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Editors Selection IGR 12-3

Surgical Treatment: Shortcomings of glaucoma surgical trials

Comment by Tarek Shaarawy on:

25129 Moving the goal posts definitions of success after glaucoma surgery and their effect on reported outcome, Rotchford AP; King AJ, Ophthalmology, 2010; 117: 18-23

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With eloquence, Rotchford and King (527) scientifically proved, in this interesting publication, what all glaucoma specialists 'kind of knew'. That our reporting of glaucoma surgical trials suffers from multiple shortcomings. At the top of the list comes our multiple, inconsistent and, quite honestly, sometimes bizarre definitions of success. The authors concluded: ' over a recent 5-year period, there were nearly as many different definitions of success after glaucoma surgery as publications on the subject. The definition used markedly affected the quoted success rate after trabeculectomy, making interpretation of and comparison between published results extremely difficult.' They also called for standardization of published outcome parameters after glaucoma surgery, so as to allow meaningful comparisons between different study reports. The good news is that that is exactly what the WGA accomplished more than one year ago in publishing the WGA guidelines on design and reporting of glaucoma surgical trials. In fact, this publication was more ambitious than what the authors called for. It did not only tackle the definitions of success, but also made solid recommendations regarding methodological methods, set standards for ethical considerations, called for economic evaluation and suggested appropriate methodology. The guidelines also provided specific statistical guidance for data analysis, and last but not least described how to report on complications. In doing so, the WGA working group of more than sixty international experts and researchers, who included surgeons, statisticians, and health economists, aimed at offering a one package that hopefully would improve the 'quality of life' of the researcher in glaucoma surgery. It is both interesting and encouraging that the solution suggested by the authors for the riddle of how to define and report glaucoma surgical success is exactly the one that the WGA guidelines opted for, namely "to encourage more detailed presentation of the preoperative and postoperative IOP results in tabular or scatterplot format so that any definition can be applied to the data after publication." It is worthy of note that the authors do not quote or reference the WGA guidelines which simply suggests that they have not been aware of its existence. This clearly means that the WGA has to put some effort in advocating and promulgating this valuable document. Having said so, an important step towards this goal has been recently achieved with the:

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