This issue of Acta (2004)

With this August issue the journal returns to its conventional format, after the preceding issue where the XXXVI Nordic Ophthalmological Congress played such an important role. The Acta Honorary Lecture, delivered at nok36, is published in the current issue. The lecture was given by Professor Leila Laatikainen of Helsinki, the recipient of the Acta Award and gold medal. ‘The fluorescein angiography revolution: a breakthrough with sustained impact’ is a delightfully interesting review of the subject, which includes a historical perspective and a long list of references. This article is highly recommended to all our readers. The guest editorial by Anja Tuulonen was inspired by the study by de Natale and coworkers on the costs of glaucoma medication after the introduction of prostaglandin medications. This study shows that, in the study area in Italy, the number of patients receiving glaucoma medication almost doubled during the study period from 1997 to 2002. Further, the cost of medication per treated patient went up by almost 150%. For health care providers, these are alarming figures. In her editorial, Tuulonen uses the results reported by de Natale et al. and glaucoma as starting points for a most thought-provoking discussion on the potential problems associated with over-treatment and over-diagnosis. There are seven more articles on glaucoma in this issue. Two papers by Ritland et al. from Norway report results from retrospective studies on mortality in exfoliative and primary open-angle glaucoma (POAG). Mortality rates were the same in both types of glaucoma. A surprising finding was that patients with more recent birth dates had lower survival rates than older patients. The results also suggest that acetazolamide usage is associated with reduced survival. Acute cerebrovascular disease and chronic cerebral disease (e.g. dementia) were more common in exfoliative glaucoma than in POAG. A common fad today, but one that has only weak scientific support, is to emphasize the importance of variations in intraocular pressure (IOP) in patients with glaucoma. It is not uncommon to hear that measuring IOP in the office is not enough, followed by the information that home tonometry has revealed that patients have ‘real’ primary open-angle glaucoma rather than the normal tension glaucoma diagnosed in the clinic. The results on self-tonometry presented in the current issue by Sacu et al. are particularly interesting against this background. The differences between the two methods were relatively large, and only every second patient succeeded in obtaining reliable self-readings even after repeated measurements. There are two papers on methods of glaucoma diagnostics in this issue. Hougaard et al. describe a new interpretation concept for optical coherence tomography (OCT) images in glaucoma. The new method, the nerve fibre layer symmetry test (NST) compares retinal nerve fibre layer thicknesses in the upper and lower retinal halves. This is analogous to the highly successful glaucoma hemifield test (GHT), which has been used for the interpretation of perimetric results for almost 15 years. The results of the NST were very good, but need to be confirmed by larger studies. The sensitivity and specificity of scanning laser polarimetry have been studied by Costa and coworkers. Refractive error was found to influence the sensitivity of the method, which was unaffected by average disc size, age and gender. Huber et al. describe the correlation between colour Doppler measurements of retrobulbar flow and arteriovenous passage time (AVP) measured by fluorescein angiography in patients with normal tension glaucoma (NTG) and in normal controls. Arteriovenous passage time was prolonged in NTG, and was correlated to end-diastolic velocity and resistive index in the central retinal artery. Akarus and coworkers describe significant differences in visual field results in smokers as compared to non-smokers. The main difference involved lower differential light sensitivities in the smokers. Visual field indices were more similar between groups, as were the numbers of significantly depressed points. Is smoking a previously overlooked reason for diffuse visual field loss? This could be due to increased cataract formation in smokers (previously documented), although the authors of the current study did not see any difference in media transparency or yellowing between the two groups in their study. In an interesting study conducted in Italy, Tagarelli and coworkers distributed questionnaires about everyday tasks and work, including car driving, to 151 subjects with defective colour vision and 302 controls. The colour-blind subjects experienced difficulties with many colour-related tasks, occupational as well as others. In comparison with the control group, the colour-blind group preferred to drive during the day and also drove less than the controls. Hove et al. studied the prevalence of retinopathy in an unselected population of patients with type 2 diabetes in Århus. The prevalence was lower than expected from the literature, but a substantial number of subjects with vision-threatening maculopathy had not been referred for timely laser treatment. In another study from Århus, Helgesen and coworkers recommend preoperative evaluation of pupil size in all patients in whom LASIK surgery is considered. In their paper, larger pupil size is associated with an increased frequency of subjective visual disturbances. Evanger and coworkers present results on refractive changes caused by hyperbaric oxygen therapy. The myopic shift induced by the oxygen treatment disappears within 10 weeks. The magnitude of the refractive change was found to depend on the mode of oxygen administration. The Diagnosis/Therapy in Ophthalmology section documents a patient with complete contraction of the anterior lens capsule after cataract surgery. In a case series from Gothenburg, Rudolph and coworkers report results of rDNA polymerase chain reaction analysis of corneal scrapings in four patients with severe infectious keratitis. With this technique the authors were able to identify a pathogenetic organism in each case. In the future this technique may come to supplement standard microbiological methods. Very positive results are reported from Japan concerning the case of a seriously chemically injured eye treated by autologous transplantation of limbal epithelial cells. A minimal biopsy was obtained from the non-injured eye, cultured for 3 weeks and then transplanted. Good photographs show a clear cornea and an even and intact epithelium. Bourghardt Peebo and coworkers from Linköping present a report of a relapsing polychondritis, a rare, potentially systemic disease often appearing with non-healing corneal ulcers. Enjoy and learn from this issue of Acta!