The Impact on Glaucoma from the OUTSIDE IN - New York Eye and ...

CME POST TEST
How OSD Affects IOP
<strong>The</strong> <strong>Impact</strong> on Glaucoma from the OUTSIDE IN
To obtain AMA PRA Category 1 Credit for this activity, you
must complete the CME Post Test by writing the best answer to
each question in the Answer Box located on the Activity
Evaluation/Credit Request form on the following page.
To take this post test/evaluation online, please see
"To Obtain AMA PRA Category 1 Credit" on page 2.
1. In what percentage of patients with glaucoma or ocular
hypertension treated with ocular antihypertensives are
symptoms of ocular surface disease (OSD) present?
a. 25
b. 50
c. 75
d. 100
2. Which of the following is directly correlated to the prevalence
of OSD?
a. Age 65 years or younger
b. <strong>The</strong> number of years in which eyeglasses are worn
c. <strong>The</strong> number of instilled ocular antihypertensive drops
d. A humid climate
3. Which of the following is/are a typical finding of OSD?
a. Patient-reported ocular discomfort
b. Redness of the eye
c. Pathology of the corneal epithelium
d. All the above are typical findings of OSD
4. A 67-year-old male patient presents to the ophthalmology clinic
for a follow-up appointment for glaucoma management. <strong>The</strong>
patient has been treated with latanoprost with benzalkonium
chloride (BAK) for 1 year. He complains of eye irritation, blurred
and fluctuating vision, and difficulty working on the computer for
an extended period of time. He has been using preservativefree
tear supplements for his symptoms. <strong>The</strong> patient’s
intraocular pressure (IOP) is 24 mm Hg (it was 16 mm Hg at
the 6-month follow-up appointment). On examination, the
patient has conjunctival redness, superficial punctate keratitis,
and poor corneal tear film. Which of the following is the most
likely cause of the patient’s poorly controlled IOP?
a. Patient tolerance to the pharmacological effects of
latanoprost with BAK therapy
b. Worsening of glaucoma
c. Drug interaction with preservative-free tear
supplements
d. Suboptimal adherence to latanoprost with BAK therapy
5. Dry eye affects patient quality of life in a similar magnitude
to that experienced in _____________.
a. Unstable angina
b. Diabetes mellitus
c. Osteoporosis
d. Hypertension
6. Which is NOT a deleterious effect of BAK?
a. Disruption of tight junction proteins
b. Programmed cell death, apoptosis, and necrosis in
epithelial cells
c. IOP elevation
d. Incitation of cytokines, chemotactic factors, and
metalloproteinases
7. A 68-year-old white female presents to the ophthalmology
clinic with complaints of red, irritated eyes. <strong>The</strong> patient is
treated with latanoprost with BAK for IOP lowering. On
examination, the patient has marked hyperemia of both
eyes. Which of the following therapeutic strategies would be
most likely to completely eliminate the patient’s red eyes?
a. Change therapy to preservative-free tafluprost
b. Add preservative-free dexamethasone, 0.01%
c. Change therapy to travoprost with SofZia
d. Initiate a drop holiday
8. Which statement regarding non-BAK preserved prostaglandin
analog ocular antihypertensives is true?
a. Preservative-free ocular antihypertensives are not as
effective as BAK-preserved ocular antihypertensives in
terms of lowering IOP
b. Travoprost with SofZia has been found to be ineffective
and not well tolerated
c. Preservative-free ocular antihypertensives are more
effective than BAK-preserved ocular antihypertensives
in terms of lowering IOP.
d. Preservative-free tafluprost has been found to have an
IOP-lowering effect of up to 30%
9. Which of the following treatment strategies is/are the most
reasonable option(s) for addressing therapeutic
nonadherence due to ocular surface complaints in a patient
currently on a prostaglandin analog with BAK?
a. Laser trabeculoplasty
b. Switch to a non-BAK preserved or preservative-free
ocular antihypertensive therapy
c. Add artificial tears to the current regimen
d. A and B are the most reasonable options
10. A 73-year-old African American female patient presents to
the ophthalmology clinic. <strong>The</strong> patient has been on an IOPlowering
regimen of brimonidine with Purite and latanoprost
with BAK. She is complaining of ocular irritation and foreign
body sensation. Ocular examination shows conjunctival
redness, rapid tear film break-up, and corneal fluorescein
staining. <strong>The</strong> patient’s IOP is 24 mm Hg and she reports
being adherent to her ocular antihypertensive therapy.
Which of the following is likely the most appropriate
therapeutic strategy for this patient?
a. Initiate a drop holiday and begin preservative-free
dexamethasone, 0.01%, followed by re-initiation of
ocular antihypertensive therapy with a preservative-free
formulation
b. Initiate a drop holiday and begin IOP-lowering therapy
with an oral carbonic anhydrase inhibitor, followed by
re-initiation of ocular antihypertensive therapy with a
preservative-free formulation
c. Initiate a drop holiday and begin preservative-free
dexamethasone, 0.01%, followed by re-initiation of
ocular antihypertensive therapy with brimonidine with
Purite and travoprost with SofZia
d. Initiate a drop holiday and begin preservative-free
dexamethasone, 0.01%; recommend laser
trabeculoplasty within 1 week
11