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Opt 733 Glaucoma Exam 1
Dr Lingel Lecture 3
23
Medical
Graduate
09/16/2012

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Cards

Term
Do we consider individual edgepoints (perimeter) when diagnosing glaucoma?
Definition
No, they are unreliable and highly variable. Ignore them.
Term
When are VF considered reliable for glaucoma dx?
Definition
Any of the following:

A single non-edge point if P < 0.5%

2 or more adjacent non-edge point at P<5% with one at P < 1%

3 or more adjacent non-edge points at P < 5%

2 adjacent points differ points differ from points across the horizontal midline by at least 10dB (nasal step)
Term
What are the only glaucoma features that use VF edge points for dx?
Definition
Nasal steps can use edge points
Term
What is the cutoff for corrected pattern standard deviation to be considered significant for dx'ing glaucoma?
Definition
P < 5%
Term
What corneal thickness is baseline for GAT?
Definition
520 micron, however, mean CCT in caucasian is about 545 microns. So there is some built in error
Term
How does corneal thickness affect glaucoma risk?
Definition
higher corneal thickness is protective
Term
What is the average difference in CCT between those of caucasian vs african descent?
Definition
30 microns
Term
When comparing NTG vs OHT, which has the tendency for higher CCT?
Definition
OHT, however, this is a very general rule. Many outliers in both directions.
Term
When comparing ultrasound vs optical pachymeters, how do their results compare?
Definition
Both are reliable, but optical may be slightly lower
Term
How many measurements should be made with a pachymeter?
Definition
3 for the result to be reliable
Term
Can we correct measured IOP (mIOP) by a factor dependent on CCT?
Definition
No, as the correlation is low enough that signficant error will be introduced
Term
Should any of the common nomograms for converting mIOP (measured IOP) to aIOP (actual IOP) be used?
Definition
No, they are not reliable enough
Term
What artificially raises IOP: a thicker or thinner cornea?
Definition
Thicker (more force to applanate the cornea itself)
Term
Why should we take baseline IOP's at different times of the day?
Definition
To get a diurnal variation baseline
Term
What can affect mIOP?
Definition
Aerobic Exercise (lower)

Lifting weights (raises)

Tonometry (lowers)

Apparel (tight necked shirt or tie raises IOP via pressure on carotids)

Gonioscopy (lower IOP by forcing AH out)

VF (30-2 threshold can cause a 5 mmHg increase)
Term
How often should gonio be done on glaucoma pt's?
Definition
yearly
Term
Which glaucoma suspects should have gonio performed?
Definition
ALL
Term
What is a sampoelesi line?
Definition
pigment dusted on the ledge of schwalbes line in gonio
Term
How does a corneal wedge aid in finding Schwalbe's line?
Definition
With your light perpendicular to the angle, look at the optic section of the cornea. You will see the anterior and posterior cornea, it will angle together and joing at SL
Term
When should iris processes be recorded in gonio?
Definition
if they are numerous enough to prevent a view of the angle
Term
What % of the population has iris processes?
Definition
33%
Term
What do the iris processes adhere to and thus help you identify on gonio?
Definition
lower 1/3 of trabecular meshwork
Term
How much angle recession indicates increased risk for glaucoma?
Definition
At least 180* of the angle
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