2.  Myopia- pigment dispersion, open angle
glaucoma (?)
 Hyperopia- small disc, angle closure
glaucoma

3. • Tuberous sclerosis
• Neurofibromatosis
• Sturge weber syndrome
• TAO

4. • Juvenile xanthogranuloma
• Oculodermal melanocytosis
• Axenfeld rieger syndrome
• Orbital varices
• CCF

5.  RAPD
 Corectopia, ectropion uveae

6. • Black adrenochrome deposits
• Conjunctival injection
• Dec tear production
• Foreshortening of the conjunctival fornices
and scarring
• Bleb
• Episcleral vessel dilation
• staphyloma

7. • Haab striae
• PED
• Microcystic epithelial edema
• Krukenberg spindle
• Exfoliation material
• KP
• Guttae
• “ beaten bronze”
appearance

8. • Van Herick method
• Iris bombé
• Heterochromia
• Iris atrophy
• Transillumination defects
• Neovascularization
• LENS
– Phacodonesis
– PSC

10. 1. diagnostic- identify abnormal angle
structures and estimate the width of the AC
2. Surgical- LTP, goniotomy
 Visualize the anterior chamber
 Eliminates tear- air interface
 Prevents total internal
reflection

11. DIRECT GONIOSCOPY INDIRECT GONIOSCOPY
 Koeppe, Barkan-Hoskins,  Goldmann, Zeiss, Susman,
Swan Jacob Possner
 done under EUA (supine)  clinic setting (sitting)
 may examine eye  one eye at a time
simultaneously  needs slit lamp
 needs handheld  confusing mirror image
 biomicroscope, light
source
 direct image

12.  Goldmann-
 needs coupling agent
 Stabilizes the globe
 Clearest visualization of the AC
 Useful for LTP
 Zeiss, Posner, Sussman-
 Four- mirror goniolens
 No need for coupling agent
 Useful for indentation gonioscopy

14.  Koeppe
 Useful for fundus exam
 Useful in patients with nystagmus or irregular
cornea

19.  Angular width of the angle recess
 peripheral iris contour
 Insertion of the iris root

20.  Pressure is applied to the cornea aqueous
humor forced into AC
 Appositional closure- (+) force opening
 Synechial closure- remain closed
 Partial synechial closure- partially open/ closed

21.  Scleral spur and schwalbe’s line- most
consistent
 Superior quadrant- narrowest
 Inferior quadrant- widest
 Pigmentation- most marked in the inferior
angle

22.  Faint red line in the posterior TM
 Episcleral venous pressure > IOP
 Hypotony
 Elevated episcleral venous pressure

23. IRIS PROCESS PAS
 Open and lacy  More solid or sheet-like
 Follows the normal  Composed of iris
curve of the angle stroma
 Structures visible in the  Obliterate the angle
open space b/n recess
processes

24.  Increases with age
 Darkly pigmented iris
 PDS
 PES
 Malignant melanoma
 trauma
 Uveitis/inflammation
 Surgery
 hyphema

25. PDS PES
 Uniform pigmentation  Patchy pigmentation
 Finer pigment  (+) sampaolesi line

26.  Wide ciliary body band
 Increased prominence
of the scleral spur
 Torn iris process
 Variation of ciliary face
width and angle depth
in different quadrants

28.  Early glaucomatous changes
 Loss of axons,blood vessels and glial cells

29. MECHANICAL THEORY ISCHEMIC THEORY
 Direct compression of  Decresed optic nerve
axonal fibers perfusion
 Distortion of the LC plates  Intraneural ischemia
 Interruption of axoplasmic
flow
 Death of RGC

30. DIRECT OPHTHALMOSCOPE INDIRECT OPHTHALMOSCOPE
 Small pupil  Uncooperative patients,
 Detection of NFL media opacity, high myope
 No stereosopic detail  Can detect ON cupping but
less pronounced with slit
lamp method
 Magnification- is
inadequate

31.  Hruby lens, 60, 78 or 90 D lens
 Can detect subtle changes in ONH
 High magnification, excellent illumination,
stereoscopic view
 Quantitative measurement of the diameter of the
disc
▪ 60D= x 1
▪ 78D= x 1.1
▪ 90D= x 1.3

32. 1. Generalized enlargement of the cup
2. Focal enlargement of the cup
3. Superficial splinter hemorrhage
4. Loss of NFL
5. Translucency of the neuroretinal rim
6. Developmenmt of vessel overpass
7. Asymmetry of cupping b/n patient’s eyes
8. Peripapillary atrophy ( beta zone)

34. Cup disc ratio
 Measure vertical and horizontal
diameter
 Large disc- large cup
▪ Eg myopia, aging, blacks
 N- < 0.3
 5% - 0.6
 Asymmetry of >0.2 -?

35.  Notching or narrowing of the rim
 Inferior and superior temporal poles

36.  Linear red streak on or near the disc
 Usually located inferotemporally
 May clear over weeks to months– localized
notching of rim and VF loss
 NTG more likely to have hges
 Prognostic sign for development or
progression of VF loss

37.  Red- free illumination
 N- plush, refractile appearance
 Thinning, less visible
 Diffuse > focal

38. • Tissue between the cup and border
• Orange or pink
• ISNT rule
• More translucent in glaucoma

39.  Alpha zone-
 irregular hyper and hypopigmentation of the RPE
 Temporal crescent seen in myopia
 Seen in normal subjects
 Beta zone
 Choriocapillaries and RPE loss
 Choroidal vesels and sclera visible-
white appearance
 More common in glaucoma patients

40.  Nasalization of vessels
 Laminar dot sign
 Bayoneting
 Baring of circumlinear vessels
 Narrowing of peripapillary retinal veseels
 Pale and excavated cup in advanced stages

41.  Confocal scanning laser ophthalmoscopy
 Scanning laser polarimetry
 Optical coherence tomography

44.  Measures differential light sensitivity or the
ability of the subject to distinguish a stimulus
light from background illumination
 Assess the visual field
1. Identify abnormal visual field
2. Quantitative assessment of normal or abnormal
fields to guide follow- up care

45.  1. short wavelength automated perimetry-
blue- yellow perimetry
 2. Frequency- doubling technology- uses a
low spatial frequency sinusoidal grating
undergoing rapid phase reversal flicker
 Simulates M cells
 3. Visually evoked cortical potentials and
electroretinography- assess RGC function

46. KINETIC STATIC
 Moving stimulus of  Non moving stimuli of
fixed intensity and size varying intensity
 Simple confrontation,  Henson, Octopus,
tangent screen, Lister Humphrey
perimeter, Goldmann  automated
perimeter
 manual

47.  Traquair’s Island of vision
 Island of sight surrounded by sea of darkness

48.  Nasal= 60
 Superior= 60
 Inferior= 70
 Temporal= 90
 Blind spot= 10- 20 temporally

49.  Almost always localized
 Respects the horizontal meridian
 Begins nasal to the blind spot
 almost always detectable within the central
30
 Structural loss precedes VF loss
 50% RNFL loss before VF defect develops

50.  Generalized depression
 Paracentral scotoma
 arcuate-/Bjerrum scotoma
 Nasal step
 Altitudinal defect
 Temporal wedge

51.  Relative or absolute
visual loss within 10 of
fixation

52.  10- 20 from fixation

53.  Relative depression of
one horizontal
hemifield compared
with the other

54.  Near complete loss of
the superior or inferior
VF
 Advanced GON

55. 1. Fixation
2. Stimulus luminance
3. Size of stimulus
4. Presentation time
5. Patient refraction
6. Pupil size
7. Wavelength of background and stimulus

56.  Numerical-
 threshold for all points checked
 Grey scale-
 decreasing sensitivity is represented by darker
tones
 Each change in grey scale tone is equivalent to 5
dB
 Total deviation-
 deviation of the patient’s result from age
matched controls

57.  Pattern deviation
 Adjusted for any generalized depression in the
overall field
 Probability values
 P indicates the significance of the defects
 < 5%, < 2%, < 1%, and < 0.5%
 The lower the P- greater clinical significance

59.  Fixation losses-
 indicate steadiness of gaze during the test
 False positives-
 detected when a stimulus is accompanied by a
sound
 Trigger happy patients
 Grey scale print out appears pale
 > 33%- unreliable

60.  False negatives-
 detected by presenting a stimulus much brighter
than threshold at a location where sensitivity has
already been recorded
 Indicates inattention or tiredness
 May also be an indicator of disease severity
 Grey scale print out has a clover- leaf shape
 > 33% unreliable

61.  Mean deviation- measure of overall field loss
 Pattern standard deviation- measure of focal
loss or variability within the field taking into
account any generalized depression in the hill
of vision

62.  Miosis- decreases threshold sensitivity in the
peripheral field and increases variability in
the central field
 Lens opacities
 Uncorrected refractive error
 Lens rim
 Ptosis
 Inadequate retinal adaptation

63. 1. Optic disc less cupped than expected for the
degree of VF loss
2. Pallor> cupping
3. Progression of VF loss is excessive
4. Pattern of VF loss is uncharacteristic for
glaucoma
5. Location of VF loss does not correspond to
the location of cupping or thinning of neural
rim