Question 1: Ocular hypertension includes:
A) Raised IOP
B) Normal retinal nerve fiber thickness
C) Normal Visual fields
D) All of the above
Answer: D) All of the above
Ocular hypertension is the presence of raised intraocular pressure in the absence of glaucomatous damage. It is defined as an intraocular pressure of > 21 mm Hg with normal optic nerve and normal visual field.
Ref: Gordon MO, Beiser JA, Brandt JD, Heuer DK, Higginbotham EJ, Johnson CA, Keltner JL, Miller JP, Parrish RK, Wilson MR, Kass MA. The Ocular Hypertension Treatment Study: baseline factors that predict the onset of primary open-angle glaucoma. Archives of ophthalmology. 2002 Jun 1;120(6):714-20. 10.1001/archopht.120.6.714
Question 2: The development of POAG in a case of ocular hypertension depends on what factors:
B) Vertical Cup-Disc ratio
C) Higher Intraocular pressure
D) All of the above
Answer: D. All of the above
Older age, higher IOP, low central corneal thickness, and a higher vertical cup disc ratio are all considered factors that can cause the progression of ocular hypertension patients to primary open-angle glaucoma.
Ref: Weinreb RN, Friedman DS, Fechtner RD, Cioffi GA, Coleman AL, Girkin CA, Liebmann JM, Singh K, Wilson MR, Wilson R, Kannel WB. Risk assessment in the management of patients with ocular hypertension. American journal of ophthalmology. 2004 Sep 1;138(3):458-67.https://doi.org/10.1016/j.ajo.2004.04.054
Question 3: Primary open-angle glaucoma is more commonly associated with:
D) None of the above
Answer: A) Myopia
Myopia is more commonly associated with primary open-angle glaucoma. Myopic eyes have longer axial lengths, and eyes with an increased axial length seem to have a greater deformability of the lamina cribrosa which might contribute to a
higher susceptibility to glaucomatous optic disc changes
Ref: Marcus MW, de Vries MM, Montolio FG, Jansonius NM. Myopia as a risk factor for open-angle glaucoma: a systematic review and meta-analysis. Ophthalmology. 2011 Oct 1;118(10):1989-94. https://doi.org/10.1016/j.ophtha.2011.03.012
Question 4: According to the ocular hypertension treatment study, which group had an increased risk of developing primary open-angle glaucoma?
A) Central corneal thickness of >588 microns
B) Central corneal thickness of >555 microns to < 588 microns
C) Central corneal thickness of < 555 microns
D) Central corneal thickness of > 655 microns
Answer: C) Central corneal thickness of < 555 microns
In ocular hypertension treatment study, participants with a corneal thickness of 555 microns or less had a 3-fold greater risk of developing POAG than participants with a corneal thickness of more than 588 microns. This will not apply to the central and south Indian populations where the mean central corneal thickness is much less or about 515 microns.
Gordon MO, Beiser JA, Brandt JD, Heuer DK, Higginbotham EJ, Johnson CA, Keltner JL, Miller JP, Parrish RK, Wilson MR, Kass MA. The Ocular Hypertension Treatment Study: baseline factors that predict the onset of primary open-angle glaucoma. Archives of ophthalmology. 2002 Jun 1;120(6):714-20. 10.1001/archopht.120.6.714
Jonas JB, Nangia V, Matin A, Sinha A, Kulkarni M, Bhojwani K. Intraocular pressure and associated factors: the central India eye and medical study. Journal of glaucoma. 2011 Sep 1;20(7):405 https://doi.org/10.1097/ijg.0b013e3181f7af9b