advertisement
Editorial IGR 8-2
Dear Reader,
IGR is now distributed to 8000 readers - glaucoma
interested ophthalmologists and related scientists.
The Glaucoma E-Mail preceding IGR provided information on the articles and
the reviewing experts of the Editors' Selection. It is expected that this
information will facilitate a targeted search by the reader.
WGA news
World Glaucoma Congress: preparations for the WGC 2007 in Singapore are on schedule. A preliminary program at a glance can be found on the WGA website, as well as information on topics and committees. The final announcement, including the scientific program, a call for abstracts and the registration forms, is planned for late October 2006.
The WGA organization has been subject to a planned revision, which has resulted in new bylaws, a new professional Director, updating of committees and a redefinement of its goals.
World Glaucoma Congress 2007
In comparison with the WGC 2005 the upcoming WGC will be characterized by an even better balance between didactic and research presentations, more basic practical management courses, more surgery. Furthermore, the evidence and/or consensus-based quality aspects of the meeting will receive renewed and focused attention from all parties involved in our association.
Editors' Selection
The Editors' Selection of this issue provides a.o. excellent comments on the role of endothelin and astrocytes in the pathogenesis of glaucoma, the role of IOP-CCT correction tables, the relation CCT-scleral thickness, the expanding size of glaucomatous receptive fields, prediction of RGC density from perimetric sensitivity, the real problem with large discs, multifocal VEP pros and cons, CSF and NPG - a hypothesis - medical and surgical IOP variation, always new substances with a potential for neuroprotection, and last but by no means least, cost-effectiveness and utility analysis.
Particularly the paper and its comment by Jönsson on
cost-effectiveness of treatment based on the OHT study deserve attention
because of the far reaching consequences for treatment. Gary Brown et al.
comment on one of the first utility analyses in glaucoma. Cost-utility
analysis is also the topic of a paper by Hollands (abstract no. 606),
showing the rising star of utility measurements for health related
quality of life. The readers attention is also directed to the paper by
Lafuma (abstract no. 609), which discusses the economic consequences of
visual impairment particularly the negative impact on productivity.
ARVO
The ARVO 2006 meeting is well represented by Top-Ten reports, a report on the 'new ideas' symposium, and a report on the special symposium on drug delivery devices. There is no doubt that eye drop therapy for glaucoma will soon belong to the past. The astonishing developments in drug delivery systems will take over to the benefit of the patient who will no longer be bothered by an appalling compliance. This excellent overview on presentday drug delivery research is highly recommended.
Consensus
This issue of IGR provides the outcome of the WGA consensus meeting on Angle Closure Glaucoma (May 4, 2006; page 136). The meeting involved 110 experts from all over the world. The preliminary reports were distributed to the worldwide glaucoma societies for comment. The final consensus outcome was the result of an extensive discussion of the reports. The full consensus report will be published in book format (Kugler Publications) in October 2006 latest.
The topic for the upcoming consensus will be Intra Ocular Pressure in all its aspects. The consensus meeting is scheduled for May 2007. The consensus outcome will be extensively discussed at the World Glaucoma Congress 2007.
Quality of care
Hoskins in an editorial (Archives of Ophthalmology 2006; 124: 905-906) discusses the new hype of 'pay for performance'. "There is a clear focus on developing quality measures rapidly and implementing a payment system that rewards physicians based in their use and reporting those measures." One of the missions is "to improve American health care through endorsement of consensus-based national standards for measurement and public reporting of health performance data that provide meaningful information when care is safe, timely, beneficial, patient centred, equitable and efficient." The WGA with its consensus program and now already three consensus outcomes published (Structure and Function in the Management of Glaucoma, Surgery of Open Angle Glaucoma, Angle Closure Glaucoma) seems to be doing spontaneously what is now the focus of governments and other institutions. Of course there is more to do than organizing and publishing the outcome of consensus meetings. There is a well-recognized gap between the recommendations of consensus outcomes and the subsequent implementation in the management of glaucoma. Here too the WGA, and particularly its associated glaucoma societies, could and should play a major role.
Academic ophthalmology
"The future of academic ophthalmology in the UK presently hangs in the balance," Sparrow writes in an editorial in the British Journal of Ophthalmology (2006; 90: 404-405). He describes the unfortunate reduction of the number of clinical professors in ophthalmology. This rightly is a cause for serious concern. Is the UK unique for this development? I seriously doubt this. "Remedial action is urgently required," and most probably all over the world.
The glutamate story
There has been considerable excitement around the proposed role of glutamate in the pathogenesis of glaucoma, not in the least because of the falsification of data by one of its major proponents. The discussion continues in all vehemence. Sizable financial interests are involved. Who is unbiased in this discussion? The final verdict still has to come out as illustrated by the editorial and correspondence in the British Journal of Ophthalmology (2006; 90: 369-370 and 730-732).
Glaucoma: a brainy disease
Glaucoma, more than a lot of other eye diseases, requires some careful deliberation - a brainy task - from the treating physician. Clinician scientists attracted to glaucoma seem to be of the more brainy type as, e.g., compared to their cataract colleagues. Now evidence is accumulating that glaucoma itself affects the visual pathway from meshwork to cortex: from eye to brain. Particularly the involvement of the lateral geniculate nucleus and cortex has been the subject of experimental animal research in the last years (and has even received the WGA award). It has even been suggested that we might as well treat the brain in addition to the eye. Some of this is the reason for an editorial by Alm in the British Journal of Ophthalmology (2006; 90: 663), with plenty questions.
Exercise
I do not hesitate to ask the readers' attention for yet another study (abstract 612) on the effect of exercise on IOP. A significant fall of IOP was reported after aerobic exercise in both sportsmen and persons with a sedentary lifestyle. Regular, moderately intense aerobic exercise is recommended.
Glaucoma hymn
The WGA Glaucoma Hymn has been translated into Chinese and used at several Glaucoma Meetings.
Erik L. Greve