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Top-Ten of the European Glaucoma Society/European Society of Cataract & Refractive Surgeons Glaucoma Day*
October 4, 2013, Amsterdam, The Netherlands
Ingeborg Stalmans
- Glaucoma burden. Although treating glaucoma according to simulation models seems to be cost-effective compared to 'no treatment', there is uncertainty whether to treat none, some or all patients with ocular hypertension. The economic evaluations suggest no clear benefit from intensive monitoring. Biannual intraocular pressure (IOP) monitoring for untreated or stable treated ocular hypertension is suggested. The optimal frequency of visual field and optic disc evaluation remains uncertain (A. Tuulonen, Tampere, Finland)
- Risk factors. IOP is the main risk factor for the onset and progression of open-angle glaucoma. Assess IOP during the day, adequately control IOP during the follow-up and look for a further decrease of IOP if glaucoma is progressing. (S. Miglior, Basiglio, Italy)
- Translaminar pressure. As anatomical fact, the orbital cerebrospinal fluid pressure is the physiological counter-pressure against the intraocular pressure in the region of the optic nerve head and is thus part of the trans-lamina cribrosa pressure difference. Speculation is, whether the orbital cerebrospinal fluid pressure may, or may not, play a role in the pathophysiology of pressurerelated optic nerve head diseases including glaucomatous optic neuropathy. (J. Jonas, Mannheim, Germany)
- A challenge to the IOP concept. IOP is not a static number (instead, it tends to fluctuate throughout the 24 hours). Mean lOP is a strong predictor of glaucomatous damage: therefore a desired therapeutic target is a uniform reduction of IOP throughout the 24 hours (L. Quaranta, Brescia, Italy)
- Medical treatment: preservatives. The continued use of glaucoma drugs containing preservatives, especially Benzalkonium chloride (BAK), can lead to toxic effects on the ocular surface and ocular inflammation. Consider preservative-free topical medication in patients with ocular surface disease, patients with multiple eye drops or younger patients with a long life expectancy and therefore a long duration of the therapy. (F. Meier-Gibbons, Rapperswil, Switzerland)
- Medical treatment: generic products. Generic drugs for glaucoma contain the same quantity of active compound as in the brand drug, but inactive ingredients may differ and no pharmacological or clinical studies are required for their use. In consequence, efficacy is usually identical, but tolerance may be reduced with generics. (J.-P. Nordmann, Paris, France)
- Medical treatment: (non-)adherence. Non-adherent patients have a lower knowledge level and a more negative attitude towards glaucoma and its treatment. However, there is no proof that an improvement of knowledge on glaucoma will also improve adherence. Improving knowledge is probably most beneficial for new glaucoma patients and patients who are motivated to be adherent. (H. Beckers, Eysden, The Netherlands)
- Laser surgeries. (1) Selective laser trabeculoplasty is at least as effective as Argon laser trabeculoplasty , and as primary treatment reduces IOP similar to prostaglandin analogues. Higher pre-laser IOP is predictive of greater IOP lowering, but with longer follow-up the effect of laser trabeculoplasty decreases. (B. Cvenkel, Ljubljana, Slovenia)
- Incisional glaucoma surgeries. (1) Even though far from perfect, trabeculectomy is still the surgery by which and to which all drainage devices or cyclodestructive procedures are compared. Various technical innovations (releasable sutures, anti-scarring agents - mitomycin C, anti-VEGF, non-penetrating techniques,) may help the surgeon to improve efficacy and/or safety outcomes of glaucoma filtering surgery. (Ph. Denis, Lyon, France)
- New glaucoma devices are neither minimally invasive, and they may not be very effective. There is great potential with paucity of evidence. (T. Shaarawy, Geneva, Switzerland )
