Board Certified Ophthalmologist Board Certified Ophthalmologist Glaucoma Diagnosis and Management Questions and Answers 2

Question 1

A 58-year-old patient presents with an intraocular pressure of 34 mmHg, a cup-to-disc ratio of 0.8, and nasal step visual field defect. Which initial medical therapy is most appropriate?

Accepted Answer

Topical prostaglandin analog

Answer

Oral acetazolamide

Answer

Topical pilocarpine

Answer

Intravitreal anti-VEGF injection

Question 2

Which diagnostic finding on optical coherence tomography (OCT) is most characteristic of early glaucomatous damage?

Accepted Answer

Thinning of the retinal nerve fiber layer in the inferior temporal sector

Answer

Thickening of the central macular region

Answer

Subretinal fluid accumulation

Answer

Epiretinal membrane formation

Question 3

A patient with pseudoexfoliation syndrome is found to have unilateral elevated IOP of 28 mmHg. What mechanism most likely accounts for the pressure elevation?

Accepted Answer

Trabecular meshwork obstruction by exfoliative material

Answer

Pupillary block from posterior synechiae

Answer

Neovascularization of the angle

Answer

Ciliary body swelling

Question 4

During gonioscopy of a patient with acute angle-closure glaucoma, which Shaffer grading would you expect to see in the affected eye?

Accepted Answer

Grade 0 (closed angle)

Answer

Grade 3 (wide open angle)

Answer

Grade 4 (wide open angle)

Answer

Grade 2 (moderately open angle)

Question 5

Which visual field test pattern is most specific for moderate glaucomatous progression beyond early disease?

Accepted Answer

Arcuate scotoma connecting to the blind spot

Answer

Generalized constriction without focal defects

Answer

Central scotoma sparing the periphery

Answer

Bitemporal hemianopia

Question 6

A 72-year-old patient on maximum tolerated medical therapy still shows progressive optic nerve cupping. Which surgical intervention has the highest long-term success rate for primary open-angle glaucoma?

Accepted Answer

Trabeculectomy with mitomycin C

Answer

Argon laser trabeculoplasty

Answer

Cyclophotocoagulation

Answer

Anterior chamber paracentesis

A 58-year-old patient presents with an intraocular pressure of 34 mmHg, a cup-to-disc ratio of 0.8, and nasal step visual field defect.Which initial medical therapy is most appropriate?

A 58-year-old patient presents with an intraocular pressure of 34 mmHg, a cup-to-disc ratio of 0.8, and nasal step visual field defect.
Which initial medical therapy is most appropriate?