Q.1 What is the first part of the macula affected in glaucoma?
Thinning of the macula, particularly the inferior macula where the retinal
ganglion cells project to the inferotemporal region of the disc, can occur early in
glaucoma. Histology studies have previously demonstrated that glaucoma can cause
thinning of the macula due to selective loss of retinal ganglion cells.
Kim YK, Jeoung JW, Park KH. Inferior Macular Damage in Glaucoma: Its Relationship to
Retinal Nerve Fiber Layer Defect in Macular Vulnerability Zone. J Glaucoma. 2017
Feb;26(2):126-132. doi: 10.1097/IJG.0000000000000576. PMID: 27820423.
Q2 Which structural thinning is typically observed first in early-stage glaucoma?
A) Macular GCIPL
B) Parapapillary retinal nerve fiber layer
In eyes with early glaucoma, changes in the macular GCIPL are often detected
before corresponding changes in the parapapillary retinal nerve fiber layer. This may be
due to the mGCIPL deviation map’s superior sensitivity in detecting abnormal thinning of
the macular GCIPL earlier than pRNFL changes. Therefore, relying solely on OCT
pRNFL analysis may overlook macular damage, and macular OCT imaging should be
incorporated into the imaging algorithm for serial observation of glaucoma patients.
Kim YK, Ha A, Na KI, Kim HJ, Jeoung JW, Park KH. Temporal Relation between Macular Ganglion
Cell-Inner Plexiform Layer Loss and Peripapillary Retinal Nerve Fiber Layer Loss in Glaucoma.
Ophthalmology. 2017 Jul;124(7):1056-1064. doi: 10.1016/j.ophtha.2017.03.014. Epub 2017 Apr 10.
Q. 3 Which type of glaucoma is commonly associated with myopia?
A) Pigmentary glaucoma
B) Primary open-angle glaucoma
C) Normal tension glaucoma
D) Secondary glaucoma
Myopia, particularly high myopia, significantly increases the risk of developing
open-angle glaucoma. There is a clear association between the degree of myopia,
patient age, and visual impairment.
Tideman, J. W. L., Polling, J. R., Jaddoe, V. W. V., Vingerling, J. R. & Klaver, C. C. W. Environmental
Risk Factors Can Reduce Axial Length Elongation and Myopia Incidence in 6- to 9-Year-Old
Children. Ophthalmology 126, 127–136 (2019).
Verhoeven, V. J. M. et al. Visual consequences of refractive errors in the general
population. Ophthalmology 122, 101–109 (2015).
Q. 4 Which site of the optic nerve is identified as the main site of retinal ganglion cell Injury?
A) Lamina cribrosa
B) Bruch’s membrane opening
The lamina cribrosa has long been identified as the main site of retinal ganglion cell
(RGC) axonal injury in glaucoma.
Tan NYQ, Sng CCA, Ang M. Myopic optic disc changes and its role in glaucoma. Curr Opin
Ophthalmol. 2019 Mar;30(2):89-96. doi: 10.1097/ICU.0000000000000548. PMID: 30562243.