Cases

Case 1 – 2024
1 Examination
Question 1: Describe the clinical photographs seen in Figure 1.
Question 2: Based on the initial history and examination, what is your working diagnosis?
Question 3: Describe the above optic nerve head photos
Question 4: Describe this patient’s visual field tests.
Question 5: Describe this patient’s RNFL OCT scans and Ganglion cell layer scan
Question 6: What is the difference between pigment dispersion syndrome, pigmentary ocular hypertension (POHT), and pigmentary glaucoma?
Question 7: What is the natural history of pigment dispersion syndrome?
Question 8: What other conditions are associated with anterior segment pigment deposition?
Question 9: What is the role of laser peripheral iridotomy in the treatment of patients with pigment dispersion syndrome or pigmentary glaucoma?
Question 10: How is elevated IOP managed in pigmentary glaucoma?
Required Reading & References
Case 1 – Examination Intro
Case 1 – Examinations – 2024
Case 2 – 2024
1 Examination
Question 1: Describe the patients optic nerve
Question 2 : Describe this visual field and what each letter refers for the letters A-E:
Question 3 : Describe this visual field and what each letter refers for the letters F-J:
Question 4: Describe the difference between the points tested for in 24-2 and 10-2 visual field test.
Question 5. Describe what are false positives and how it is deternined by automated visual field testing.
Question 6: What are false negatives and what are features on a visual field which suggest the defect is caused by false negatives?
Question 7: How are fixation losses determined and what is the most common reason for high fixation losses?
Question 8: What is the Hodapp-Anderson-Parrish criteria for Minimum Criteria for Diagnosing Acquired Glaucomatous Damage in a 24-2 Examination
Question 9: What features would suggest conversion from being a Glaucoma Suspect to Manifest Glaucoma?
Question 10: What features would suggest a non-glaucomatous optic neuropathy rather than glaucoma?
Required Reading & References
Case 2 – Examination Intro
Case 2 – Examinations – 2024
Case 3 – 2024
1 Examination
Question 1:Describe the colour fundus photographs in Figure 1.
Question 2: What is your assessment of the visual fields?
Question 3: Describe the patient’s OCT retinal nerve fibre layer (RNFL) and ganglion cell layer (GCL) analysis
Question 4: What is your working diagnosis?
Question 6: Why do patients with NVG and a high IOP (e.g. IOP > 40 mmHg) not complain of pain?
Question 5: Describe the Figure 1
Question 7: What are the three most common causes of neovascular glaucoma?
Question 8: What should be done to manage the high IOP in patients with NVG?
Question 9: What other treatment is indicated?
Required Reading & References
Case 3 – Examination Intro
Case 3 – Examinations – 2024
Case 4 – 2024
1 Examination
Question 1: How do you distinguish a true disc pallor from a glaucomatous disc appearance?
Question 2: What is your assessment of the visual fields?
Question 3: Describe the patient’s OCT retinal nerve fibre layer (RNFL) and ganglion cell layer (GCL) analysis
Question 4: What is the likely diagnosis?
Question 5: Discuss the pathophysiology of NAION, including the risk factors.
Question 6: Discuss the management options for NAION.
Question 7: Describe the patient’s OCT retinal nerve fibre layer (RNFL) and ganglion cell layer (GCL) analysis
Question 8: Is the patient’s fellow unaffected eye at risk of developing NAION? Why or why not?
Question 9: Why would you use Brimonidine tartrate in NAION?
Question 10: What is the relevance of taking sildenafil in this case?
Required Reading & References
Case 4 – Examination Intro
Case 4 – Examinations – 2024
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Required Reading & References

Cases Case 1 – 2024 Required Reading & References

Required reading

Bustamante-Arias A, Ruiz-Lozano RE, Carlos Alvarez-Guzman J, Gonzalez-Godinez S, Rodriguez-Garcia A. Pigment dispersion syndrome and its implications for glaucoma. Surv Ophthalmol. 2021 Sep-Oct;66(5):743-760. doi: 10.1016/j.survophthal.2021.01.002. Epub 2021 Jan 12. PMID: 33444629.

Recommended reading

Niyadurupola N, Broadway DC. Pigment dispersion syndrome and pigmentary glaucoma–a major review. Clinical & Experimental Ophthalmology. 2008;36(9):868-882.

Pang R, Labisi SA, Wang N. Pigment dispersion syndrome and pigmentary glaucoma: overview and racial disparities. Graefes Arch Clin Exp Ophthalmol. 2023 Mar;261(3):601-614. doi: 10.1007/s00417-022-05817-0. Epub 2022 Sep 10. PMID: 36085315.

Siddiqui Y, Ten Hulzen RD, Cameron JD, et al. What is the risk of developing pigmentary glaucoma from pigment dispersion syndrome? Am J Ophthalmol. 2003;135(6):794e9

Michelessi M, Lindsley K. Peripheral iridotomy for pigmentary glaucoma. Cochrane Database Syst Rev. 2016;2:CD005655.

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