Foreword
This is the third Consensus Book published under the
auspices of AIGS. As with prior consensus reports, this one has great
potential to impact patients, both individually and collectively.
Reports for this consensus were prepared and discussed using the same
internet based e-Room system as used with the previous two reports. The
Consensus Faculty consisted of the leading authorities in Angle Closure,
with representatives from six continents. These 110 experts dedicated
their knowledge, time, and insight to the preparation of the reports
between January 1 and May 1, 2006. Prior to the meeting, each of the
AIGS member Glaucoma Societies was sent a draft of the consensus report
for comment. Each member Society also was invited to send a
representative to attend the consensus meeting. The report then was
discussed extensively during the Consensus Meeting that was held in
Hollywood, Florida on May 3, 2006. Reports and Consensus Statements were
revised following these discussions.
Consensus is based on the published literature and
expert experience. While one strives to practice evidence-based
medicine, many aspects in ophthalmologic practice have not been subject,
or are not amenable, to long-term prospective randomized controlled
trials. Though expert consensus is not a surrogate for rigorous
scientific investigation, it does have value, in particular, where the
appropriate evidence is lacking. Generating consensus inexpert opinion
for Angle Closure therefore aims to derive the most appropriate
management for our patients and will highlight areas where further
research is required.
Robert N. Weinreb, Consensus Chair, AIGS
Erik L. Greve, Executive Vice President, AIGS
"But if you can assemble a diverse group of people
who possess varying degrees
of knowledge and insight, you’re better off entrusting it with major
decisions rather
than leaving them in the hands of one or two people, no matter how smart
those
people are."
James Surowiecki, The Wisdom of Crowds, 2004
See also:
International
Glaucoma Review
Association of
International Glaucoma Societies
Preface
This is the third glaucoma consensus held under the
auspices of the AIGS. It is anticipated that the discussions and
conclusions from this consensus will impact care of patients with Angle
Closure and Angle Closure Glaucoma significantly. As with the previous
consensus meetings on Glaucoma Diagnosis and Open Angle Glaucoma
Surgery, the consensus reports were developed over several months in an
interactive internet system. The Consensus faculty, consisting of
leading authorities on Angle Closure from throughout the world, met in
Fort Lauderdale on May 3, 2006 to discuss the reports and refine the
consensus points.
Primary Angle-Closure Glaucoma is a leading cause of
blindness throughout Asia, and may be more common in European-derived
populations than previously recognized. Even though Open-Angle Glaucoma
is more common than primary Angle Closure Glaucoma, it has been
estimated that nearly half of all glaucoma blindness is due to Angle
Closure Glaucoma because it tends to be more severe. Further, an aging
population should increase the number of individuals affected by Angle
Closure Glaucoma. Clearly, strategies need to be articulated to face
this challenge.
There has been an explosion of research on Angle Closure
and Angle Closure Glaucoma during the past two decades. Ultrasound
biomicroscopy provided information about the angle that had been hidden
from an observer using only a conventional slit lamp. This had lead to
changes in our understanding about the mechanisms of disease as well as
our approaches to disease management. Even the basic terminology used to
discuss Angle Closure and Angle Closure Glaucoma has changed. Newer
instruments, such as anterior segment OCT, now offer the promise of even
more detailed assessment of the anterior chamber angle. Nevertheless,
our current management of patients with Angle Closure Glaucoma remains
similar to what it was decades ago, starting with iridotomy and
performing additional surgeries as needed.
Trying to determine best practices for Angle Closure and
Angle Closure Glaucoma with the rapidly growing literature on the topic
is daunting. As with the previous two AIGS consensuses, the Angle
Closure Consensus is based on the published literature and expert
experience. Although consensus does not replace and is not a surrogate
for scientific investigation, it does provide considerable value, in
particular, when the desired evidence is lacking. The goal of this
consensus was to establish what we ‘know’ and what we need to ‘know’ to
better elucidate the mechanisms, and optimal screening and treatment
strategies for angle closure. It is expected that this consensus report
will serve as a benchmark for our current understanding, and that it
will be revised and improved with the emergence of new evidence.
David S. Friedman
Paul Foster
Tin Aung
Robert N. Weinreb
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