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Editorial IGR 6-2
Dear Reader,
Global Glaucoma Patients Meeting
On Friday October 22, 2004 representatives of glaucoma patient groups from all over the world met for the first time with WGA officers and WGA Glaucoma Industry Members in New Orleans on invitation of the WGA. This unique and historical meeting was organized under the guidance of the WGA Liaison Committee on Glaucoma Patient Organizations (GPO) and Glaucoma Foundations, chaired by Robert Ritch and Ivan Goldberg, aided by Yoshiaki Kitazawa, Paul Chew, Remo Susanna and John Thygesen.
Essential parts of the organization were taken over by the patients themselves when the Glaucoma Patient Organization Steering Committee had been established, with Naomi Sussman (USA), Edith Marks (USA), Sherry Holthe (USA), David Wright (UK) and Beverley Lindsell (Australia) as mayor players. The glaucoma patient group decided to call itself Glaucoma International Network: GIN. GPO's from Japan, Hong Kong, Singapore, Nepal, Australia, New Zealand, USA, UK, France, Lithuania, Norway, Netherlands, Ghana, Brazil, Canada, China and Denmark gave brief reports on the functioning of their organization. More countries are already involved. The link with WGA will be through the GPO Liaison Committee. Regular meetings were agreed upon. The common interests of GIN and WGA were discussed. These were, a.o.: WHO, prevention, translate consensus results to patients, translate guidelines on diagnosis and treatment to patients, patients view on Quality of Life, patients view on prevention, compliance and persistency and patient satisfaction. Plans were made for a website, GPO meetings, print media and video's for patient support. Subjects such as advocacy, community awareness, patient stimulated research and physician education are priorities.
World Glaucoma Congress
The Final Announcement and call for papers for the World Glaucoma Congress is out, both in print and online: http://www.worldglaucoma.org/WGC2005 Registration has started. The Scientific Program is exciting and the Social Part will be unforgettable. The uniqueness of the meeting lies a.o. in the involvement of the worldwide Glaucoma Societies, which will convene in the Inaugural Assembly for the first time ever.
WGA Global Guidelines
The WGA is creating the first Global Guidelines on Diagnosis and Treatment of Glaucoma. They will be ready before the World Glaucoma Congress and will be presented in a lecture as well as in a course.
Second Global WGA Consensus on the Surgical Management of Glaucoma
The preparation on the Global Consensus on the Surgical Treatment of Glaucoma has started. This Consensus, which deals with the surgical aspects of OAG, will also be ready before the World Glaucoma Congress. The Consensus will be involved in the extensive surgical sessions and courses of the scientific program of the World Glaucoma Congress.
Value Based Medicine Again
The concept of Value Based Medicine has been subject of an earlier IGR-introduction. All new concepts take time to become part of our clinical thinking. The importance of Value Based Medicine, and its superiority over Evidence Based Medicine, lies in comparability of values of interventions in different specialties, e.g. how does cataract extraction compare to hip surgery in terms of Quality of Life. The instrument used is cost-utility analysis which measures the value (= improvement in Quality of Life and Length of Life) conferred by an intervention. That sounds great. It is not that easy however, as very few cost utility analyses are truly comparable. This problem is subject of an editorial by Brown and Brown in the British Journal of Ophthalmology, and recommended reading (see also Your Special Attention For).
Race and Glaucoma
The most recent OHTS paper (abstract 603) told us that more African Americans convert to glaucoma despite a 23% IOP reduction: twice as high as in the other participants. This important finding is discussed in an editorial by Miller in the Archives of Ophthalmology (see also Your Special Attention For).
Risk of Conversion to Glaucoma
Risk of conversion from OHT to Glaucoma is the subject of a host of presentations and publications. Mansberger presented a 'Risk Calculator', which can be found on www.discoveriesinsight.org/glaucomarisk.htm. The calculator includes well-known aspects like age, diabetes mellitus, CCT, IOP, PSD and vertical CDR. The author is careful to point out the pros and cons of the calculator. Furthermore the calculator is for risk of conversion to an early stage of glaucoma that is not easily related to future reduction of Quality of Life. An interesting aspect is the combination of cost and NNT (Numbers Needed to Treat). The five years cost of preventing ONE ocular hypertensive to convert to early glaucomatous VFD is USD 264,600.-. One of several good reasons to treat ocular hypertensives selectively. Risk management has been the topic of a series of papers by Weinreb and others, that appeared in the American Journal of Ophthalmology online in August and the Supplement in September and will be extensively discussed in IGR 6-3.
Fuchs
When you read the announcement for the World Glaucoma Congress (click here for the pdf file of the final announcement), you will find a photograph of Ernst Fuchs (1851-1930), who worked in Vienna, Austria. One of the many things this great scientist described is the 'heterochromic cyclitis'. The pathogenesis of this disease has long been an enigma. It has now been suggested that rubella - a rubella specific gene sequence is found in aqueous humor - plays a role in this disease (see also Your Special Attention For).
What Else in this Issue
This issue of IGR presents thoughts on the patients view on glaucoma by
Viswanathan, a picture of the gorgeous Optic
Nerve Head models by Claude Burgoyne. The rotating 3-dimensional image of the model
can be seen on here and on the WGA startpage www.GlobalAIGS.org.
Four Glaucoma Societies present their Top-ten and
a small group of European Glaucoma Experts their
Top-thirty on progression.
The Editors Selection bubbles with news, such as glaucoma and mortality, TGF-beta and lamina cribrosa, machine classifiers, nitric oxide and bloodflow, cholesterol lowering medication, bimatoprost versus latanoprost, neuroprotective NMDA antagonists, antifibrotic genetherapy, and implants versus cyclodestruction. and much, much more.
Ken Wilber explains 'excellence an elitism' and Buddha remains silent.
These are the times to be in glaucoma!
Erik L.Greve
