Preface
This is the fourth glaucoma consensus held under the auspices of the
AIGS, now renamed as the World Glaucoma Association (WGA). We anticipate
that the discussion and conclusions from this consensus will have broad
impact, as the relationship between IOP and the disease is fundamental
to the care of glaucoma patients worldwide. As with the previous
consensus meetings on Glaucoma Diagnosis, Open-Angle Glaucoma Surgery
and Angle-Closure Glaucoma, this consensus report was developed over
several months in an interactive internet system. The Consensus faculty,
consisting of leading authorities on various aspects of IOP from
throughout the world, has met in Fort Lauderdale on May 5, 2007 to
discuss the reports and refine the consensus points.
In the 1980s, health policy researchers from outside ophthalmology
challenged the most closely-held beliefs in our field. They pointed out
that an objective review of the extant literature provided little
evidence that IOP bore a strong risk relationship to glaucoma, and
furthermore that there was even less evidence that lowering IOP was of
any benefit in the treatment of the disease. Ophthalmology responded
with over two decades of groundbreaking clinical and basic research.
Multi-center clinical trials like the AGIS, OHTS, EMGT and CNTGS leave
no doubt that IOP is a primary risk factor for the disease and that
lowering IOP is beneficial in a majority of our patients. Basic
research, in particular animal models of elevated IOP and glaucomatous
damage, form another intellectual cornerstone establishing the
relationship of IOP to the disease.
And yet… over the last decade we have begun to acknowledge that the
relationship of IOP to the disease is not as clear-cut as we like to
believe. Indeed, our ability to even measure IOP accurately has come
into question, with the recognition that central corneal thickness
significantly affects tonometry. What should we be measuring? Random IOP?
IOP fluctuation? Nocturnal IOP? How should IOP be studied in clinical
trials? How should clinicians use IOP in the care of individual
patients?
Obtaining consensus on how IOP should be measured and used in the
care of patients and in performing clinical research is a daunting task.
As with the previous AIGS consensuses, the IOP 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 understand the role of IOP in glaucoma.
We hope that this consensus will serve as a benchmark of our
understanding in 2007, and that it will be revised and improved with the
emergence of new evidence.
James D. Brandt
Ted Garway-Heath
Makato Araie
Robert N. Weinreb
See also:
International
Glaucoma Review
World Glaucoma
Association
Foreword
Intraocular Pressure is the subject for the fourth Consensus report
published under the auspices of the AIGS, now renamed as the World
Glaucoma Association (WGA). It seems like yesterday (November, 2003)
that the inaugural AIGS Consensus meeting was held in San Diego to
discuss Glaucoma Diagnosis. Since then we have had annual consensus
reports on Open Angle Glaucoma Surgery and Angle Closure and Angle
Closure Glaucoma. Each of them has been preceded by several months of
active participation in our Project Forum E-Room (beginning in January,
2007 for the IOP Consensus) by expert members of the various consensus
committees. As done with prior reports, the preliminary document was
circulated to each of the member societies of the WGA, and additional
comments were solicited for the document. Each member Society also was
invited to send a representative to attend the consensus meeting that
was held in Fort Lauderdale, Florida on May 5, 2007. The report then was
discussed extensively during the Consensus Meeting and Consensus
Statements were revised following these discussions.
Intraocular Pressure is a topic that touches the essence of our
subspecialty. Its measurement is a vital aspect of glaucoma diagnosis
and treatment. For now, it is the only modifiable risk factor.
Measurement of IOP is a relatively recent – one century – addition to
our diagnostic armamentarium. Even though the measurement of IOP is
relatively simple, it is by no means uncomplicated. The greatest
limitation is probably the paucity of measurements that are obtained in
practice. Although continuous IOP measurement is on the horizon, it
still is not ready for clinical practice.
Arriving at a consensus often can be circuitous and filled with
compromises. However, this opportunity is used to critically assess the
evidence and develop consensus points. The reader will find this
consensus report instructive, practical, and thought-provoking.
Moreover, it has great potential to impact patients, both individually
and collectively, through both their care and research.
Robert N. Weinreb
Erik L. Greve
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