition?
o Bean-pot enlargement of the cup
o Bayoneting of the BV
58. Drance heme is a significant sign in what type of Glaucoma?
o NTG
59. What type of damaged cells is the FDT more sensitive to?
o My-cells
60. FDT may be more sensitive in detected what?
o Early damage
61. Threshold Automated perimetry is ?
o Qauntitative
62. what type of people have more false negs?
o Glaucoma idiots
63. what are popcorn fields do to?
o High false positive
64. what part of the VF is important in end stage glaucoma
o Global indicies
65. 4 criteria to look at on a field to determine if it is usable?
o Appropriate, reliable, repeatable, and correlates to the nerve
66. how do u determine depth of field loss on a VF?
o PSD or CPSD
67. Mean Deviation increase in progressive glaucoma, yet it can also do this in?
o Cataracts, uncorrected refractive error, and miotic pupils
68. Statistic filter #1 is ? if it is large it is?
o Total deviation
o Bad
69. Most common field defect in early VFs? Seen in combo with?
o Arcuate
o Nasal steop
70. diffuse vs localized, which one is defined for specific glauocoma
o localized
71. Field should coincide with what appearance?
o ONH
72. TOP SS measures? NFA measures?
o Topography/ contour of nerve over time (mts and valleys)
o Change in NFL thickness over time (grass length on the mountains and valleys)
73. Dark areas in TOP SS =?
o Depressed
74. NFA measures the retardation and converts data to what measurement?
o Thickness
75. NFA is qualitation or quantitative?
o Quantitative
76. The fixed corneal compensator compensates for what in the GDx?
o Coreal bifringes
77. HRT is good for both…?
o Glaucoma and macular edema
78. what does it mean in an HRT if the image quality is greater than 40
o repeat test, unrealiable picture
79. OCT is good for?
o Glaucoma and optic neuropathies
80. According to the AGIS what is the appropriate way to address all advance disease?
o Drugs
o Drugs and laser
o Drugs, laser, filtration
81. The AGIS 7 said the best control in IOP is what number?
o 12.3
82. The results of the EMGT reduced the IOP by what? This basically states that if u lower IOP by this percentage then the drug is efficacious?
o 5.1
o 25%, yet conclude that this was not low enough due to treatment modalities
83. EMGT was considered what by the US standards? Why?
o Unethical
o Control group was not treated
84. The European Glaucoma prevention study concluded that?
o There is no statistically significance btw med therapy and placebo in lowering IOP
85. In cataract formation the NTG said?
o There is an increase in glaucoma pts. With filtration sx
86. NTG also concluded that IOP?
o Part of the pathogenesis and should treat NTG pts to lower IOP
87. Which Prosaglandin caused the most hyperemia?
o Lumigan
88. OHTS suggests that black people have a higer risk of POAG bc of?
o Thinner central corneas and larger vertical CDs
89. The practical implicaytions that arose from the OHTS was?
o Consider meacuring CCT in ALL patients with OHTN
90. Depression and anxiety can be a side effect of what class of topical Glaucoma drops? Having what color cap?
o Beta blockers
o Yellow or blue
91. You should never give a patient more that 1 drop in a 12hr period of this class of drop bc of?
o Beta blockers, and cardiac arrest
92. Beta blockers do what to control iop?
o Decrease aqueous production
93. always check this when a patient is on Beta blockers?
o Pulse
94. Which drug has minimal alterations in blood lipids?
o Cateolol (Ocupress)
95. which drug causes uveitis in 100% of its patients?
o Metipranolol (Optipranolol
96. what s the safest Beta Blocker drop?
o Betoptic-S
97. Cholernergics work on lower IOP by? What is the color of the cap?
o Increasing Outflow
o Green
98. This is the third efficacious drug? Under which 2 other drug
o Pilo
o Xalatan, timolol
99. Pilo is the DOC for what type of Glaucoma?
o Pigment dispersion syndrome
100. What is a Pilocarpine bath?
o Sweating, muscle weakness, diahrrea
101. Main ocular contraindication for direct acting Miotics
o Ocular inflammation
102. Best cholernergic agonist for Aphakes?
o Echothiophate (Phospholine iodide)
103. Adrenergic agonists work on IOP by?
o Icreasing outflow
104. Apraclonidine is aka? Used for
o Iopidine
o Acute IOP elevation
105. Which drug was replaced by Brimonidine?
o Dipivefrim (propine)
106. Major side effect of alphagan P
o Epinephrine maculopathy, of irreversible CME
107. CAIs work on IOP by?
o Decreasing aqueous production
108. Major side affect of oral CAI is?
o Metabolic acidosis
109. Patients with angle closure should use?
o Diamox/acetazolamide
110. Prostagladins are contraindicated with people that have?
o HSV keratitis, Ocular Inflammation, CME
111. Inflammation of the eye, one should not use these 2 glaucoma classes of drugs
o Prostagladins and miotics
112. Prostagladin cap color is?
o Blue/green
113. Xalatan can drop IOP by
o 30%
114. At high concentrations xalatan can ?
o Increase IOP
115. Prostaglandins work on lower IOP by?
o Increase outflow va uveoscleral route
116. Lumigan differs from Xalatan bc?
o Not temp dependent and causes more hyperemia
117. 3 chemical names of xalatan, lumigan, and travatan?
o Latanoprost, Bitmatoprost, travoprost
118. Theoretically Travatan can work better in what demographic?
o AA
119. what type of drug class is best to add to Latanoprost?
o CAIs…ie azopt and trusopt
120. What is GLCIA-MYOC and what is its importance?
o Protein found in the TM, Lamina and aqueous
o HIGH levels of this protein in juvenile glaucoma inable the TM to eliminate mutant proteins
121. what drug Failed at neuroprotection?
o Verapamil
122. what should the IOP target be in teens?
o 10- mid teens
123. what drug can cross over to the other eye? For what type of tx is this applicable to?
o Beta blockers
o Uniocular therapeutic tx
124. what are the reduction modicfications in mild mod and advanced glaucoma?
o 30% reduction, 30-40, 50+
125. what drug has a medication drift? What is a med drift?
o Timoptic, when the IOP after long use can start to increase
126. what type of workup is neccisary in NTG pts?
o Cardiologic and neurologic
127. what drugs cause decrease in blood flow to the optic nerve? What is the exception? And what type of glaucoma is this contraindicated in?
Topical adrenergics (except Alphagan)
Contraindicated for LTG
128. what class of drug can potentially increase peripheral profusion?
o Ca channel blockers
129. what drug increases profusion on the ONH?
o Xalantan
130. what type of glaucoma is found in young myopic males?
o Pigmentary
131. what procedure is used for Pigmentary glaucoma but is still controversial?
o LPI
132. LPI’s change the shape of the iris from what to what?
o From Q to R
133. Small KP’s are pathoneumonic for what type of glaucoma? What is the tx for this?
o Fuchs heterochromic iridocyclitis
o Tears and f/u
134. name 2 glaucomas where steroids and cycloplegics are used?
o Acute angle closure and possner schlossman
135. what are the two thearpuetic drugs used in IOP above 40?
o Glycerin—vomit, and contraindicated for diabetics
o Diamox
136. Under 40 what is the sx u send them for?
o YAG/ argon PI
137. ALT treats where in the angle?
o Pigmented TM over schlemms
138. Where would the ALT have to hit to cause pain and inflammation?
o CB
139. when adjusting power in the ALT what is a sign of too much power? Too little?
o Large bubbles
o Seeing nothing
140. Less energy durin ALT is necessary when the pt has…?
o More pigment
141. drug used in pre op for alt? post op?
o alprclonidine (iopidine)
o alproclondine or brimonidine
142. Complications in ALT that can cuase an increase in IOP are?
o 360 vs 180
143. PAS can occur if?
o The burns are too far apart
144. Best outcome for ALT is in these Glaucomas?
o COAG(phakic)
o Pigmentary (REMEMBER MORE PIGMENT BETTER THE RESULTS)
o PEX
DO not give prostaglandins if you see this
inflammation. Contraindication: Inflammatory Glaucoma
Seeing Herpes Keratitis should make you not use this drug
prostaglandin
*in US one of the most common reasons a pt would have their eye enucleated is due to _________*
Neovascular Glaucoma
The use of steroids and cycloplegics. (to quiet eye for surgery prep)
And prompt referral for Pan-Retinal Surgery are indicated for what type of glaucoma
Neovascular Glaucoma
Steroid induced glaucoma contraindicates what surgery?
ALT
This drug is given only once a day in the morning (because evening is a period of aqueous suppression.)
Timolol with Gelrite (Timoptic XE) 0.25%, 0.50%
This drug is relatively safer in COPD
Betopic S
What is the number one reason for medical malpractice lawsuits against
ODs
Answer: Failure to diagnose Glaucoma
MAXIMUM Dosage for a Beta Blocker-
1 drop, and then another drop 12 hours later (1.5%)