23. Glaucoma Clinical Examination

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Author:
sookylala
ID:
241174
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23. Glaucoma Clinical Examination
Updated:
2013-11-12 04:58:32
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Glaucoma Clinical Examination
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Glaucoma Clinical Examination
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  1. How does glaucoma cause cupping?
    loss of RGC-> decrease in rim-> decrease in cup size
  2. most suspicious CD ratio?
    small cup + large CD ration
  3. What are glaucoma key features?
    • thinning of rim- CD ratio change
    • ISNT rule
    • bv
    • NFL
    • lamina cribosa
    • PPA
  4. bv changes in glaucoma?
    • bayonetting
    • shift nasally`
  5. NFL changes in glaucoma?
    • inferotemporal wedge defect is most common
    • see striations
    • loss of neuroretinal rim-> defects in central fibres
  6. how much NFL is lost when VF defect appears
    40%
  7. lamina cribosa and glaucoma?
    if visible suspicious
  8. alpha PPA?
    hyperpigmentation near the OD
  9. b PPA?
    • complete atrophy down to choriocapillaris
    • indicative of glaucoma signs
    • more commonly in temporal region
  10. Murray Fingeret's 5 rules?
    • 1. scleral RING: OD size
    • 2. size of RIM
    • 3. RNFL
    • 4. REGION outside the OD: PPA
    • 5. RETINAL/OD haemorrhages
  11. What does end stage damage look like?
    • all neural disc tissue is destroyed
    • disc white and deep
    • atrophy of retinal NF
    • striations absent
    • bv dark and sharply defined
  12. IOP diurnal variation and POAG?
    • normal: 3-6
    • >10 diff sus!
  13. gold standard VF?
    • Humphrey¬†
    • Central 24-4 FAST SITA
    • 54 pts, 6 degrees
    • full threshold white on white
    • repeat 2: for confirmation of progression
  14. what percentage is unreliable for VF?
    >20%
  15. GHT results?
    • p<1%: ONL
    • p<3%: boderline
  16. VF scotomas with glaucoma?
    • relative paracentral scotoma: 10-15
    • Seidel scotoma: NFL shape
    • Arcuate scotoma
    • Nasal step
    • Ring scotoma: from arcuate scotoma
    • temporal wedge defect
    • Hemifield defect
  17. Characteristics of VF defects and glaucoma?
    • localised
    • hoz midline
    • begin nasal to BS
  18. Criteria for VF with glaucoma
    • 1. >3 non edge pts, depressed >10db
    • 2. >3 pts sens p<5% and 1 pt sense p<1%
    • 3. PSD at p<5%
    • 4. GHT: abnormal field
  19. SWAP
    • blue dots/yellow bg
    • early VF loss
    • Kcell pathway
    • longer testing time, higher variability, affected by cataracts, effectivness???
  20. DDx optic nerve drusen
    • bilateral
    • assoc w VF defect
    • x glaucoma
    • maybe not ONLY be in cup
  21. DDx tilted disc?
    • straight edge inferior
    • disc margin indistinct
    • more absolute VFD
  22. DDX coloboma?
    • congenital
    • inferior
    • complete loss of ONH
    • assoc scotoma
  23. DDx congenital optic pit
    • various size/location
    • greyish white
    • assoc macula detachment

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