Board Certified Ophthalmologist FREE 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 progressive visual field loss. What is the most appropriate next step in management?
- Trabeculectomy (Correct answer)
- Repeat visual field testing in 6 months
- Add a fourth topical medication
- Laser peripheral iridotomy
Correct answer: Trabeculectomy
Trabeculectomy is indicated when medical therapy fails to control progressive glaucomatous damage.
Question 2: Which class of glaucoma medications works by decreasing aqueous humor production through inhibition of carbonic anhydrase?
- Dorzolamide (Correct answer)
- Latanoprost
- Brimonidine
- Pilocarpine
Correct answer: Dorzolamide
Dorzolamide is a topical carbonic anhydrase inhibitor that reduces aqueous humor production.
Question 3: A 55-year-old presents with acute angle-closure glaucoma. After initial medical management lowers the IOP, what definitive treatment should be performed?
- Laser peripheral iridotomy (Correct answer)
- Trabeculectomy
- Selective laser trabeculoplasty
- Goniotomy
Correct answer: Laser peripheral iridotomy
Laser peripheral iridotomy is the definitive treatment for acute angle-closure glaucoma to prevent recurrence.
Question 4: Which visual field defect is most characteristic of early glaucomatous damage?
- Nasal step (Correct answer)
- Homonymous hemianopia
- Bitemporal hemianopia
- Central scotoma
Correct answer: Nasal step
A nasal step, where there is a difference in sensitivity across the horizontal midline nasally, is a classic early glaucomatous field defect.
Question 5: What is the primary mechanism of action of selective laser trabeculoplasty (SLT) in lowering intraocular pressure?
- Stimulating biological remodeling of trabecular meshwork cells (Correct answer)
- Creating thermal burns in the trabecular meshwork
- Increasing uveoscleral outflow
- Decreasing aqueous humor production
Correct answer: Stimulating biological remodeling of trabecular meshwork cells
SLT selectively targets pigmented trabecular meshwork cells, stimulating a biological response that improves aqueous outflow.
Question 6: In a patient with pseudoexfoliation glaucoma, which finding on gonioscopy is most characteristic?
- Sampaolesi line (Correct answer)
- Peripheral anterior synechiae covering 360 degrees
- Neovascularization of the angle
- Angle recession
Correct answer: Sampaolesi line
A Sampaolesi line, which is pigment deposited anterior to Schwalbe's line, is characteristic of pseudoexfoliation glaucoma.
Board Certified Ophthalmologist FREE Glaucoma Management Questions and Answers 2
A patient with primary open-angle glaucoma on maximum tolerated medical therapy continues to show progressive visual field loss.
What is the most appropriate next step in management?