Comm Eye Health Vol. 26 No. 81 2013 pp 20. Published online 21 May 2013.

Primary open-angle glaucoma: reader feedback

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Thank you to everyone who commented on our double issue on primary open-angle glaucoma, Comm Eye Health J 2012;25(79&80).

John Sandford-Smith (UK) pointed out both an error and an omission. In ‘Detecting possible glaucoma with only limited equipment‘, the last sentence of section 6 (page 49) reads: ‘Remember. A RAPD is not only caused by a cataract.’ In fact, a cataract in an otherwise healthy eye never causes a RAPD. Apologies both to the authors and our readers for the error, which occurred during editing. The ommission was in the panel about sub-conjunctival 5FU injection, on page 75, where no advice was given about dose strength and volume. In response, the article’s author suggests a dose of 10 mg. If using 5FU at a concentration of 50 mg/ml, the volume injected would be 0.2 ml.

Daniel Laroche (USA) disagreed with the statement that IOP below 21 is ‘normal': ‘There is good evidence that the mean normal IOP is 15 and the mean glaucoma IOP is 18. When I see patients with IOP of 17–19 I look carefully at their nerve fibre layer to ensure there is no early glaucoma.

Finally, Hugh Taylor (Australia) suggested that more emphasis should be placed on the the family history of glaucoma: “A family history of glaucoma will increase the chances of developing glaucoma up to eight times. This has a far bigger impact than any other known risk factor. We have to work hard to make sure that all patients with glaucoma inform their relatives. When we are examining patients in general, we must also specifically ask them about their family history.”

The letters are available in full below.

Dear Editor,

I was very pleased to receive your recent volume of the Journal (Issues 79 & 80: Primary open-angle glaucoma). May I point out an error and also make a suggestion.

The error is on page 49 at the very bottom of section 6, about use of the torch and the relative afferent pupil defect (RAPD) to diagnose glaucoma. The very last sentence says “Remember. A RAPD is not only caused by cataract”. In fact, a cataract in an otherwise healthy eye never causes a RAPD. (The original sentence read ‘… a RAPD is not caused by a cataract alone.’ Apologies both to the authors and our readers for the error, which occurred during the editorial process. Ed)

The suggestion is about sub-conjunctival 5FU injection as described in the panel on page 75. It unfortunately omits to give any advice about dose, strength, volume, etc. and these sorts of things are of great help to people who are isolated and do not have ready access to information. (For a sub-conjunctival 5FU injection, the article’s author suggests a dose of 10mg. Using a bottle of strength 50 mg/ml, this means the volume injected is 0.2 ml. Ed)

Otherwise lots of helpful information to everybody and I’m sure many of your readers will find it a huge benefit.

John Sandford-Smith, Retired consultant ophthalmologist, the Leicester Royal Infirmary, UK

Dear Editor,

The recent journal issue (Issues 79 & 80: Primary open-angle glaucoma) looks great. I would like to point out two things.

There was a mention that IOP below 21 is normal. I think we have to move away from this. There is good evidence that the mean normal IOP is 15 and the mean glaucoma IOP is 18. When I see patients with IOP of 17–19 I look carefully at their nerve fibre layer to ensure there is no early glaucoma.

There was also a mention of how important a glaucoma counselor is. This is true. To help with this, I have been using tablet devices to show my patients educational glaucoma videos, e.g. placing eye drops in the eyes. This has helped to reduce the amount of time my staff and I have to spend with the patient to discuss these issues, although we always reassess compliance. Tablet devices are getting much less expensive and serve as a great resource. Glaucoma videos are widely available from AAO, the web (e.g. YouTube), or can be custom made with your local information technology person.

Once again excellent work.

Daniel Laroche, Glaucoma Specialist, New York, USA

Dear Editor,

I want to congratulate the editor and the authors on the splendid issue of Community Eye Health Journal dealing with glaucoma. What a wonderful handbook and compilation of glaucoma this issue represents.

I want to emphasise the importance of the family history of glaucoma. A family history of glaucoma will increase the chances of developing glaucoma up to eight times. This has a far bigger impact than any other known risk factor.

We as eye care providers need to communicate the following messages to every patient who has glaucoma:

You must tell your brothers, sisters, sons and daughters, and parents that they are likely to have glaucoma too.

Encourage these family members of yours to come for an eye examination every year.

Remind your family members: when they have an eye examination, they must tell the examiner that they have a family history of glaucoma – their eyes need to be tested thoroughly.

Doing the above can help to prevent your loved ones from going blind – if glaucoma is detected early, it can be treated and the person’s sight will be saved.”

Most people are not yet aware that they do have a family history of glaucoma and, for that reason, we have to work hard to make sure that all patients with glaucoma inform their relatives. When we are examining patients in general, we must also specifically ask them about their family history.

Hugh R Taylor, Melbourne Laureate Professor and Harold Mitchell Chair of Indigenous Eye Health, University of Melbourne, Australia