Editorial (IGR: 6-1) | International Glaucoma Review #

Editorial IGR 6-1

Dear Reader,

An anniversary: twenty years of IGR

The International Glaucoma Review and its predecessor Glaucoma Abstracts have been serving the glaucoma-interested community for 20 years. The first issue - much thinner than it is now with just 62 pages - appeared in 1984. Glaucoma Abstracts, as its name was in those days, was an initiative of the European Glaucoma Society (EGS). The aim was and still is to provide members of glaucoma societies with concise, classified information on the literature on glaucoma. It was sponsored by Chibret, who went by the vision never to interfere with editorial matters. The first editorial by the Honorary President of the EGS, Professor Baron Jules Fran�ois, and myself as chief editor can be found here.

The EGS was soon joined by the American (AGS) and Japanese Glaucoma Societies. In those days, the AGS was represented by George Spaeth, Dick Simmons, Bruce Shields and Douglas Anderson. Together with Yoshi Kitazawa who represented the Japanese Glaucoma Society, they made the important move to join the EGS in an alliance that can be seen as the predecessor of the Association of International Glaucoma Societies (WGA). The name was changed to Glaucoma Abstracts International. This is now the right place to thank Bruce Shields and Yoshi Kitazawa for their many years of editorial support for the International Glaucoma Review (IGR). Glaucoma Abstracts International changed into International Glaucoma Review in 1998, and its sponsorship was taken over by Pharmacia. IGR started serving all major regional glaucoma societies throughout the world, and this was reflected in the members of the Editorial Board, particularly the Society Editors. With the foundation of the WGA, IGR became its journal and Robert Weinreb joined the board as editor.

The greatest joy for me after twenty years is the overwhelming enthusiasm with which IGR has been received over the years by my colleagues. Whenever I meet colleagues there are always several who spontaneously voice their appreciation of IGR as a quick and easily accessible source of top quality information on the glaucoma literature and more. It has been a great experience to be able to work with the top experts in our subspecialty. My heartfelt gratitude goes to the editorial board and the other reviewers. They ensure the quality of IGR. Robert Weinreb deserves a special thank you because it was with him that I had the opportunity to create the final and essential changes: IGR's transformation into the journal of the AIGS. Roger Hitchings was and still is the other person who was instrumental in this transformation and has been the best successor as President of the EGS that I could have dreamt of.

The following five anniversary editorials are from colleagues/friends who have helped me in various ways to get IGR to where it is today: a highly appreciated source of information on glaucoma, glaucoma societies, glaucoma meetings, supplemented by wisdom, poetry and fun. That sounds like life to me.

This Volume

This volume of IGR is the first to encompass more detailed instructions for its reviewers. These instructions are in line with the Guidelines of the AIGS, and include disclosure of any possible conflict of interest by the reviewers.

VBM

In an editorial in EBEC (2004; 5: 68-70), Brown stresses the importance of value-based medicine: "It quantifies the value conferred by a health care intervention by quantifying the improvement that it yields in length of life and quality of life". For glaucoma, the emphasis would be on Quality of Life. This provides a more accurate representation of the value of what we do than evidence-based medicine. A very interesting aspect of value-based medicine is the use of a common utility value for interventions in glaucoma as well as in other diseases. As an example: the utility value gain of cataract extraction is comparable to that of total hip arthroplasty! Value-based medicine seems to be the way to go.

Glaucoma Societies

The AGS convened in early March in Sarasota (sweet memories of ARVO). Top-Ten by Robert Noecker.

The Latin American Society convened in Rio de Janeiro and had its members and audience vote on several aspects of the diagnosis and treatment of ocular hypertension and glaucoma. The results can be found in this issue.

The Polish Glaucoma Society mentions as one of their Top-Nine points a Polish epidemiological study which was performed among close to 5,000 inhabitants. Prevalence of Glaucoma varied from 0.4%-4.6% in different age groups.

The EGS held its seventh congress since 1980 (30th May-5th June, 2004, Florence, Italy; every four years). It was also its best so far and the largest glaucoma meeting ever organized, with over 2000 participants. The Top-Ten bullet points are presented by Gabor Holl�.

ARVO

ARVO presents more abstracts on glaucoma research than any other meeting. As quantity and quality may not always go hand in hand, a selection by experts is extremely helpful. For ARVO 2004, the reader will find Top-Tens (or less) by Hernandez, Perez-Grossman, Pfeiffer, Melamed, Wax and Martin.
The reader will also find a most interesting concept for in vivo observation of apoptosis by Cordeiro et al. (presented at ARVO and commented on by Martin Wax), a bullet-point summary of a lecture at the EGS congress by Paul Kaufman on genetherapy, and a discussion on early glaucoma. All highly interesting. The winners of the AIGS Award 2003 and the Top-Ten nominations can be found here.

This Volume

VBM

Glaucoma Societies

The AGS convened in early March in Sarasota (sweet memories of ARVO). Top-Ten by Robert Noecker.

ARVO

This Volume

VBM

Glaucoma Societies

The AGS convened in early March in Sarasota (sweet memories of ARVO). Top-Ten by Robert Noecker.

ARVO

The EGS was soon joined by the American (AGS) and Japanese Glaucoma Societies. In those days, the AGS was represented by George Spaeth, Dick Simmons, Bruce Shields and Douglas Anderson. Together with Yoshi Kitazawa who represented the Japanese Glaucoma Society, they made the important move to join the EGS in an alliance that can be seen as the predecessor of the Association of International Glaucoma Societies (AIGS). The name was changed to Glaucoma Abstracts International. This is now the right place to thank Bruce Shields and Yoshi Kitazawa for their many years of editorial support for the International Glaucoma Review (IGR). Glaucoma Abstracts International changed into International Glaucoma Review in 1998, and its sponsorship was taken over by Pharmacia. IGR started serving all major regional glaucoma societies throughout the world, and this was reflected in the members of the Editorial Board, particularly the Society Editors. With the foundation of the AIGS, IGR became its journal and Robert Weinreb joined the board as editor.

This Volume

VBM

Glaucoma Societies

The AGS convened in early March in Sarasota (sweet memories of ARVO). Top-Ten by Robert Noecker.

ARVO

The EGS was soon joined by the American (AGS) and Japanese Glaucoma Societies. In those days, the AGS was represented by George Spaeth, Dick Simmons, Bruce Shields and Douglas Anderson. Together with Yoshi Kitazawa who represented the Japanese Glaucoma Society, they made the important move to join the EGS in an alliance that can be seen as the predecessor of the Association of International Glaucoma Societies (AIGS). The name was changed to Glaucoma Abstracts International. This is now the right place to thank Bruce Shields and Yoshi Kitazawa for their many years of editorial support for the International Glaucoma Review (IGR). Glaucoma Abstracts International changed into International Glaucoma Review in 1998, and its sponsorship was taken over by Pharmacia. IGR started serving all major regional glaucoma societies throughout the world, and this was reflected in the members of the Editorial Board, particularly the Society Editors. With the foundation of the AIGS, IGR became its journal and Robert Weinreb joined the board as editor.

This Volume

VBM

Glaucoma Societies

The AGS convened in early March in Sarasota (sweet memories of ARVO). Top-Ten by Robert Noecker.

ARVO

Editors' Selection

The Editors' Selection will take you through the expected 50% increase of prevalence of POAG, novel mechanisms for neuroprotection, the role of astrocytes, Alzheimer again, a rodent model of glaucoma, a model for a function-structure relationship, disc hemorrhages and peripapillary atrophy, oral antihypertensive drugs and blood flow, the low prevalence of pseudoexfoliation in China, more on ACG, mononuclear blood cells in NPG, persistency, 50% iris pigmentation after latanoprost in the Japanese, Ginkgo biloba as a neuroprotector, trabeculectomy outcomes, and IOP in the yellow footed tortoise. My goodness, what a list, and that is only part of it.

Enjoy reading,

Erik L. Greve

Guest Editorial by Bruce Shields

As we celebrate twenty years of the International Glaucoma Review and its predecessor, Glaucoma Abstracts International, we are also celebrating twenty years of progress in our understanding of the mechanisms and management of the glaucomas and of the clinicians and scientists who gave us that knowledge. But even more so, I feel that we should be celebrating the person who founded these two publications, in which this vast body of knowledge has been chronicled.

Erik Greve's dream to catalogue the ever expanding volume of international glaucoma literature must have begun over a quarter of a century ago. The dream became a reality in 1984, when he launched the first issue of Glaucoma Abstracts. In 1989, he was kind enough to invite Professor Yoshi Kitazawa and myself to join him as co-editors. However, Erik was and has remained the inspiration and perspiration - indeed, the heart and sole - of this important work.

The journal has made a major contribution to the scientific discipline of glaucoma. To my knowledge, it is the only repository of the last twenty years of important glaucoma literature in a concise and informative format. One of the unique aspects of IGR has been the detailed classification system, which acknowledges the constantly evolving developments in the field. This alone is a major contribution, since it provides future investigators with easy reference to the critical knowledge of the past.

The classification and archiving of our glaucoma literature would have been contribution enough to earn Erik a place on the honor role of glaucoma history. But he did not stop there. The content of IGR has grown over the years to include many additional features, such as the Editors' Selection, which offers a commentary on recent articles of particular importance, information on upcoming glaucoma meetings world-wide, brief reports on the key papers from those meetings, and other useful features.

However, Erik's greatest contribution may well be his use of IGR as a focal point to bring together glaucoma societies from around the world. Today, the Association of International Glaucoma Societies has sixteen member societies. Each AIGS member organization is represented in IGR by a Society Editor, who updates their society's activities in the journal. But the AIGS is much more than just a federation of societies, linked by a common journal. Thanks to the leadership of Professor Greve and his colleagues, it is now a highly active organization with international meetings and an ambitious agenda to advance our knowledge of glaucoma through international cooperation.

As we journey through our professional careers, we become increasingly aware of the privilege and pleasure we have enjoyed from associating with some of the world's most remarkable people. For me, it has been a singular joy to know Erik Greve and to call him a friend, and I know that I speak for many in this regard. So, on this special occasion, please join me in saluting Professor Erik L. Greve for his remarkable contributions to our profession and to our lives. And I have a feeling that the best is yet to come.

Guest Editorial by Yoshiaka Kitazawa

Twenty years of normal tension glaucoma in Japan. Celebrating the 20th anniversary of IGR

A recent epidemiological glaucoma survey has demonstrated an unexpectedly high prevalence of normal tension glaucoma (NTG) in the city of Tajimi, Honshyu Island, Japan. Namely, 3.6% (95% CI 3.2-4.6), while that of primary open angle glaucoma (POAG) and open angle glaucoma (OAG) with intraocular pressure (IOP) exceeding 21 mmHg, was as low as 0.3% (95% CI 0.1-0.5). The results of this particular survey, referred to as Tajimi study, confirmed those of the previous Japanese survey carried out in 1988-1989, in that NTG is the most prevalent type of glaucoma in Japan.

At present there is a consensus among Japanese ophthalmologists that NTG is the glaucoma they are most likely to encounter in their practice. Things were totally different twenty years ago when NTG was considered to be rare, if present at all.

A series of hospital-based, non-population-based, studies indicated that primary angle closure glaucoma (PACG) was just as common as POAG or OAG with elevated IOP. Accordingly, it would be fair to say that much emphasis was placed upon the importance of differentiating chronic POAG from POAG by gonioscopy, rather than on discerning subtle, early glaucomatous changes of the optic disc in daily practice.

What has happened to glaucoma in Japan over the past twenty years? It is unfortunate that no population-based studies on the prevalence of glaucoma were carried out in Japan at that time. Many 'population' studies reported in the 1960s and 1970s failed to fulfill the requirements which would qualify them as 'epdemiological', and it is quite impossible to conclude whether the prevalence rate of different types of glaucoma has truly changed or not. However, there seem to be two issues to go on from the evidence. Firstly, the crucial importance of detecting glaucomatous optic neuropathy (GON) rather than elevated IOP in making the diagnosis of glaucoma was not recognized fifteen to twenty years ago. Our understanding of GON, and the methodology of its early detection, have come on by leaps and bounds over the past decade. The advent and rapid progress of imaging of the optic nerve head and retinal nerve fiber layer are just one example of this. Nowadays, GON is discerned in its much earlier stages than twenty years ago. Secondly, the Tajimi study disclosed that 93% of OAG patients went undetected until they were examined during the survey. It is very likely that they would otherwise have remained 'occult' glaucoma patients for many years to come. This fact supports the conjecture that none of the OAG patients detected was suffering from bilateral blindness due to glaucoma, which would probably have encouraged them to request an eye examination. The advanced diagnostic capabilities in the identification of GON and the higher rate of undetected patients in Japan should account for the high prevalence of newly diagnosed NTG cases in the Tajimi study, it being the first epidemiological survey in Japan, which could well explain the apparent increase in the prevalence of NTG in that country.

In order to address the question of whether or not the prevalence rate of NTG is truly higher in Japanese than in other ethnic groups, a multinational, collaborative, epidemiological study is needed in the future. The Japan Glaucoma Society would welcome such an opportunity.

Guest Editorial by George Spaeth

For most of the world's people, real glaucoma means real blindness. Even those who are wealthy, intelligent, and fortunate enough to live in areas where good health care is available cannot be assured that they will keep their sight if they develop glaucoma. Clearly, the situation is less than ideal. Finding a solution requires solving two quite distinct problems: firstly, how can the care for all patients be improved, and secondly, how can the care for individual patients be improved. The solutions to these two problems may be quite different. For example, a method of diagnosing glaucoma that requires expensive, high-maintenance equipment and that can be operated well by a technician, may be appropriate in certain areas but will never work in others, such as those that do not have the funds to purchase, maintain, and operate such equipment. Common to solving both problems is understanding the issues and communicating meaningfully between researchers, industry, nonprofit organizations, academia, and government.

The American Glaucoma Society (AGS) was founded to address issues of most importance and interest to those in the field of glaucoma in North America. Other glaucoma societies, such as those in Europe and Japan, have similar missions, appropriate for the geographical region of the society. But glaucoma is a global condition, and if individual people and all people are to receive optimal care, global consideration is necessary. Bringing regional societies together is one way to develop communications. Another, much less expensive and much more inclusive way, is to utilize the written word. The development of the periodical, International Glaucoma Abstracts, was, in my opinion, a brilliant way to enhance communication.

For thousands of years healers have been members of an international community. While clearly there are regional differences, the basic goal is the same everywhere: the well-being of the individual person, and the well-being of all persons. While the successes of medical practice are great, it is painfully clear that few of the world's people are sufficiently healthy that they can celebrate life fully. In the wealthier regions, the pressures of career, business or image are often overwhelming, whereas in the poorer regions, resources are so sparse or faulty that it is often difficult or impossible to be truly healthy.

There is much still to do, but the development of an Association of International Glaucoma Societies and the publication of the International Glaucoma Review are important steps in the right direction.

Guest Editorial by Roger Hitchings

In these days of rapid and all embracing communication, where journal titles and abstracts are available free at the press of a computer button, and digital reprints for the payment of a credit-card-deductible fee, it seems difficult to remember those far off days, twenty years ago when Glaucoma Abstracts first began.

Twenty years ago there was no such thing as downloadable information, it was all 'hard copy' and as a result, slow (and expensive). To be widely read in your specialty meant wading through acres of print in many, often hard to obtain, journals. The advent of Glaucoma Abstracts was seen then as a huge advance, and a tremendous service to the glaucoma community.

Erik Greve deserves the credit for identifying the need, the process and the finance, as well as for having the energy to act as editor. He produced lucid, categorized summaries of all available glaucoma literature, and distributed it worldwide. In so doing, he made it possible for the entire glaucoma community to be both well read and informed.

In today's electronic age where journal abstracts are available often before hard copy production, it might be thought that the need for this review journal had lessened. However, Glaucoma Abstracts has itself changed. It has metamorphosed into International Glaucoma Review, while remaining under Erik Greve's stewardship. It is still distributed worldwide, and is available from www.glaucoma.com. It is 200 pages long and is divided into four sections or levels. Level one comprises approximately 1200 abstracts, making up 80% of IGR. Level 2 is the 'Editors' Selection' and comprises a critical review of the most interesting 10%. Level 3 consists of highlights from the Editors' Selection, and level 4 is a bullet pointed News Flash section on the most important research announcements. IGR may be likened to a tub of warm water, allowing the interested ophthalmologist the choice of inserting just a toe if his time is limited, right up to complete immersion at level 1. The glaucoma community is seen as one of the best informed of all ophthalmic specialties, IGR maintains the principle, established two decades ago, of keeping us that way.

Guest Editorial by Robert Weinreb

The International Glaucoma Review (IGR) has reliably published abstracts and comments from the finest scientific information and clinical reports relating to glaucoma since being founded by Professor Erik Greve two decades ago. It has served as a respected venue for highlighting groundbreaking contributions to glaucoma science and clinical practice, as well as a credible forum for professional interchange. In addition to the international dissemination of timely and important knowledge on glaucoma, it has brought the glaucoma community closer together. In 2002, the IGR became the official journal of the nascent Association of International Glaucoma Societies.

Although there are numerous ways of measuring the success of a medical journal, the convergent paths for maximizing it must include a foundation of evidence-based information, respect for innovation, rejection of mediocrity, and commitment to excellence. Further, nothing great in the world has ever been accomplished without passion. Congratulations to Professor Greve, the Managing and Chief Editor of IGR, who has consistently espoused these principles for IGR. Only he could have provided the necessary fusion of distinguished leadership, guidance and persistence required for its unquestioned success. The entire international glaucoma community has benefited from his efforts.

Issue 6-1

Table of Contents Editor's Selection

Change Issue