Editorial (IGR: 8-4) | International Glaucoma Review #

Editorial IGR 8-4

Dear Reader,

ADIEU

This is the last introduction that I write as Chief Editor of IGR.

I shall use the first part for the usual informative matters of fact concerning the journal, the association, etc. The second part will be devoted to some reflections that came up while considering this ADIEU.

Part 1: Informative matters

Merger WGC-IGS

The leadership of the WGA has had long and intense talks with the organizers of the IGS: International Glaucoma Symposium. Those talks, which took place in a congenial atmosphere, resulted in a MERGER of the World Glaucoma Congress and the International Glaucoma Symposium after 2007. See also page 398.

Consensus

The discussions which will lead to the 4^th Global WGA Consensus on IOP are in full swing. The seven sections that will be addressed in this consensus are: basic science of IOP, measurement of IOP, variation of IOP, epidemiology of IOP, IOP as a risk factor for glaucoma/progression, clinical trials on IOP, and target IOP in clinical practice. The meeting will be held in Fort Lauderdale on Saturday, May 5 in the Convention Center AND WILL BE OPEN TO INTERESTED COLLEAGUES FREE OF CHARGE.

WGC

By the time you read this, close to two hundred invited speakers will have found their place in the scientific program of the WGC. Posters will have been graded and selected. Some highlights of the program will be:

Global assembly with all glaucoma societies including topics like promulgation i.e., dissemination of consensus outcomes and advocacy i.e., how to improve the position of glaucoma among health authorities.
Opening session with Dr. Vivian Balakrishnan, minister of Information, Communications and the Arts from Singapore, and Kishore Mahbubani, former Ambassador of Singapore to the UN, President of the General Assembly and one of the contenders for Secretary General of the UN; also author of the book, Can Asians Think? and other titles.
Special Top-science presentation by Singapore expert Professor Edison Liu, Director of the Genome Institute of Singapore.
Didactic sessions, including screening, pathophysiology, risk and progression, medical therapy versus non-penetrating surgery, place of combination therapy, new developments in medical treatment, laser versus medical treatment, cyclodestruction in the developing world, surgical grand-
rounds and surgical video sessions.
Basic and clinical science sessions including how important is IOP, risk modelling, cell death, antiscarring.
Debates and symposia including importance of bloodflow, how early to detect, place of combined eye drops, anterior chamber imaging in ACG, myopia and glaucoma, laser versus medical therapy.
Grand finale with watching cells die, stemcells for glaucoma, the future of eye drops, glaucoma neuroprotection available?

Aqueous humor outflow

A report was published on an expert meeting on aqueous humor outflow. For interested readers the report presents a welcome update on the various aspects of outflow. Of interest is a long list of questions needing answers. Of course the participants struggled with differences in terminology and technology, resulting in the incomparability of studies. They hope for a consensus on this matter in which they seem to depend on ARVO. Why not just do it (see Special Attention).

Combination therapy containing a betablocker

Spratt et al. from Moorfields deserve our congratulations for discussing the delicate problem of the position of betablockers in combination therapy. They note that it is the 0.5% (the high) concentration that is used in combined drops. They express concern that the betablocker may not be recognized as a component, hidden in the proprietary name. Doctors are advised to be careful in selecting the patients to whom they plan to prescribe the combination drop and check for betablocker contra indications (see Special Attention).

This issue

This issue has Top-Ten reports from the combined SEAGIG and GSI meeting and from the OGS and also two brief statements from the 2005 WGA-Awardees, Dr. Simon John on the role of animal models, and Dr. Hiroshi Sakai on uveal effusion and angle closure. The Editors' Selection presents a.o. reviews on quality of life, new uses of MRI, IOP behaviour over time, Glaucoma Probability Score, predictive value of retinal nerve fiber layer reduced thickness, consistency of OHT definition, variation of risk estimation, progression in study patients versus random patients, cataract and medical treatment. The reader will find more than enough of interest.

Part 2: Reflections on adieu

I have written the introduction since 1984 and with great pleasure. It started as a source of literature information to the members of the EGS. It is a true satisfaction that after so many years the journal is thriving as the journal for the WGA and serving 8400 glaucoma interested ophthalmologists. In a sense the journal is the birthplace of the WGA, as it started serving three glaucoma societies - EGS, AGS, JGS - in the early nineties, and sixteen regional glaucoma societies from 1998 onward. The WGA developed from this cooperation in literature information.

What has driven me to edit IGR for twenty-three years? Well, first of all my own curiosity; secondly a drive to find order and truth in the flow of glaucoma publications, and thirdly to be able to express my findings in writing so my colleagues could benefit from a concise overview. As you know, IGR provides not only virtually all abstracts on glaucoma, but also and more importantly, comments on 10% of the published literature. In the very beginning I wrote all these comments myself, later together with Bruce Shields and Yoshi Kitazawa. In the late nineties the content of the abstracts became so complex that a greater diversity of expertise was needed: we changed to invited expert reviewers for different abstracts. That is how the IGR functions now and according to the results of questionnaires it does so to the great satisfaction of its readership.

Successor

Robert Weinreb joined the journal as Editor in 2002 and was responsible for the basic research aspects of the Editors Selection, which made editorial life a lot easier for me.

He has given the best of his ideas to continuous reshaping the format of the journal with me. Many years ago I already asked him to become my successor. Since then we have had an intense cooperation not only on the journal, but even more so on the development of the WGA. It is with trust and gratitude that I can now hand over the wheel to him.

Reviewers

It is important for our journal to provide independent, unbiased reviews. The reviewer needs to know his/her topic including study design and statistics better than anyone. It is a truly difficult job to be a good reviewer. This cannot be emphasized enough. This is the time and place to thank all these reviewers from the bottom of my heart: you made the journal.

IGR Database

The ongoing project we - Robert Weinreb, Caroline Geijssen, Simon Bakker (of Kugler Publications) and I - have been working on, is the IGR database. I cannot tell you how happy we are that our journal will soon - starting with volume 9 - have its own database. In the first phase, abstracts will go back to 1998 and in the second phase all the way back to 1984. The IGR abstract database holds thousands of abstracts related to Glaucoma since 1984, all classified, and some 10% commented on by leading experts.

The objectives of the database are:

1. Reduce search time: Only glaucoma abstracts in database, no false positives to wade through, thanks to the excellent elimination of thousands and thousands of unrelated abstracts.

2. Enlarge quality of results: Smart filtering possibilities (classification, journal, year, etc.) Expert comments from the Editors' Selections over the years will be included.

3. Easy navigation: Users will be able to retrieve information in as much ways as possible, making navigation easier than in a printed journal.

Users (e.g., members of the participating glaucoma societies) will have personalized tools to enhance the IGR online experience. Because of the superior quality of the database there is a huge interest and we expect a large number of visits.

This is a milestone in the history of IGR. It will be unique among journals. We expect readers to experience great benefit from the IGR database.

Science

So what is science?: the joy of the inquisitive and intelligent mind to answer a question in a responsible and repeatable way. Responsible means both in a 'detailed' way - impartial whatever the outcome - uninfluencing, non-manipulating, paying due homage to preceding investigators, as well as using appropriate design, statistics, presentation, discussion and conclusion.

Science is the joy of finding out. The joy of moving forward. The joy of slowly and steadily becoming a little less ignorant. Yes, knowledge - the results of science - is an essential aspect of human development. The quest for knowledge is an irresistible drive in some humans. The true scientist is driven by this longing to know, which in time may result in the possibility to improve the conditions of humanity.

Primum non nocere

The first guideline for the doctor is, according to our colleague Hippocrates, 'do no harm'. In order to avoid harm you must know. We can only know through appropriate studies. Such studies allow the demystification of our profession. It follows that not only it is our duty to do the studies and to report them, but also to independently review them. In this sense the IGR fulfils an essential Hippocratesian requirement. It does not end with reviews and with confirmation. A consequent duty is to agree on the results and make the agreement-consensus available. Lastly we have to disseminate and see that they are implemented in the daily management of a patient. The reader will immediately grasp that the chain from question to implementation may harbor many weaknesses which can disfigure the system.

Some of my wishes for glaucoma

Prevention including lifestyle improvement;
Comparison to other diseases of the impact on quality of life of glaucoma damage and treatment;
Screening for glaucomatous damage at a high specificity, high impact level and thus at acceptable cost level;
Diagnosis based a.o. on in vivo observation of diseased (not yet dead) cells;
Adaptable/flexible fibrosis inhibition with limited side effects;
Treatment based on implantation of a drainage device that includes continuously monitoring of IOP and a consequent automatic regulation of outflow. The doctor after implantation needs only to set the required IOP level.

Last but not least

This introduction opens with 'ADIEU' which every francophil knows means 'to God'. If we replace the word God by a metaphysical state of being, then this wish uttered while parting is the very best we can give to a fellow human being. This is not the place to explain the above; you will hear from me later in this life. Let me now confine my self to citing Schelling (1775-1854), one of the most interesting philosophers of our times: 'It is the universal spirit of nature that gradually structures raw matter. From bits of moss, in which hardly any trace of organization is visible, to the most noble form, which seems to have broken the chains of matter, one and the same drive governs. This drive operates according to one and the same ideal of purposiveness and presses forward into infinity to express one and the same archetype, namely, the pure form of our consciousness.'

Erik L. Greve

Issue 8-4

Table of Contents Editor's Selection