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The WGA Glaucoma Consensus
Robert N. Weinreb
The World Glaucoma Congress offered a timely venue for the communication to the glaucoma community of the most recent Consensus Report on Intraocular Pressure. In addition to the presentation of the highlights of this report, there was updating of the first Consensus Report on Glaucoma Diagnosis from 2003, overviews with presentations of consensus points from the Open Angle Glaucoma Surgery (2005) and Angle Closure and Angle-Closure Glaucoma (2006) Consensus Reports, and a meeting of Glaucoma Consensus promulgation with representatives from member societies.
The Glaucoma Consensus Initiative of the World Glaucoma Association is based on an assumption that groups make better decisions than even their smartest member. Although the opinions of individuals within a group often are imperfect, more often the collective group intelligence is excellent. So, if one assembles a sufficiently large and sufficiently diverse group of glaucoma specialists and scientists, their recommendations and insights are likely to be superior to those of a single clinician.
More than ever, seismic and affordable changes in technology and communications have made possible global glaucoma collaboration. The skill, ingenuity and intelligence of numerous and diverse practitioners and scientists can be harnessed more efficiently and effectively than ever possible before. One only needs a computer and a network connection to participate and to be a part of the dialogue. Mass collaboration across geographic borders, cultures and professional backgrounds is now both economical and enjoyable.
There is immediacy in our ability to learn from each other by sharing, adapting and updating new information, and agreeing on the significance of the information. Linking networks of glaucoma specialists has tangible, ongoing important implications for glaucoma research, glaucoma clinical care and glaucoma education on a global basis. These changes present far-reaching opportunities for every person who gets connected. Moreover, those who actively engage and contribute to the dialogue be cut off from the network and will become more isolated.
Highlights of the Intraocular Pressure Consensus Report
The publication of the full IOP Consensus Report and consensus points
(Kugler
Publications, The Hague, The Netherlands; Weinreb RN, Brandt JD, Garway-Heath
D, and Medeiros F (eds)) was timed to coincide with the World Glaucoma
Congress in Singapore. The report is divided into six sections: 1. Basic
science of intraocular pressure (Ernst Tamm, Carol Toris, Jonathan Crowston,
et al.); 2. Measurement of intraocular pressure (Ted Garway-Heath,
Aachal Kotecha, Fabian Lerner, et al.); 3. IOP as a risk factor for
glaucoma development and progression (Felipe Medeiros, James Brandt, John
Liu, et al.); 4. Epidemiology of intraocular pressure (Anne Coleman,
Louis Pasquale, Christopher Girkin, Rupert Bourne, Aiko Iwase); 5. Clinical
trials and intraocular pressure (Felipe Medeiros, Ravi Thomas, Steven Mansberger,
et al.); 6. Target IOP in clinical practice (Henry Jampel).
The
report is comprehensive and provides an overview of all aspects of IOP.
Some interesting, and sometimes controversial, points that are addressed
and that particularly are worthy of note include:
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The uveoscleral outflow pathway contributes in a major way to total outflow.
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Goldmann applanation tonometry (GAT) is still the gold standard, however its position is being reassessed. Although unproven, several new tonometers offer the potential for more accurate IOP readings. To optimize GAT measurements, routine assessment of calibration is recommended.
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There is strong evidence to support higher mean IOP as a significant risk factor for the development and the progression of glaucoma. However, there is insufficient evidence to support 24-hour IOP fluctuation or IOP variation over periods longer than 24 hours as a risk factor for either development or progression.
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Clinical trials comparing IOP-lowering efficacy of different treatments should provide 95% confidence intervals for the difference in IOP reduction.
Detailed information on the Consensus books can be obtained from Kugler Publications, The Hague, The Netherlands, or by clicking here