Board Certified Ophthalmologist FREE Board Certified Ophthalmologist Glaucoma Management Questions and Answers 2 — Questions and Answers
Question 1: A patient with primary open-angle glaucoma on maximum tolerated medical therapy continues to show visual field progression. What is the most appropriate next step in management?
- Laser trabeculoplasty (Correct answer)
- Trabeculectomy
- Add another prostaglandin analog
- Observation with repeat visual fields in 6 months
Correct answer: Laser trabeculoplasty
Selective laser trabeculoplasty (SLT) is an appropriate escalation step before incisional surgery in patients failing medical therapy.
Question 2: Which of the following medications acts by decreasing aqueous humor production AND increasing uveoscleral outflow?
- Brimonidine (Correct answer)
- Timolol
- Latanoprost
- Pilocarpine
Correct answer: Brimonidine
Brimonidine, an alpha-2 agonist, has a dual mechanism of reducing aqueous production and enhancing uveoscleral outflow.
Question 3: A 55-year-old patient presents with acute angle-closure crisis. After initial medical management with topical and systemic agents, what is the definitive treatment?
- Laser peripheral iridotomy (Correct answer)
- Trabeculectomy
- Goniotomy
- Long-term oral acetazolamide
Correct answer: Laser peripheral iridotomy
Laser peripheral iridotomy is the definitive treatment for acute angle-closure by eliminating pupillary block.
Question 4: What is the target IOP reduction generally recommended as an initial goal for newly diagnosed primary open-angle glaucoma?
- 10-15% from baseline
- 20-30% from baseline (Correct answer)
- 40-50% from baseline
- Reduction to single digits regardless of baseline
Correct answer: 20-30% from baseline
A 20-30% reduction from baseline IOP is the standard initial target recommended by major glaucoma trials including the OHTS and EMGT.
Question 5: Which visual field defect pattern is most characteristic of early glaucomatous damage?
- Central scotoma
- Arcuate scotoma (Correct answer)
- Homonymous hemianopia
- Bitemporal hemianopia
Correct answer: Arcuate scotoma
Arcuate (Bjerrum) scotomas following the nerve fiber layer pattern are the hallmark early visual field defect in glaucoma.
Question 6: A patient on chronic topical prostaglandin analog therapy develops progressive periorbital darkening and increased iris pigmentation. What is the most appropriate management?
- Immediately discontinue the medication
- Counsel the patient that changes are cosmetic and typically irreversible, then discuss whether to continue or switch therapy (Correct answer)
- Increase the dosage to achieve better IOP control
- Add topical corticosteroids to counteract the pigmentation
Correct answer: Counsel the patient that changes are cosmetic and typically irreversible, then discuss whether to continue or switch therapy
Prostaglandin-associated periorbital changes and iris darkening are cosmetic side effects; the decision to continue or switch should involve shared decision-making with the patient.
Board Certified Ophthalmologist FREE Board Certified Ophthalmologist Glaucoma Management Questions and Answers 2
A patient with primary open-angle glaucoma on maximum tolerated medical therapy continues to show visual field progression.
What is the most appropriate next step in management?