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Annual meeting of the French Glaucoma Society
Paris, May 8th, 1999
Alain Béchetoille
The French Glaucoma Society consists of two branches. The 'Comité de Lutte contre le Glaucome' (CLG) aims to enhance public awareness, as well as that of the medical and ophthalmological community, regarding glaucoma and its treatment. The other, the 'Société Francophone du Glaucome' (SFG) aims to support research on glaucoma, particularly among young French-speaking ophthalmologists. The joint annual meeting of these two societies took place on May 8th, 1999, at the Méridien-Montparnasse in Paris.
As is the case each year, SFG had a lengthy program of five-minute (5{x}2 slides) presentations, followed by a general discussion after each paper. Every year, a jury awards the two best presentations. This year, among the 14 presentations, X. Zanlonghi et al. of Nantes and J. Massy et al. of Rouen were the ones to be honored.
Zanlonghi's paper was on quality of life, and dealt with reading strategies used by glaucoma patients. He pointed out that, while reading, the eye follows a sequence of saccades, interrupted by periods of fixation. During fixation, the eye identifies letters and words with its foveolar visual field, whereas information coming from the peripheral visual field is used to program the next saccades. Zanlonghi studied this phenomenon in glaucoma patients using 'le moniteur ophtalmologique', which was programmed for this purpose, and found that the saccade process was very much impaired in glaucoma patients with severe bilateral visual field defects. This specific handicap impairs the use of conventional reading rehabilitation strategies in glaucoma patients, as well as the use of conventional magnifying devices. Zanlonghi concluded by suggesting new reading rehabilitation strategies for these patients.
Massy spoke about non-perforating glaucoma surgery. His study was retrospective, covering 50 primary open-angle glaucoma patients examined 18 months after a deep sclerectomy procedure, without a collagen implant or the addition of a viscoelastic substance. There was a complete rate of success in 81% of the 50 patients, which was defined as an intraocular pressure of 21 mmHg or less, without medication. However, this success rate fell to 50% when the criterium for success was 16 mmHg, without medication. Discussion and comments from Massy, and between Massy and the audience, revolved around the ability of non-perforating surgery to meet the criterium of needed target pressure without medication in the long-term. Everyone agreed on the necessity of setting up long-term prospective studies to compare the safety and efficacy of non-perforating surgery for glaucoma versus standard trabeculectomy.
The CLG program contained updated lectures on gonioscopy, as well as optic disc and visual field evaluations, including FDT. Thereafter, Bron focused on the importance of pachymetry for weighing up the measurements given by conventional Goldmann or air tonometry, in dealing with epidemiology, diagnosis and the eventual treatment of ocular hypertension. His data confirmed that mean central corneal thickness was statistically higher in ocular hypertensive eyes than in normal eyes, raising the point that some readings were falsely elevated, due to the difficulty encountered by tonometers in flattening thick corneas. However, there is a large overlap between the two groups and what is true for populations is somehow difficult to transfer to individuals. At the moment, there are no charts to accurately correct Goldmann tonometry readings to pachymetry readings. Romanet introduced new data from his long-standing research on the relationships between intraocular pressure and sleep. These data confirmed that intraocular pressure is higher at night, during sleep, in primary open-angle glaucoma patients, including those with normal-pressure glaucoma, than was previously thought. These findings have many potential consequences for the diagnosis and treatment of supposed normal-pressure glaucoma patients.
A long session was then devoted to glaucoma surgery, and particularly to non-perforating surgery, which has been performed regularly for some years by many CLG members. Discussions focussed on the long-term results of these procedures. The members also discussed the supposed influence of different techniques on these results, for example, whether or not to go forward to Descemet's membrane, or the use of implants and/or viscoelastic substances and/or antimetabolites. The low rate of complications with non-perforating surgery was confirmed by everyone present. Finally, everyone also agreed on the necessity of setting up well-designed studies to determine whether non-perforating surgery is as safe and efficient in the long run as conventional trabeculectomy. The surgical session continued with lectures on congenital glaucoma surgery, repair of defective blebs, and refractory glaucoma surgery.
The meeting ended with a controversial discussion on how best to treat elevated intraocular pressure in chronic open-angle glaucoma patients, with the choice between medication, lasers and surgery. It was clear that, depending on the individual case, these three choices were more complimentary than exclusive.
