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Editorial IGR 7-3
Dear Reader,
Glaucoma research is important to readers of IGR, and even more so to the patient. I am always astonished about the vast amount of research that is being conducted on even the most remote areas of human interest. Glaucomatology is only a tiny part of that colossal production. Some studies reviewed in this issue are interdisciplinary, involving glaucomatologists and other scientists. Interdisciplinary research in general has touched upon topics like stress, sexual activity and - yes - happiness. Senior Tibetan Lamas show a type of brain activity (functional MRI) that is far away from that measured in 'ordinary' (non-Lama) people who may, from time to time, be prey to negative emotions. Happiness related brain activity occurs predominantly in the left prefrontal cortex, whereas negativity displayed a pattern of activity in regions of the right prefrontal cortex (Richard Davidson, University of Wisconsin, Madison, USA). Here we have evidence-based happiness.
The journal of Biological Psychology (Stuart Brody, University of Paisly,
UK) reports that persons who have regular sexual intercourse have less
stress before or during public speaking. Blood pressure changes related to
public speaking also responded favourably to sexual activity. Whether this
finding will have an impact on the Quality of Life of our Glaucoma-speakers
needs to be studied. The authors speculate that the 'pair-bonding' hormone
oxytocine may be behind the calming effect.
Chen and He (abstract no. 962) found that there are marked differences in
anxiety and depression scores (as measured by questionnaires) between
patients with acute PACG and chronic PACG. Those with acute ACG are more
anxious and depressed.
How wide is this span of human intellectual interest: stress, anxiety,
sexual activity, meditation, depression, glaucoma. How little do we know
about the interactions between these fields of interest. Isn't this the
fascination of research: the endless discovery? The vastness?
This issue of IGR presents topics varying from the most essential basics of epidemiology to the crucial question of apoptotic mechanisms in glaucoma: we learn that Normal Pressure Glaucoma is more prevalent than Angle Closure Glaucoma in Japan. Why in Japan and not in China? Is a risk calculator based on quantitative prospective data the solution for our decision process? Is age, IOP and CCT all we have as useful risk factors? Or even more fascinating: will computers turn out to be better deciders than us doctors? Why do we find cerebrovascular disease in pseudoexfoliation? Time and time again we are told that cooperation with medical therapy is poor, very poor indeed. We will see in this issue that pressure-wise the results of laser treatment are comparable to that of prostaglandins. However laser treatment has a 100% patient-cooperation (compliance, persistence). Or is the long-term laser effect not sufficient? The answer can be found in Value Based Ophthalmology (Brown and Brown, Evidence-Based Ophthalmology 2005; 6: 181-182). Determine the value of each intervention, determine the cost and conclude. I wish it were that simple.
WGA committee reports
This is a very special issue of IGR, as it presents two reports from WGA committees: one on Screening of Open Angle Glaucoma and one on Cooperation with Medical Therapy. These reports are the result of extensive deliberations of global experts in the field. Representatives of the WGA Glaucoma Industry Members were among the members of the Committee on Cooperation with Medical Therapy.
The issue of screening for POAG (or for ACG) is much debated. The report is
clear in its conclusion... that is: for now. Techniques are so rapidly
evolving, that population screening may be much more effective in the near
future for both POAG and PACG.
Cooperation with medical therapy was already discussed. New delivery and
registration devices may provide an answer. They are coming.
WGA Consensus program
The continuing education program of the WGA is organizing its third global Consensus meeting, this time on Angle Closure Glaucoma. The preparations are far advanced, i.e., participants have placed their reports in the Consensus e-Room and discussion is in full swing. The preliminary report will be presented for comment to all Glaucoma Society associated in the WGA. This report and the comments by the Glaucoma Societies will be discussed in the Consensus meeting on May 3, in the Hollywood Beach Marriott Hotel in Fort Lauderdale (ARVO), 1-7 PM (on invitation only). The results of this discussion form the basis for the final global WGA Consensus Report on Angle Closure Glaucoma.
WGC
Preparations for the World Glaucoma Congress 2007 in Singapore, July 18-21 are advancing well. The present status can be found on the WGA website. The first announcement will be out in early May. Details of the Scientific Program will be known in November.
Erik L. Greve
