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Editorial IGR 2-3
Dear Reader,
Volatile times for glaucomatology. On the one hand, our definitions are seriously being questioned and major trials are far from comparable. On the other, we have for the first time solid proof from a large randomized prospective study (AGIS) that low post-surgical IOP is associated with little progression. The latter finding is glorious, particularly for those who remember the papers that questioned whether primary open-angle glaucoma was a treatable disease at all. The comment by Paul Palmberg, in this issue of IGR, on the AGIS study, illustrates the good news and is highly recommended.
Two papers that appeared in the new Journal Evidence Based Eye Care are mentioned in the "Attention" paragraph. They address "Evidence based medicine" and "Levels of evidence". Yes, we need the hard facts of evidence. We also need the irreplaceable wisdom of thorough thinking. Hard facts of evidence involve blood, sweat and tears. The thinking (or daydreaming) is the nice part, the two together are invincible.
Every therapeutic decision that we make and have to explain to the patient brings up the question: is there enough evidence that the treatment "works". "Works" means: will it increase the quality of life of the patient or, at least, not decrease it. If that evidence is not available do we still treat? Do we indeed consider evidence in every therapeutical move we make?
A report by Heijl (see Editor's Selection) failed to demonstrate any significant benefit from treating patients with ocular hypertension with a beta-blocker. We still do that. Is the study wrong? Are we wrong? Food for thought and further discussion.
The relativity of IOP readings is stressed in three editorials in Ophthalmology. Obligatory reading for the Glaucomatologist (see "Your Special Attention For"). Absolute IOP measurements will not help us, for instance, to distinguish between NPG and HPG. We still do that, though. Time to stop.
Now that we are talking about the subject of IOP, you may have forgotten or you never knew that Llamas and Alpacas are not the same animal, even though they are both camelids. Alpacas have a significantly higher intraocular pressure than Llamas. If you have one as a patient you might need to know this (abstract 836).
From IOP to imaging. What are we measuring when nerve fiber layer thickness increases after trabeculectomy, or when the optic nerve head fills up after medical or surgical reduction of IOP? How do we know that our measurements are representative of the glaucomatous process and not just simple changes in volume related to pressure but not to glaucoma? We really need to know the difference.
In this issue of IGR, the reader will find several reports in the TOP-X style of our Journal, from glaucoma meetings all over the world. The Editor's Selection by Yoshi Kitazawa covers the large range of glaucoma-related research. This unique feature of IGR provides a wealth of information on present day topics.
E.L. Greve
