Opthal: Primary Open-Angle Glaucoma: Free MSRA Podcast

👁️ Primary Open-Angle Glaucoma (POAG) – Deep Dive, Fast RecallA chronic, progressive optic neuropathy causing irreversible peripheral vision loss (→ tunnel vision), typically from raised intraocular pressure (IOP) with an open anterior chamber angle.Most common type of glaucoma in the UK and worldwide.🧠 Pathophysiology & MnemonicResistance at the trabecular meshwork → ↑IOP → optic nerve damage → vision loss.Mnemonic: Trabecular Trouble → Pressure Up → Nerve Down → Vision Out⚠️ Risk Factors (Mnemonic: A FAT HEAT)• Age >40• Family history• African/Asian/Hispanic ancestry• Thin cornea• High IOP• Eye conditions (e.g. myopia)• Associated disease (DM, HTN)• Trauma/steroids📊 Epidemiology• ~2% over-40s UK, ~10% over-70s• ~90% of UK glaucoma cases• Often asymptomatic until late — "silent thief of sight"👁️ Clinical Features• Early: Asymptomatic• Late: Bilateral peripheral vision loss → tunnel vision• Exam:– Raised IOP (>21 mmHg, Goldmann)– Optic disc cupping (↑cup:disc ratio)– Visual field defects (nasal step, arcuate scotoma)– Open angle (gonioscopy)🩺 Differential Diagnosis• Angle-closure glaucoma (acute, painful, red eye)• Secondary glaucomas (e.g. steroid-induced)• Ocular hypertension (↑IOP, no optic damage)• Normal-tension glaucoma• Optic neuropathies (e.g. ischaemic, compressive)🔎 Investigations• Tonometry: Goldmann applanation = gold standard• Visual fields: Perimetry• OCT: Nerve fibre layer thinning• Gonioscopy: Confirms open angle• Pachymetry: CCT (thin = ↑risk, underestimates IOP)💊 Management (NICE UK)🎯 Goal: Lower IOP to prevent progression• 1st line: Prostaglandin analogues (latanoprost – ↑outflow)• 2nd line:– Beta blockers (timolol – ↓production)– Carbonic anhydrase inhibitors (dorzolamide)– Alpha agonists (brimonidine)• Laser: SLT (selective laser trabeculoplasty) – 1st line in some• Surgery: Trabeculectomy, MIGS (minimally invasive glaucoma surgery)• Monitoring: IOP, visual fields, OCT💡 DVLA: Inform if visual field affected📈 Ocular Hypertension (OHT)• Raised IOP, no nerve damage/field loss• NICE: Consider SLT or drops if IOP ≥24 mmHg⚠️ Complications• Irreversible blindness• Medication side effects (e.g. redness, systemic beta blocker effects)• Surgical: hypotony, bleb infection, scarring• ↓Quality of life: driving, independence📉 Prognosis• Good with early detection & adherence• Poor compliance or late presentation → progressive vision loss🧪 Screening/Prevention• Regular eye checks:– Every 2 years for adults– Yearly if over 65 or risk factors– Family history: annual from 40–50• POAG ≠ angle-closure → no LPI📚 POAG MSRA Resources:📝 Revision Notes:https://www.passthemsra.com/topic/primary-open-angle-glaucoma-revision-notes/🃏 Flashcards:https://www.passthemsra.com/topic/primary-open-angle-glaucoma-flashcards/📖 Accordion Q&A:https://www.passthemsra.com/topic/primary-open-angle-glaucoma-accordion-qa-notes/🎯 Rapid Quiz:https://www.passthemsra.com/topic/primary-open-angle-glaucoma-rapid-quiz/🧠 Quiz:https://www.passthemsra.com/quizzes/primary-open-angle-glaucoma/🌐 Main Sites:https://www.passthemsra.com | https://www.freemsra.com🏁 TakeawayChronic, asymptomatic optic nerve damage with irreversible vision loss if missed. Early detection + IOP control = preserved sight.#MSRA #Glaucoma #POAG #Ophthalmology #PasstheMSRA #FreeMSRA #IOP #OCT #VisualFields #SilentThiefOfSight #MSRAFlashcards #MSRAQuiz #PrimaryOpenAngleGlaucoma