Quizwise related to the ImageWise case above.
Read to remember quiz (R2RQ)
Qn. 1. What sector of the retinal nerve fiber layer (RNFL) showed the most severe damage in the right eye on follow up?
A. Nasal
B. Temporal
C. Inferior
D. Inferotemporal and superotemporal
Qn. 2. What was the change observed in the ganglion cell layer (GCL) over 6 months?
A. Severe thinning
B. Moderate thinning
C. Mild thinning
D. Minimal change
Qn. 3. What sector of the RNFL showed severe thinning in the left eye on follow up?
A. Nasal
B. Temporal
C. Inferior
D. Supero-temporal
Qn. 4. What does the preservation of the GCL despite RNFL loss imply?
A. The patient will lose central vision
B. The patient may maintain central vision
C. The patient will become blind
D. The visual field loss will rapidly progress
Qn. 5. What is the main takeaway regarding the importance of glaucoma treatment compliance?
A. Compliance is not very important
B. Moderate compliance is sufficient
C. Strict compliance can prevent progression
D. Progression is inevitable despite compliance
Quizwise on factors associated with the progression of glaucoma
Qn. 1. Which factor is commonly associated with the progression of glaucoma ?
a. Dietary changes
b. Regular physical exercise
c. Compliance with medications
d. None of the above
Qn. 2. What is the most vulnerable sector of the RNFL for glaucomatous damage?
a. Supero-temporal
b. Infero-temporal
c. Supero-nasal
d. Infero-nasal
Qn. 3. Which of the following factors does not accurately identify patients at risk of non-compliance with their prescribed regimen?
a. Sociodemographic variables
b. Visual acuity (VA)
c. Old age
d. Knowledge of glaucoma
Qn. 4. Which dosing frequency is associated with greater noncompliance?
a. Once-daily regimen
b. Twice-daily regimen
c. More than twice daily regimen
d. No clear association with dosing frequency
Qn. 5. What is the role of brain-derived neurotrophic factor (BDNF) in the pathophysiology of glaucoma?
a) Triggering apoptosis in retinal ganglion cells
b) Inducing retinal neurodegeneration
c) Inducing synaptic and structural plasticity
d) Maintaining the survival retinal ganglion cells
Answers for Quizwise related to the ImageWise–
Ans. 1. D. Inferotemporal and superotemporal
Explanation: The case report states that the inferotemporal sector of the RNFL in the right eye exhibited particularly severe damage. This sector is known to be most susceptible to glaucomatous damage.
Ans. 2. D. Minimal change
Explanation: Despite the significant RNFL loss, the GCL showed only minimal change of -1 over 6 months. This was likely because the RNFL loss occurred in areas that spare the central macular GCL.
Ans. 3. D. Supero-temporal
Explanation: Compared to the baseline scan, severe thinning was observed in the supero-temporal sector of the left eye’s RNFL.
Ans. 4. B. The patient may maintain central vision
Explanation: Since the macular GCL was spared, the patient may continue to preserve central vision despite peripheral RNFL loss.
Ans. 5. C. Strict compliance can prevent progression Explanation: The case demonstrates the rapid progression that can occur with non-compliance, underscoring the critical importance of adhering to glaucoma therapy.
Answers for Quizwise on factors associated with the progression of glaucoma –
Ans. 1. c. Compliance with medications
Compliant patients seem to experience slower progression of glaucomatous damage than noncompliant patients.
Ref. Olthoff CM, Schouten JS, van de Borne BW, Webers CA. Noncompliance with ocular hypotensive treatment in patients with glaucoma or ocular hypertension: an evidence-based review. Ophthalmology. 2005 Jun 1;112(6):953-61.
10.1016/j.ophtha.2004.12.035
Ans. 2. b. Infero-temporal
The infero-temporal sector of RNFL has been found to be the most vulnerable sector for glaucomatous damage.
Ref. Lee WJ, Park KH, Seong M. Vulnerability zone of glaucoma progression in combined wide-field optical coherence tomography event-based progression analysis. Investigative Ophthalmology & Visual Science. 2020 May 11;61(5):56-.
https://doi.org/10.1167/iovs.61.5.56
Ans. 3. d. Knowledge of glaucoma
Studies show that better VA, male gender and older age are at higher risk of being noncompliant.
Ref. Olthoff CM, Schouten JS, van de Borne BW, Webers CA. Noncompliance with ocular hypotensive treatment in patients with glaucoma or ocular hypertension: an evidence-based review. Ophthalmology. 2005 Jun 1;112(6):953-61.
10.1016/j.ophtha.2004.12.035
Ans. 4. c. More than twice daily regimen
Once daily and twice daily regimens are not associated with higher incidence of noncompliance.
Ref. Olthoff CM, Schouten JS, van de Borne BW, Webers CA. Noncompliance with ocular hypotensive treatment in patients with glaucoma or ocular hypertension: an evidence-based review. Ophthalmology. 2005 Jun 1;112(6):953-61.
10.1016/j.ophtha.2004.12.035
Ans. 5. d. Maintaining the survival retinal ganglion cells
The brain-derived neurotrophic factor (BDNF) is a potent trophic factor which protects the retinal ganglion cells from excitotoxic insult.
Ref. Lambuk L, Mohd Lazaldin MA, Ahmad S, Iezhitsa I, Agarwal R, Uskoković V, Mohamud R. Brain-derived neurotrophic factor-mediated neuroprotection in glaucoma: A review of current state of the art. Frontiers in Pharmacology. 2022 May 20;13:1802.
https://doi.org/10.3389/fphar.2022.875662