Term
| Some assumptions made when supporting the notion of uni-ocular trials of glaucoma meds |
|
Definition
Diurnal variation equal in both eyes
Each eye responds equally to med
No cross over effect
Patient compliance/confusion |
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Term
| Name a critical component of EVERY glaucoma follow-up |
|
Definition
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|
Term
| How often do you follow up a new patient with mild glaucoma until target pressure is reached |
|
Definition
|
|
Term
| How often do you follow up a new patient with SEVERE glaucoma until target pressure is reached |
|
Definition
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|
Term
Once target pressure is reached, how often do you see a mild case of glaucoma to check 'recent control'?
Long term control? |
|
Definition
1-3 months for recent
3-6 months for long term |
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|
Term
| When seeing a glaucoma patient for follow-up who has been put on a beta blocker, name specific topics you should ask them about (in terms of changes they have experienced with the med) |
|
Definition
Blood Pressure
Pulse
Lung capacity |
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Term
| What is an important component of evaluating IOP stability, in terms of scheduling follow-ups |
|
Definition
| Make sure you check their IOP at different times of the day, eg. Check around the peak action time of med, just before 2nd drop etc. |
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|
Term
| Describe Reverse uniocular trial |
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Definition
| Take pt off drug in 1 eye only, to see how the pressure reacts to ensure no tachyphylaxis has occurred. |
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Term
| During follow-up visits always evalute ___________ & ____________ together |
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Definition
| always evaluate VF and optic nerve head together |
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|
Term
| Approximately how often should you have your 'severe' glaucoma patient perform a visual field? |
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Definition
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|
Term
| Name the 4 categories of VF 'changes' |
|
Definition
New defect
Deepening of pre-existing defect
Expansion of pre-existing defect
Generalized depression |
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|
Term
| Name some ways to tell that your patient has not been compliant with their meds |
|
Definition
Refill history
Expected side effects missing
Confusion regarding their schedule |
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|
Term
| Name 2 drug types that are generally 1st choice for glaucoma treatment |
|
Definition
| Prostaglandin analogues or beta-blockers |
|
|
Term
| If normal tension glaucoma and you are starting them on a beta-blocker, which one should you use specifically |
|
Definition
| Betaxolol-because it is selective and does not cause vasoconstriction as much |
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|
Term
| An option for changing treatment when pressure is not met but there are no troublesome side effects? |
|
Definition
| Increase concentration of existing med if possible |
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|
Term
| 2 options ot consider if neither prostaglandins or beta-blockers are working |
|
Definition
| Combination med or Brimonidine bid or qid |
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Term
| If you've tried a beta blocker, a prostaglandin and a combination and they are still not working, what is a good next option |
|
Definition
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|
Term
| Important consideration of additive therapy in terms of drug effectiveness |
|
Definition
| Additional drugs have less effect than the initial drug |
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|
Term
| If wanting to add to a prostaglandin but beta-blockers are contraindicated, name some other options |
|
Definition
brimonidine
Dorzolamide/brinzolamide |
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|
Term
| 4 indications for surgery |
|
Definition
Noncompliance
Continued damage with maximum medical therapy
Cost concerns
Quality of life concerns |
|
|
Term
| What is the best 1st surgery for African American patients? |
|
Definition
|
|
Term
| What is the best 1st surgery for Causasians? |
|
Definition
|
|
Term
| ALT vs SLT-which can be re-treated |
|
Definition
|
|
Term
ALT vs SLT
which has a smaller burn size |
|
Definition
|
|
Term
ALT vs. SLT
Which causes more damage to surrounding tissue? |
|
Definition
| ALT causes more damage to surrounding tissue |
|
|
Term
| Laser Trabeculotplasty basically replaces _____ (#) glaucoma med(s) |
|
Definition
| Basically replaces just 1 med |
|
|
Term
| According to the study by Song, J et al, SLT only buys you about ____ _________ |
|
Definition
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|
Term
| Name a med used to prevent pressure spikes following laser trabeculoplasty |
|
Definition
| Use Iopidine (alpha agonist) |
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|
Term
| Trabeculectomy connects which 2 anatomical structures |
|
Definition
| Connects anterior chamber to sub-Tenon's space |
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|
Term
| What is the most common trabeculectomy procedure |
|
Definition
| Partial-thickness Trabeculectomy |
|
|
Term
| Difference between partial and full trabeculectomy |
|
Definition
Partial- a scleral flap is made
Full-no scleral flap, only Tenon's and conjunctiva over sclerotomy |
|
|
Term
| What is the main risk of a full-thickness trabeculectomy |
|
Definition
|
|
Term
|
Definition
| Catheter is snaked through Schlemm's canal 360 degrees in an attempt to dilate it and remove blockages |
|
|
Term
| Which causes mor eof an IOP drop, trabeculectomy of canaloplasty |
|
Definition
| Trabeculectomy, won't get into single digit IOPs with canaloplasty |
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|
Term
| What procedure is done in conjunction with partial thickness trabeculectomy |
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Definition
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|
Term
| Name 3 advantages of filtration devices over trabeculectomies |
|
Definition
Don't need PI
less risk of obstruction
Typically less hypotony (exit of aqueous is more controlled) |
|
|
Term
| Describe Trabectome surgery |
|
Definition
| Electrocautery is used to ablate a segment of the inner wall of Schlemm's |
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