Glaucoma

Question 1

Who do we treat?

Answer 1

All patient wiith IOP >21 + disc change
Ocular HTN + risk factors
Normal Ocular tension + visual field loss

Question 2

Glaucoma treatment goal

Answer 2

≥25% below pre-treatment IOP

Question 3

Risk factors for glaucoma (open angle)

Answer 3

elevated IOP
Age > 60
Black > 40
Family history
increased cup:disk ratio
Thin CCT
low ocular perfusion pressure
T2DM
myopia

Question 4

Risk for glaucoma (AAC)

Answer 4

Shallow anterior chamber depth (east asian)
Family history
Hyperopia
Age

Question 5

Glaucoma treatment

Answer 5

Surgery - fast
Meds- slow

Question 6

Glaucoma surgery

Answer 6

trabeculectomy
laser
trabeculectomy
aqueous shunts

Question 7

Glaucoma meds

Answer 7

1. PG analog (prost)
2. Beta block (lol)
3. a agonist (dine)
4. CA
5. Rho kinase

Question 8

PG analogs

Answer 8

Efficacy BIM or LBN
ADR: OMI>LBM=LTN
lots of occular irritation

Question 9

Beta blocker

Answer 9

QD dose LVB, TIM
less ADER BTX
local irritation
sinus bradycardia

Question 10

A agonist

Answer 10

Brimodine
dry moouth
drowsy
CV disease

Question 11

CA

Answer 11

combo DFTC
monotherapy
Good ADR profile

Question 12

Rho kinase

Answer 12

lots of ADR “netarsudil”
53% hyperemia
20% hemorrhage

Question 13

AACE goal

Answer 13

1. preserve vision
2. prep eye for laser peripheral iridotomy
   - decrease IOP (CA, BB, aa, hyperosmotic)
   - open up the angle (pilocarpine)
   - decrease inflammation (steroid)

Question 14

acute angle closure glaucoma

Answer 14

1. carbonic anhydrase - acetazolamide PO or IV
2. beta block - levbunolol, timolol
3. alpha agonist - aparclonidine
4. antimusc - pilocarpine

Question 15

If AAC still in pain after 1-2 hours

Answer 15

Hyperosmotic to bring down IOP
- PO glycerin
- IV mannitol
+ repeat 4 main drugs

Question 16

If AAC w/ swelling or edema

Answer 16

Add opthalmic steroid

Question 17

Montioring AAC therapy

Answer 17

check IOP 15-30 min
When IOP 13-21, check angle