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Staccato Report of the Paris Closed Meeting of the European Glaucoma Society

August 31st - September 1st, 2001, Paris, France

The EGS has two types of meetings: every four years, the major large research and teaching congress open to everyone, and every year a closed, invitation only, small, discussion meeting on selected topics. The Paris Closed Meeting consisted of five scientific sessions and one debate. Each chairman provided three conclusions from his session.

Surgery

Franz Grehn

• Green et al. reported good results on the safety of TGF-b2 antibodies for fibrosis inhibition in primary trabeculectomies. Preliminary IOP data were encouraging. Controls, 25 mmHg reduced to 17.7 mmHg. Treated, 25 mmHg reduced to 13.6 mmHg.

• Rai et al. reported a high incidence of bleb-related infection after MMC.

• Grehn and Marquardt pointed out the advantages of intensified post-filter care using aggressive 5-FU and needling that accounted for one-third of the absolute long-term success rate.

Non-Perforating Surgery of Glaucoma

Alain Béchetoille

• In NPSG, the membrane peeled off from Schlemm's canal floor is composed of juxtacanalicular and external corneoscleral trabeculum.

• NPSG appears to be slightly less effective than standard trabeculectomy in the long term, however, its efficiency increases to a comparable level when using additional therapy, such as peroperative 5-FU implants and/or postoperative goniopuncture.

• NPSG has less early complications and a less frequent cataract rate after four years compared with standard trabeculectomy.

Optic Nerve Imaging I

Roger Hitchings

• The HRT II can be used in population screening.

• Total population studies are needed to establish a normal data set.

• The HRT II appears to be more popular than OCT, LDF, Discam or Topcon.

Optic Nerve Imaging II

Clive Migdal

• The Zeyen group investigated the long-term variability of the HRT. Rim area showed the least variation in this selected group of ocular hypertensives.

• Two papers from the Moorfields group (James Tan and Ted Garway-Heath) looked at glaucomatous change, using the HRT, investigating potential applications, variability, and validity. It was suggested that a triplicate test strategy improved sensitivity, with specificity remaining unchanged. There appeared to be a curvilinear correlation between structure and function (i.e., functional reserve was present).

• Hans Lemij (Rotterdam) presented data from the GDx in approximately 650 cases, and in selected cases showed that progression demonstrated by the GDx matched field deterioration over a period of three years.

• Jost Jonas (Mannheim) evaluated which optic disc morphology factors might predict subsequent change. Significant risk factors were rim area and size of the beta zone, but not disc size or shape.

Miscellaneous

Günther Krieglstein:

• Diestelhorst: Medication with lyophilization as drug carrier improves therapeutic ratio and patient compliance, and is free from preservatives. Refrigeration is unnecessary for currently available medications.

• Gramer: Family history, vasospasms, and migraine had no effect on the natural course of POAG and NTG.

• Michelson: Telematic transmission of self-tonometry values may contribute to diagnostic efficacy in glaucoma management.

• Iester et al.: High resolution perimetry and frequency doubling perimetry test different ganglion cell populations, yet give good agreement in pre-perimetric glaucoma.

• Lütjen-Drecoll: Morphologically, POAG and PEX neuropathy appears to be different. Since there is higher IOP in PEX, some IOP-independent mechanisms may be involved in POAG neuropathy.

• Orgül: Vasospastic syndrome choroidal blood flow does not respond to physical exercise.

Debate

The highlight of the meeting was the debate. A motion was put forward that "We over-treat our glaucoma patients". This motion was defended by Carlo Traverso and John Thygesen, and opposed by Erik Greve and Norbert Pfeiffer. The defense centered around the misdiagnosis of ocular hypertension and early glaucoma, the unbelievably high sales of medication per human glaucoma patient and, of course, side-effects. The opposition, focusing on established glaucoma, presented data on the absence of uniform treatment behavior, on the need for low IOP in advanced glaucoma, and on the practical reality that such low IOP was not achieved. Their contra-motion was that, "We under-treat our established glaucoma patients". Over-treatment of ocular hypertension was seen by the opponents as a problem of over-diagnosis.

The audience offered reasons for both statements and suggested that, in fact, both over-treatment (of ocular hypertensives and early glaucoma) and under-treatment occur. Put to the vote, the motion received the majority of votes, although 'under-treatment' also received firm support.

The truth is possibly more subtle:

• we over-treat early glaucoma and ocular hypertension

• we under-treat advanced glaucoma