FREE Board Certified Ophthalmologist Glaucoma Management Questions and Answers

Question 1

A 65-year-old male with moderate primary open-angle glaucoma (POAG) has been using latanoprost for several years, but his intraocular pressure (IOP) is no longer at target.
You decide to switch him to latanoprostene bunod.
What is the additional mechanism of action provided by latanoprostene bunod compared to latanoprost?

Accepted Answer

It increases trabecular meshwork outflow via nitric oxide donation.

Answer

It increases aqueous production.

Answer

It enhances uveoscleral outflow only.

Answer

It constricts the ciliary muscle to decrease aqueous inflow.

Question 2

A 58-year-old woman with newly diagnosed, mild primary open-angle glaucoma (POAG) and ocular hypertension is treatment-naïve. According to the 6-year results of the Laser in Glaucoma and Ocular Hypertension (LiGHT) trial, which of the following is the most appropriate initial treatment to offer this patient for better long-term disease control and a lower rate of progression?

Accepted Answer

Selective Laser Trabeculoplasty (SLT)

Answer

A topical beta-blocker

Answer

A topical prostaglandin analog

Answer

Immediate trabeculectomy

Question 3

Which of the following patient factors is considered a significant, non-IOP-related risk factor for the progression of glaucomatous damage in a patient with established primary open-angle glaucoma?

Accepted Answer

Low corneal hysteresis

Answer

High myopia

Answer

Thick central corneal thickness (>580 microns)

Answer

Systemic hypertension

Question 4

A 45-year-old patient with chronic anterior uveitis develops elevated intraocular pressure (IOP) refractory to topical beta-blockers and carbonic anhydrase inhibitors. The inflammation is currently well-controlled on a topical steroid. Which of the following would be the most appropriate next step in surgical management?

Accepted Answer

Implantation of a glaucoma drainage device (tube shunt)

Answer

Argon Laser Trabeculoplasty (ALT)

Answer

Trabeculectomy with mitomycin C

Answer

Transscleral cyclophotocoagulation (CPC)

Question 5

A 72-year-old patient with advanced glaucoma undergoes a trabeculectomy with mitomycin C. Three weeks post-operatively, his IOP is 2 mmHg, the anterior chamber is shallow, and fundus examination reveals choroidal effusions. The bleb is diffuse but there is no evidence of a leak on Seidel testing. What is the most likely cause of this patient's hypotony?

Accepted Answer

Overfiltration through the scleral flap

Answer

Aqueous misdirection (malignant glaucoma)

Answer

Pupillary block

Answer

Bleb failure due to scarring

Question 6

A 68-year-old glaucoma suspect is being monitored with annual spectral-domain OCT of the retinal nerve fiber layer (RNFL). According to glaucoma progression analysis software and established research, which of the following changes in average RNFL thickness would be most suspicious for true glaucomatous progression, exceeding expected age-related thinning?

Accepted Answer

A decrease of 5 µm over two years

Answer

A decrease of 0.5 µm over one year

Answer

A decrease of 2 µm over five years

Answer

An increase of 3 µm over one year