American Board of Internal Medicine (ABIM) Certification Practice Exam

Which findings are indicative of primary open angle glaucoma?

1. Decreased visual acuity and eye pain

2. Increased cup-disc ratio and disc hemorrhages

3. Intraocular inflammatory processes

4. Visual field loss and photophobia

The correct answer is: Increased cup-disc ratio and disc hemorrhages

The findings indicative of primary open angle glaucoma primarily include an increased cup-disc ratio and disc hemorrhages. In this condition, the optic nerve head often shows structural changes, with the cup (a depression in the optic disc) becoming larger relative to the disc itself—this is known as an increased cup-disc ratio. This change reflects the loss of retinal ganglion cells due to increased intraocular pressure over time. Disc hemorrhages are also a notable finding associated with primary open angle glaucoma. They occur due to damage to the nerve fibers and can indicate disease progression. Recognizing these specific changes is essential for diagnosing glaucoma and monitoring its progression. On the other hand, decreased visual acuity and eye pain are not typical findings in primary open angle glaucoma, as this condition often develops silently over many years without significant symptoms in early stages. Intraocular inflammatory processes are more characteristic of other types of glaucoma, such as acute angle-closure glaucoma or secondary glaucomas, rather than primary open angle glaucoma. Visual field loss and photophobia may occur, but they are more nonspecific symptoms and typically arise in later stages of the disease. Thus, the presence of an increased cup-disc ratio and disc hemorrhages are critical signs that directly indicate primary open angle