Glaucoma: Low Tension Glaucoma (Guest Lecture) Flashcards Preview

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Flashcards in Glaucoma: Low Tension Glaucoma (Guest Lecture) Deck (12)
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1
Q
  1. Low Tension Glaucoma: What is it?
    a. Genetics?
    b. IOP Dependent Factors? (2) (Patho)
    c. IOP Independent Factors? (5)
    d. ON BF: MOPP: = ?
A
  1. Optic neuropathy: Optic Disc Cupping, w/VF loss, Open Angle, and Normal IOPs (21 mmHg or LESS)
    a. Rare: <1%: OPTN
    b. Sensitive ON and Diurnal Fluctuation
    c. Vascular, Rheologic, Immune, Neurodegenerative, Nutritional/Toxic
    d. 2/3 (diastolic + 1/3(systolic - diastolic) - IOP
2
Q

Risks for Glaucoma

  1. Neurodegenerative (NTG)
  2. Nutritional/Toxic
A
  1. No risk of developing Dementia or Alz’s Disease w/NTG

2. ANY Nutritional Deficiency or Toxic Insult can cause INCREASED SUSCEPTIBILITY to GLAUCOMATOUS DAMAGE

3
Q

When should you image?

A

Age, RAPD, Bitemporal/Homonymous VF Defects; Disc Pallor; Dyschromotopsia; VF defect > than Optic Disc Cupping; unexplained VA loss; Vertically Aligned VFs

4
Q

Typical Clinical Findings w/Low Tension Glaucoma?

A

Open Angle, Optic Disc Cupping, Disc Hemorrhage, Peripapillary Atrophy

5
Q

Disc Hemorrhage: More common w/what?

A
  1. In NTG
    * Normal IOP: More blood is Extravasated (allows visualization)
    * Elevated IOP: Tamponade of Blood Occurs: Prevents clinically visible Hemorrhage
6
Q

Sleep Apnea:

  1. What is it?
    a. Increased Prevalence of what?
  2. VF: What is normally seen?
A
  1. Increased CO2 Levels, Hypoxia, fragmented sleep.
    a. of NTG in pts w/OSA
  2. Early Paracentral Defects
7
Q

Study: He talked about study on NTG where they followed 140 eyes of 140 Pts to see if IOP played a role in the progressiveness of NTG. What did they find?

A

Cataracts more common in Surgical Treatment Group, and Duration to progression for those treated about almost twice as LONG as those who had nothing done.

*Goal was 30% IOP reduction

8
Q
  1. Goals of Treatment?
A
  1. Reduce Peak Pressure 30%; REDUCE DIURNAL FLUCTUATION; Improve ocular BF; maybe Neuroprotection…?
9
Q

Medical Tx

  1. 1st Line
  2. 2nd Line
  3. 3rd Line
A
  1. Prostaglandin Analogues
  2. Alphagan P (best w/PGA); Dorzolamide (Improves Ocular Circulation)
  3. Beta-Blocker (AM Dosing ONLY!) ***DONT REDUCE NIGHT TIME HYPERTENSIVE MEDS!!
10
Q

Treatment: Lasers

  1. Less effective for what 2 things?
A
  1. for LOW PRESSURES and those WITHOUT PIGMENT!
11
Q

Surgical GOALS
1. 5 Things

  1. RISK? (1)
A
  1. REDUCE IOP to LOW TEENS: Remove Fluctuation, Reduce Med Dependence; STOP PROGRESSION
  2. HYPOTONY
12
Q

TRABECULECTOMY

  1. What is it?
A
  1. Augmented w/Antimetabolites; Addition of EXPRESS SHUNT

* GOLD STANDARD (BEST OPTION for ACHIEVING LOW IOP!!!