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Editorial IGR 5-2
Dear Reader,
Classification
One of the unique aspects of IGR is its classification. To our knowledge, no other literature classification system uses this degree of refinement. Due to new developments, particularly with regard to laboratory techniques, revision of some parts of the classification has become necessary. Minor changes have been made to Classifications 1 (population genetics, prevention and screening moved from 7), and 2 (meshwork, aqueous humor dynamics); Classification 3 (laboratory methods) has been completely updated; Classification 4 has been deleted; and Classification 7 moved to 1. We expect these changes to further improve the search for specific abstracts. Click here to see the list of classifications.
Proqualiex and Pigs
This almost sounds like a fairy tale about a magician and his animals (or veterinary
medicine). However, there is nothing magical about these names. Proqualiex stands
for the management of glaucoma, based on rate of PROgression, QUAlity of LIfe, and
LIfe EXpectancy. This management approach is the only one with an NNT of ONE, because
longitudinal follow-up has its own reference standard. Proqualiex is the management
approach for the near future when it will be easy to measure rate of progression
in practice, and when it has become clear at which level and by what type of damage
(functional or structural) Quality of Life is reduced.
PIGS stands for Progression In Glaucoma Scholars (or Science). It is well known
that there is no uniform definition for progression, nor is the relationship between
the different methods of measuring progression clear. A group of experts, headed
by Douglas Anderson of Miami, will meet after this issue of IGR is in print in an
attempt to define progression (rate of) and/or to indicate what research is needed
to improve our knowledge of progression. The outcome of this initiative is of essential
importance to the management of glaucoma.
RCTs again
Quite a few authors have explained the (relative) value of RCTs in the management of glaucoma. In previous issues, IGR has directed attention to this subject. RCTs were also reviewed in the recent second edition of the EGS Guidelines for Diagnosis and Treatment. A short note on an editorial by Lichter (AJO) on RCTs is included in this issue. A recommended balanced view. No doubt we are much better off now that we have definite proof that the treatment of glaucoma works. This does not necessary mean that every ocular hypertension or even every glaucoma patient needs treatment. On top of evidence-based medicine, there is also common-sense-based medicine.
Target pressure
A hot topic of the last ten years, and a much debated one. Target pressure becomes
relevant only after the decision to treat has been made. And even target pressure
should be seen against the
background of the Quality of Life of a patient, as pointed out by Vernon in
this issue.
Persistency
As doctors, we assume that when we prescribe a drug to a patient, he will take this drug as prescribed (compliance) and will also continue to do so (persistence). We may have learned that compliance is not always what it is supposed to be. We have never, or have hardly ever, heard of patients who may not take their prescribed drugs and may not even return to their doctor. On the GIM (Glaucoma Industry Member)page, persistency is discussed based on three abstracts included in this issue. The reader's attention is particularly directed to the fact that persistency may by no means be as good as it should be. We probably should include that in our management decisions.
Neckties
Our habits of ceremonial dressing are seriously threatened by a paper which concludes that neckties increase IOP. What about our dress code: 'Business' will increase IOP, 'Business Casual' will not. What is more important, dress or IOP? After all the dress we enjoy now (if so). More about this in the Editor's Selection.
Editor's Selection
The Editor's Selection is a real treat. Comments range from the glutamate effects of the expression of neurotrophin to the cost of eye drops. In between, there is death and glaucoma (no, not Death in Venice), brain and glaucoma (that is, the brain of the glaucoma patient, not of the doctor!), cytoskeleton drugs, MMPs (Mediocre Military Police/Male Members of Parliament), agreement on progression (see PIGS), multifocal VEP, nonperforators and setons, and much more. A delight to see that glaucoma research is so alive.
WGA
WGA is going full speed
ahead. It has three new member societies: SEAGIG, OGS and ISGS. Details on these
new Societies can be found on here
Welcome!
Preparations for the First Global WGA Consensus Meeting on Structure and Function
in the Management of Glaucoma are progressing on schedule. A new discussion preparation
system, e-Room, is being used. It is expected that, by the time the actual meeting
takes place (November 13th and 14th), all the finesses of the Consensus will have
been ironed out. What a challenge that will be. The Consensus will be published
and distributed among WGA members, and probably on a much wider scale as well.
WGA has brought out its Code of Practice (see
www.GlobalAIGS.org), which was based on
the EGS Code of Practice and approved by all member Glaucoma Societies.
The Guidelines for Reporting and Publishing and for the Conduct of Glaucoma Meetings
are expected to be finalized at the Information and Planning Exchange Meeting on
Sunday, November 16th, 2003. More about plans for WGA meetings in the next issue.
Criteria for the organization of Glaucoma Societies have also been established.
Erik L. Greve
