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Top-Five of the Nordic Glaucoma Meeting
Malmö, Sweden, September 18–19, 2015

Gauti Jóhannesson and Miriam Kolko, Malmö, Sweden

1. Preliminary results from ‘The Bergen Angle Closure Study’
   The presentation covered the preliminary results from ‘The Bergen Angle Closure Study’. The study is first of all to document the prevalence of primary angle-closure suspects (PACS), primary angle closure (PAC) and primary angle-closure glaucoma (PACG) in a population of western Norwegian descent (Caucasians). More than 4000 randomly selected persons older than 40 years of age will be screened, while those with narrow anterior chamber angles will undergo further investigations. So far, 1000 persons have been examined with a 60% response rate. Among them eight PACG, 12 PAC and 27 PACS have been identified. Even though the results are preliminary, the incidence of primary angle-closure glaucoma seems to be far more common than anticipated until now. (J. Askvik, Norway)
2. How can we improve glaucoma care?
   The presentation highlighted the challenges of glaucoma care in Europe as summarized at the Closed Meeting of the European Glaucoma Society in June 2015. As many health systems are on the verge of insolvency, there is a need to find ways to do more with less money. As all impacts (good and bad) ‒ including costs in health care ‒ arise from decisions made by ophthalmologists, changes such as the following are needed: (1) Make strategic choices (provide citizens/ patients with only the care they need, not trying to aim to serve everything to everybody); (2) Prioritize most resources to prevent permanent visual disability by segmenting the patients’ risk; (3) Produce high-volume, good-enough quality and low-cost services by standardizing ‘usual’ (non-urgent) care; and (4) Produce services efficiently, e.g., by implementing virtual clinics/telemedicine. In conclusion, ‘we cannot solve our problems with the same thinking we used when created them’ (Albert Einstein). Therefore, we need radical and significant changes in our thinking and behavior by starting with a belief that more is possible with less money. (A. Tuulonen, Finland)
3. Risks for glaucoma caused visual impairment
   The presented study identified risk factors for glaucoma. Higher IOP and worse visual field status at baseline were important risk factors for glaucoma-induced visual impairment. Older age at death was another important risk factor for glaucoma blindness, a fact that might make it particularly relevant to include patient’s life expectancy, when calculating the individual risk of blindness. Visual field defects near the point of fixation (often called ‘threat to fixation’) did not add any significant risk when the stage of visual field loss was taken into account. (D. Peters, Sweden)
4. Glaucoma-induced visual loss in Iceland
   The presentation summarized the incidence of blindness caused by glaucoma in Iceland. In the 1950s, glaucoma caused more than half of all blindness in Iceland, which meant that at that time the country had a higher prevalence of glaucoma blindness than any other European country. As a result of increased awareness, preventive measures and new treatments, glaucoma now accounts for only 4% of blindness according to the Icelandic Organization of the Visually Impaired. (E. Gunnlaugsdóttir, Iceland)
5. Glaucoma-caused visual impairment in Finland 1983-2013/Prevalence, incidence, choice of treatment—a Danish nationwide study
   The comprehensive population registers in Finland and Denmark were used to obtain data on the burden of glaucoma in each of the countries. Similar results were obtained in the independent registers. Hence, the number of patients treated for glaucoma was 83.675 (approx. 1.5% of the population) in Finland and 95.643 (approx. 1.7% of the population) in Denmark, numbers that are very similar. In both countries the number of patients treated for glaucoma has doubled since the 1990s. Based on the Finnish Registry of Visual Impairment (VI) the mean age of VI registration has deferred by 5,1 years during the past 30 years. Despite this favorable development, VI is estimated to increase due the increased number of glaucoma patients from 83.675 in 2012 to 120.000 in 2040. Eighty-plus-years-old glaucoma patients will increase by 135% in Finland. Over all, numbers from Finland and Denmark showed a similar pattern and future studies should compare registers in the Nordic countries. (H. Uusitalo, Finland and M. Kolko, Denmark)

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