Pfizer, UK National Institute for Health Research Biomedical Research Centre.

This conservative repeatable protocol affords delivery of the minimum dose of photocoagulation necessary to achieve a safe, long-term ocular hypotensive response, while minimizing the risk of serious adverse effects, and is valuable in the difficult treatment of refractory glaucoma.

Primary open angle glaucoma (POAG), a major cause of blindness worldwide, is a complex disease with a significant genetic contribution. We performed Exome Array (Illumina) analysis on 3504 POAG cases and 9746 controls with replication of the most significant findings in 9173 POAG cases and 26 780 controls across 18 collections of Asian, African and European descent. Apart from confirming strong evidence of association at CDKN2B-AS1 (rs2157719 [G], odds ratio [OR] = 0.71, P = 2.81 × 10−33), we observed one SNP showing significant association to POAG (CDC7–TGFBR3 rs1192415, ORG-allele = 1.13, Pmeta = 1.60 × 10−8). This particular SNP has previously been shown to be strongly associated with optic disc area and vertical cup-to-disc ratio, which are regarded as glaucoma-related quantitative traits. Our study now extends this by directly implicating it in POAG disease pathogenesis.

The Stratus OCT normative database may be misleading in highly myopic eyes from Caucasians resulting in a substantial proportion of false positive errors. Particular caution is needed when the RNFL appears to be below the normative database normal limit at the upper or lower poles or on the nasal side of the disc. Stratified normal databases are required for accurate diagnosis of conditions resulting in nerve fibre loss such as chronic glaucoma.

A single sub-Tenon's injection of 30 mg triamcinolone seem to be safe and effective as a route of steroid delivery after uneventful phacoemulsification surgery. Larger numbers in patients at high risk are required to assess its effectiveness in reducing the risk for pseudophakic CME.

No abstract

The three papers in this symposium are based on presentations to an RSM meeting on the Diabetic Eye, held on 9 April 2003. The matter is particularly topical because the National Service Framework for Diabetes calls for a high-quality retinal screening programme. After a review of the various ophthalmic conditions likely to be encountered in diabetic patients (A Negi, S A Vernon) we proceed to the most important, diabetic retinopathy, with a discussion of screening methods (D M Squirrell, J F Talbot) and an account of laser treatments (J G F Dowler). Colour versions of the clinical photographs are available online [www.jrsm.org]. Publication was coordinated by Professor Susan Lightman, of Moorfields Eye Hospital, London, UK.

Purpose: The UK Glaucoma Treatment Study (UKGTS) demonstrated the effectiveness of an intraocular pressurelowering drug in patients with glaucoma using visual field progression as a primary outcome. We now test the hypothesis that responses on patient reported outcome measures (PROMs-secondary outcome measure) differ between patients receiving a topical prostaglandin analogue (Latanoprost) or placebo eye drops in UKGTS. Design: Multi-centre, randomised, triple-masked, placebo-controlled trial. Participants: Newly diagnosed glaucoma patients recruited into the UKGTS with baseline and exit PROM data (n= 182 and n=168 patients from the treatment and placebo group, respectively). Methods: The UKGTS was a multi-centre, randomised, triple-masked, placebo-controlled trial, where patients with newly diagnosed open angle glaucoma were allocated to receive Latanoprost (treatment) or placebo (trial registration number: ISRCTN96423140); the observation period was 24 months. Patients completed general health PROMs (EQ-5D and SF-36) and PROMs specific to glaucoma (GQL-15 and GAL-9) at baseline and at exit from the trial. Percentage change between baseline and exit measurement on PROMs were calculated for each patient and compared between treatment arms. In addition, differences between stable patients (n=272) and those with glaucomatous progression (n=78), as determined by visual field change (primary outcome), were assessed. Main Outcome Measure: PROMs on health-related and vision-related quality of life. Results: Average percentage change on PROMs was similar for patients in both arms of the trial with no statistically significant differences between treatment and placebo groups (EQ-5D, p = 0.98; EQ-5D VAS, p = 0.88; SF-36, p = 0.94, GQL-15, p = 0.66; GAL-9, p = 0.87). There were statistically significant differences between stable and progressing patients, as determined by visual fields, on glaucoma-specific PROMs (GQL-15, p = 0.02; GAL-9, p = 0.02) but not on general health PROMs (EQ-5D, p = 0.62; EQ-5D VAS, p = 0.23; SF-36, p = 0.65) Conclusions: Average change in PROMs on health-related and visionrelated quality of life was similar for the treatment and placebo group in the UKGTS. PROMs, specifically those used in the UKGTS, may not be sensitive enough to be used as a primary endpoint in clinical trials when participants have newly diagnosed early stage glaucoma. Taxonomy Patient-Reported Outcome, Glaucoma