Glaucoma

Question 1

What are ancillary lenses

Answer 1

Handheld lenses like 90d 78d 60d

Question 2

Magnification and image of DO

Answer 2

15x
upright image
monocular view without stereoscopy

Question 3

RNFL defect seen with which filter

Answer 3

Red free filter

Question 4

Disc hemorrhages seen with what type of glaucoma

Answer 4

NTG

Question 5

laminar dot sign

Answer 5

Visibility of lamina cribrosa fenestrations within the cup

Question 6

2 types of cupping

Answer 6

Color and contour cupping

Question 7

CDR asymmetry of how much raises suspicion of glaucoma

Answer 7

Of more than 0.2cdr

Question 8

loss of NRR can be

Answer 8

focal notching
concentric loss of NRR

Question 9

correction factor on magnification of lens

Answer 9

60d 1
78d 1.1
90d 1.3

Question 10

measurement of size of ONH by DO

Answer 10

5 degree aperture of Welsh allyn DO at 15cm distance

Question 11

Optociliary shunts also known as

Answer 11

Retino-choroidal shunt vessels/collaterals

Question 12

Optociliary shunts seen in

Answer 12

CRVO
Optic nerve sheath meningioma
Chronic glaucoma
Chronic pappiledema

Question 13

Earliest site for loss of RNFL

Answer 13

Inferotemporal and superotemporal

Question 14

Disc haemorrhage last for

Answer 14

2 to 4 months

Question 15

Disc haemorrhage leave behind

Answer 15

Area of focal notching 15 to 18 months later

Question 16

Beta zone

Answer 16

area of absent RPE and in some areas absent photoreceptors with the presence of an intact Bruch’s membrane
seen in glaucomatous nerves
Causes absolute scotoma

Question 17

Alpha zone

Answer 17

more common in normal eyes and is located beyond zone beta away from the nerve. It contains areas of hyper or hypopigmentation and areas of irregular RPE.
Relative Scotoma

Question 18

Size of optic disc

Answer 18

the size of disc

· Small (diameter <1.50 mm)

· average (diameter 1.50-2.00 mm)

· large (diameter >2.00 mm)

Question 19

Baring of circumlinear vessels

Answer 19

means the supporting rim tissue under these vessels has thinned or receded, making the vessels appear unsupported (“bared”) over the optic cup

Question 20

Bayoneting sign

Answer 20

In advanced glaucoma, where there is deep cupping and localized loss of the neuroretinal rim, blood vessels crossing the disc margin make a sharp, abrupt angle—often close to 90°—as they dip down into the deepened optic cup and then reappear along or beyond the rim

Bayonet is a weapon

Question 21

Differentiate Optociliary shunt from NVD

Answer 21

Optociliary shunt vessels are generally loopy and thick in appearance and do not cause leakage on fluorescein angiography

Question 22

Plateau Iris configuration vs plateau Iris syndrome

Answer 22

PIS is persistence of Angle closure despite LI

Question 23

1. Double hump sign seen in
2. And with which instrument
3. What makes double hump

Answer 23

1. Plateau Iris configuration
2. Indentation gonio
3. First hump by lens, second hump by Ant. Rotation of CB

Question 24

Spaeth system gives 4 types of info about angle. They are?

Answer 24

1. the site of insertion of the iris root in the eyewall
   2) the width or geometric angle of the iris insertion
   3) the contour of the peripheral iris near the angle
   4) the intensity of the trabecular pigmentation

Question 25

What does the Shaffer classification assess?

Answer 25

The width of the anterior chamber angle (risk of angle closure).

Question 26

What is Grade 2 in the Shaffer classification?

Answer 26

20°, trabecular meshwork visible → Moderate risk

Question 27

Level of iris insertion acc to Spaeth classification

Answer 27

• A – Anterior to Schwalbe’s line • B – Behind Schwalbe’s line • C – At scleral spur • D – Deep to scleral spur • E – Extremely deep, at level of ciliary body

Question 28

Full form of EAGLE study

Answer 28

Effectiveness in Angle closure glaucoma of early lens extraction

Question 29

Target IOP

Answer 29

Range of IOP that halts the progression of Glaucoma without compromising the QOL of the patient

Question 30

Study AGIS 1. Full form 2. Reasonable initial IOP reduction to

Answer 30

1. Advanced Glaucoma Intervention study 2. Less than 18mmHg

Question 31

Target IOP first given by which study?

Answer 31

CIGTS COLLABORATIVE Intial Glaucoma treatment study.

Question 32

What are the general risk factors for POAG?

Answer 32

1. Age (older age) 2. Race (Black) 3. Family history 4. Genetic (MYOC, OPTN, TBK1)

Question 33

What are the ocular risk factors for glaucoma?

Answer 33

1. High IOP 2. Myopic (susceptibility) 3. Disc hemorrhage 4. Thin cornea 5. Anti-VEGF therapy

Question 34

What are the systemic risk factors for POAG?

Answer 34

1. Hypertension (HTN) 2. Diabetes Mellitus (DM) 3. Nocturnal hypotension 4. Sleep apnea 5. Difference in Translaminar pressure gradient (TLPG) 6. OCP 7. Vasospastic disorder (migraine) 8. Low Ocular perfusion pressure (OPP)

Question 35

Which genes are associated with POAG risk?

Answer 35

1. MYOC (Myocilin) 2. OPTN (Optineurin) 3. TBK1

Question 36

Normal iop range

Answer 36

10-21 Gaussian curve skewed to right 15.5 +\-2.6 2SD includes 95% population

Question 37

Ocular perfusion pressure

Answer 37

MAP - IOP 50-70 MAP 2/3DBP + 1/3SBP

Question 38

VH grading

Answer 38

4 ACD = CT 3 ACD b/w 1/4 to 1/2 of CT 2 ACD = 1/4 CT 1 ACD < 1/4 CT 0 Flat “ = b/w = < “

Question 39

What are the levels of iris insertion in Spaeth classification?

Answer 39

A = Anterior to Schwalbe’s line B = Between Schwalbe’s line and scleral spur C = At scleral spur (normal) D = Deep, posterior to scleral spur, at ciliary body face E = Extremely deep, beyond ciliary body band

Question 40

How is the angular width recorded in Spaeth classification?

Answer 40

Measured between trabecular meshwork & peripheral iris; Expressed in degrees (0°–40°); >30° = wide open; <20° = narrow

Question 41

configuration of the peripheral iris described in Spaeth classification?

Answer 41

B= Bowing F = FLAT P = Plateau (convex, e.g. plateau iris) C = Concave

Question 42

How is angle pigmentation graded in Spaeth classification?

Answer 42

0 = none 1+ = minimal 2+ = mild 3+ = moderate 4+ = intense

Question 43

What is the Shaffer classification of anterior chamber angle?

Answer 43

Grade 4: 35°–45°, ciliary body band visible, closure impossible Grade 3: 25°–35°, SS visible, closure impossible Grade 2: 20°, TM visible, closure possible Grade 1: 10° SS or ATM visible, closure probable Grade 0: 0°, angle closed, definite closure

Question 44

Describe Plateau iris.

Answer 44

Flat or slightly convex central iris With N or slightly shallow central AC having Narrow Angle Recess With sharp backward iris angulation

Question 45

The Glaucoma Continuum

Answer 45

Risk > Accelerated Apoptotis > GC Death Axon Loss > ONH Change undect› detect> VF early, mod, sever, Blind Riskapo

Question 46

Differentiate alpha beta gamma zone OD

Answer 46

a Irregular RPE, Bruchs present, normal b Absent RPE, Bruchs present, Glau, High Myopia g Both absent, Glau, High Myopia