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Editorial IGR 2-2
Dear Reader,
The last issue of IGR (2-1) appeared on the occasion of the 20th anniversary of the EGS, the VIth congress and millennium meeting. The meeting surpassed all expectations with close to 1500 participants, a new format, intensive audience participation through interactive questions and answers and, last but not least, beautiful weather in London (most of the time). The reader will find point-wise summaries and more about EGS 2000 in this issue.
In a closed discussion group, it was realized how little we know about the benefits of early treatment. Although many glaucomatologists seem to expect it to be beneficial, there is no evidence for this, and we may even wonder whether it will always be in terms of quality of life (see also, note on early diagnosis and quality of life on page 21). And then, what is early glaucoma? How should it be defined? Loss of more nerve fibers than the age-related loss? Early progression? We still do not know.
In an editorial in Eye, Hitchings predicted that we will be diagnosing glaucoma from 'measurement data'. "Glaucoma will be seen as an acquired deformity of the optic disc of characteristic appearance with EITHER sector measurements that fall outside the normal range OR evidence of progressive sectorial change. These changes of the optic disc may be associated with evidence for visual loss or elevated IOP." How early will that be? How many nerve fibers lost?
Teleglaucoma may very well be an important addition to our management of glaucoma. In the Editor's selection, two papers relating to this subject are discussed, and a review is mentioned under Your special attention for.
The debate on selective loss of ganglion cells continues. As yet, there seems to be no winner in this magno versus parvo match. This is also handled in the Editor's selection. As is everything you ever wanted to know about splinter hemorrhages. Everything? Do we know how they originate? Are they proof of primary vascular disease? Bruce Shields commented on this in an editorial in the American Journal of Ophthalmology and also in the present Editor's selection.
A Danish survey in ophthalmologists showed that almost all (93%) of the glaucoma patients received treatment. Forty-two percent were on combination therapy and, of these, 80% were receiving three or more drugs. One has to wonder about effectiveness and compliance.
If you lose your eyelashes due to a drug-induced allergic reaction, do not despair. Latanoprost may bring them back rapidly (at least, this was demonstrated in one case report).
All this and much more illustrates the tremendous activity that goes on in glaucoma research and debate.
Apart from the Editor's selection by Bruce Shields - that pearl of the IGR- the reader will find several reports (JGS, SAGS, Polish Glaucoma Society, EGS), almost all in the new IGR format which was introduced in issue 2-1: point-wise summaries or Top 10.
Enjoy your reading,
Erik Greve
