This Issue of Acta (2002)

Review articles summarise new and old knowledge helping us to understand on-going development and to deliver modern care. When starting as chief editor of this journal I expressed in an editorial as one of my goals for the journal, to publish at least one review article in every issue. In the current edition of Acta we are fortunate in being able to publish no less than three such articles. The first review article by Cordain deals with the development of juvenile onset myopia. The fascinating paper shows that when the human visual system is examined from an evolutionary perspective, it becomes apparent that humans living as hunter-gatherers rarely develop myopia. Myopia can be a life-style disease developing when environmental conditions of modern civilisation are introduced. Insulin resistance may play a key role in the pathogenesis via interactions with hormonal regulation of vitreal chamber growth. So excessive reading may not be the only factor explaining the rapid increase of myopia prevalence in developing societies. Seregard and Algvere present a review on age-related maculopathy. Our knowledge of the subject has increased considerably during the last few years, and the authors have based their article mainly on results from a literature search of recently published papers, many of which deal with pathogenetic factors, e.g. oxidative damage and lipofucsin, and on defence mechanisms. The review includes modern data on epidemiology and risk factors, and a short update on the treatment modalities that are now under investigation. Cyclodextrins in eye drop formulations is the subject of the third review article authored by Loftsson and Stefánsson. We are now seeing the start of a development when cyclodextrins are being used to improve topical drug delivery for eye diseases. In the future these substances can facilitate the usage of many substances that might otherwise not be available for topical use. This issue of Acta also contains a historical article. Tarkkanen and Kivelä tell the story of the discovery of the exfoliation syndrome by a young Finnish ophthalmology resident John G. Lindberg; the cover of this issue of the journal shows his portrait. The exfoliation syndrome was first described in Lindberg's thesis, presented at the University of Helsinki in 1917. The enticing story tells that others wanted to take the credit for his discovery. Today Lindberg's discovery is clearly recognised. The international research society on the exfoliation syndrome is named after him, and his name is one of the greatest in Nordic ophthalmic history. Among the original articles, Kreyberg and co-workers present a large multicentre trial comparing fucidic acid and chloramphenicol eye drops for the treatment of acute neonatal conjunctivitis. Both substances give identical and good results. The uveal effusion syndrome is an unusual condition, often diagnostically challenging. In a large case series Fledelius and coworkers demonstrate that ultrasonic B-scan imaging may be of great help. Today children with leukemia are often cured with bone marrow transplantation after total body irradiation. Holmström reports that the great majority of treated children develop cataract. Bone marrow transplanted children need regular eye examinations to prevent permanent visual impairment. Nitric oxide (NO) is much mentioned in discussions on the pathogenesis of glaucoma today. Kotikoski and coworkerscompared the amount of NO metabolites in aqueous humour and serum of glaucoma patients and controls undergoing cataract surgery. The mean levels did not differ between groups, but lower values tended to occur in more severe cases of glaucoma, while levels were increased in the aqueous humour of eyes with pseudoexfoliation. Syrdalen and coworkers report present vitrectomy results with clear clinical implications, a study of patients with Terson's syndrome. Tsilou and coworkers discuss the diagnostic features of Usher syndrome. The editorial of this issue deals with publication bias, and makes the statement that Acta Ophthalmologica will help fight such bias, by inviting and publish well performed trials even if these show negative results, and especially if the results challenge previous concepts and ‘established truths’. There are four such papers in this issue. I comment on them in the editorial; their negative results are all of clinical importance. Thus, Marchini and coworkers show that the Ocuton S home tonometer gives readings that are consistently higher than those of the Goldmann tonometer. Ohlsson and coworkers demonstrate that the Lang II stereo card gives poor results if used for screening for strabismus and amblyopia. Friström shows in a long-term study that colour contrast sensitivity testing could not predict those patients with ocular hypertension who later developed glaucomatous field loss, nor did the test outperform modern standard perimetry. In a large double masked study of glaucoma patients Bergstrand and coworkers found no changes in ocular retrobulbar or retinal blood flow with topical dorzolamide.