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

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?

Accepted Answer

Laser trabeculoplasty

Answer

Trabeculectomy

Answer

Add another prostaglandin analog

Answer

Observation with repeat visual fields in 6 months

Question 2

Which of the following medications acts by decreasing aqueous humor production AND increasing uveoscleral outflow?

Accepted Answer

Brimonidine

Answer

Timolol

Answer

Latanoprost

Answer

Pilocarpine

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?

Accepted Answer

Laser peripheral iridotomy

Answer

Trabeculectomy

Answer

Goniotomy

Answer

Long-term oral acetazolamide

Question 4

What is the target IOP reduction generally recommended as an initial goal for newly diagnosed primary open-angle glaucoma?

Accepted Answer

20-30% from baseline

Answer

10-15% from baseline

Answer

40-50% from baseline

Answer

Reduction to single digits regardless of baseline

Question 5

Which visual field defect pattern is most characteristic of early glaucomatous damage?

Accepted Answer

Arcuate scotoma

Answer

Central scotoma

Answer

Homonymous hemianopia

Answer

Bitemporal hemianopia

Question 6

A patient on chronic topical prostaglandin analog therapy develops progressive periorbital darkening and increased iris pigmentation. What is the most appropriate management?

Accepted Answer

Counsel the patient that changes are cosmetic and typically irreversible, then discuss whether to continue or switch therapy

Answer

Immediately discontinue the medication

Answer

Increase the dosage to achieve better IOP control

Answer

Add topical corticosteroids to counteract the pigmentation