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Editorial IGR 6-3
Dear Reader,
The Conscience of Glaucoma
The cover of this issue of IGR carries the line: "the conscience of glaucoma". Why did we print these words? The Glaucoma-conscience can be seen as the benevolent, though critical, unbiased, well founded, all-overseeing and independent force that drives truth in Glaucoma publications. It is more than Evidence Based Medicine. It is a mentality, a scientific state. It is wisdom. Does it exist? Well, the reviewers of IGR give it a try. The idea behind IGR is to provide the reader with that expert glaucoma conscience particularly in the case of the comments of the Editors' Selection.
Life and Glaucoma
What is this life if full of care, there is no time to stand and stare? (writes the poet). We have no time because we sit and look at computer screens or we drive in a car. Yes, of course there is more, but computers and cars are indispensable companions of modern life. There is some good news: older persons with glaucoma drive at least as safely as if not more safely than their fellow citizens without glaucoma (McGwin et al., abstr. no. 762). Of course there are limits to this conclusion (end stage) but at least this aspect of Quality of Life is long preserved. However if you decide to have a handsfree telephone conversation in your car you need to realize that an attention diverting effect has been measured (Barkana et al., abstr. no. 858). Number of missed points of visual field examination during handsfree telephone communication were increased; fixation losses increased five-fold; reaction-time was longer. So be careful, you may be driving dangerously when you talk on the phone simultaneously. What if you talk to your passengers? No data yet. Soon talking in cars will be out. And the computer? In Japanese with myopia heavy computer work is associated with glaucoma. Not so for emmetropes. With the present frequency and intensity of computer use this is a worrisome finding. Even more so because it escapes us why myopes would be the only ones affected. We are waiting for confirmation and for a good reason explaining the computer-myopia link (see Editors' Selection). Also from Japan comes the Tajimi study (see Editors' Selection). This study came to the conclusion that Normal Pressure Glaucoma has a high prevalence in Japan. There is more: no difference in CCT, 90% of NPG undetected, but few blinded by glaucoma. This is a landmark study with consequences for the Japanese health system and beyond.
WGA
This is the last issue of Volume 6 (literature of the last 4 months of 2004 and some earlier difficult to obtain abstracts). It is also the last issue before the World Glaucoma Congress (WGC). Work on the WGC is proceeding rapidly and according to schedule. Expectations are high and so is input of energy. In the mean time the WGA has started a new subcommittee on 'Cooperation with Medical Therapy'. The subcommittee will deal with several aspects of medical treatment, including the alarming issues of lack of compliance, persistency and adherence. This subcommittee is chaired by Harry Quigley and Roger Hitchings and comprises both glaucomatologists and representatives from our Glaucoma Pharma Industry Members. It is expected that this initiative will lead to comparative data on adherence to different types of treatment and propositions to improve the admittedly serious lack of patient cooperation. No doubt this issue will also be seen in the light of optimal adherence to laser and incisional surgical treatment. An important task.
WGA Consensus Meeting
The preparations to reach a consensus on 'Surgical Treatment of Glaucoma' have started in e-Room. This is an ongoing process involving some 100 experts, which will eventually lead to an in vivo consensus meeting on April 29, 2005 in Fort Lauderdale. The results of the consensus meeting will be presented at the World Glaucoma Congress.
CCT
Since the OHTS, corneal thickness has received an immense amount of publicity. Goldman indicated that an IOP correction of 2.5 mmHg was to be expected for an infinitely thin cornea. Most patients do not have such thin corneas but just somewhat thinner or thicker than average, needing possibly a minor correction. That is, if you use the Goldman applanation tonometer and not one of the newer tonometers that claim - and rightly so after an increasing number of studies - to measure IOP independent from CCT. What does all this mean? Well, Douglas Anderson explains his approach in a review in this issue.
Sclera
Mind my words, said Ross Ethier in a talk at the meeting of the Optometric Glaucoma Society. The word is sclera. And it is. The more we know about the mechanical properties of the optic nerve head, the more it seems that the sclera is a major player in the pathogenesis of glaucoma. Some of this can be read in the mini-review (in print and 'video' online) by Ethier and in comments by Harry Quigley in the Editors' Selection on work by Ethier and Burgoyne.
1 mmHg
One millimeter IOP reduction reduces the risk of progression by 10%. So they say. Is it the truth and nothing but the truth? Yes, BUT not the only truth and a truth that should be seen in perspective. That is what Ravi Thomas and friends tell us in their review in this issue.
Glaucoma Societies
In the last four months of the past year at least four Glaucoma Societies met and also larger bodies such as the AAO and RANZCO (Royal Australian and New Zealand Congress of Ophthalmology) with glaucoma sections. To our great satisfaction this issue reports a.o. on the Russian Glaucoma Conference held in Moscow. Slowly but steadily communication all over the globe improves. We welcome the first report on the Russian meeting
Editors' Selection
The Editors' Selection has that crème de la crème information that we all need so badly; it is the very seat of the 'Conscience of Glaucoma'. Apart from subjects already mentioned, there is the crème of basic research, visual function and driving, better OCT, female structural function, the struggles of electro-glaucoma diagnosis, sclerosis, and the mechanism of non-penetrating surgery.
Poetry
The reader will find recent poetry from the superb new opera Tea by Tan Dun and - what contrast! - a professional poem by one of our colleagues on congenital glaucoma and poems selected by Eamonn O'Donoghue.
Lectori saluto
Erik L. Greve
NB: Classification 6. 20 has been changed from 'Other' to 'Progression'. Other has
become 6.30.
