Russian Journal of Clinical Ophthalmology
ISSN 2311-7729 (Print), 2619-1571 (Online)

Current trends in studying glaucoma: a review of published data

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DOI: 10.32364/2311-7729-2021-21-4-194-199

L.A. Zaporozhetc1, V.N. Alekseev2, Е.А. Egorov3, Е.В. Martynova2, Yu.A. Alekseev2

1Leningrad Regional Clinical Hospital, St.-Petersburg, Russian Federation

2I.I. Mechnikov North-Western State Medical University, St.-Petersburg, Russian Federation

3Pirogov Russian National Research Medical University, Moscow, Russian Federation

Aim: to analyze recently published data on the trends in glaucoma studies, etiology, pathogenesis, clinical course, diagnostic challenges, and treatment for glaucoma based on current recommendations and published data over the last 50 years.

Materials and Methods: this paper reviews English published data on glaucoma indexed in PubMed database and papers from the "Ophthalmological Journal" and "American Journal of Ophthalmology over 50 years (1970–2019), and open access journals («National Journal Glaucoma" and "British Journal of Ophthalmology") over the last ten years (2010–2019).

Results: published data analysis demonstrated a steadily increased interest in studying all aspects of glaucoma from 1970 until now. In 2010–2019, there was a growing interest in the personalized approach to the study and treatment of glaucoma. Over this period, studies on the fundamental basis of glaucoma and its surgical management became the priority in Russia and foreign  countries. Meanwhile, the interest in glaucoma surgery is still predominant in Russian published data from 1970 until now (although its growth rate reduced by 2019). In the 1980s, studying the functional status of glaucoma using automated perimetry gained the most popularity. Since 2000, the interest has switched to the morphometry of optic nerve head (ONH) using optical coherence tomography.

Conclusions: primary studies on glaucoma are similar in Russia and foreign countries, i.e., theoretical aspects (etiology and pathogenesis) and improving surgical techniques. Our findings demonstrate a growing interest in a personalized approach to study glaucoma. Since 2010, there has been an increase in domestic published data on conservative treatment for glaucoma. To date, the most promising diagnostic modality is ONH morphometry.

Keywords: primary glaucoma, published data, automated perimetry, Heidelberg retinal tomography, optical coherence tomography, glaucoma treatment.

For citation: Zaporozhetc L.A., Alekseev V.N., Egorov Е.А. et al. Current trends in studying glaucoma: a review of published data. Russian Journal of Clinical Ophthalmology. 2021;21(4):194–199 (in Russ.). DOI: 10.32364/2311-7729-2021-21-4-194-199.

Glaucoma is one of the crucial issues in ophthalmology. Many recent papers aim to study various aspects of this multifactorial disease. Despite the universal development of informational websites, ophthalmologists receive basic information on trends in studying glaucoma when reading specialized medical literature.

Statistically, American doctors spend 2-5 hours per week reading periodicals and receive up to 12 journals (paid and open-access). In Russia, 38% of doctors spend up to 5 hours reading specialized medical literature, and 37% spend more than 5 hours per week [1].

Contact with a wealth of information inevitably raises several issues. Systematizing of information obtained is among these issues. Common recommendations are as follows:

1. To pay attention to authors and affiliations. The reputation of authors and institutions guarantees that the paper is a high-quality one.

2. To take a closer look at "Materials and Methods." Advertising of "evidence-based medicine principles" has become a common practice. Specific obligations of periodicals dictate this. However, these principles are not always followed, as seen from studying this section.

3. The criteria for high-quality publication are "Background," "Aim," "Materials and Methods," "Results" (including their statistical analysis), "Discussion," and "Conclusions."

Reader's decision to apply the study's results is a personal aim of reading specialized literature but not a mandatory aim of the article per se.

 Subjective aims to read specialized literature are as follows:

– to stay informed on events in the professional world;

– to learn how experienced professionals manage patients;

– to interpret correctly modern diagnostic techniques;

– to know clinical patterns and course of diseases;

– to understand etiology and pathogenesis of diseases;

– to distinguish proper treatment from useless and harmful procedures;

– to understand reports on need, usefulness, utility, and economy of preventive and treatment tools;

– to impress other professionals.

The analysis demonstrates that the aims of writing scientific papers are as follows:

– to determine the diagnostic value of a method studied;

– to determine drug efficacy and safety;

– to compare various treatment schedules;

– literature review;

– meta-analysis.

This article aimed to analyze up-to-date published data and characterize current trends in glaucoma studies, etiology, pathogenesis, clinical course, diagnostic challenges, and treatment for glaucoma based on the recommendations mentioned above and published data over the last 50 years.

Materials and Methods

Semantic sections categorize all scientific publications on various academic disciplines to improve information perception. Medical journals generally include sections on clinical studies, experimental studies, practical healthcare, etc. According to journal differentiation, publications on glaucoma, its etiology, pathogenesis, clinical course, diagnostic and treatment issues are also conventionally classified.

To analyze trends in studying glaucoma, this paper reviewed domestic and foreign publications over a long period, i.e., English articles indexed in PubMed database, articles from the Ophthalmological Journal and American Journal of Ophthalmology over 50 years (1970–2019), and open access journals (National Journal Glaucoma and British Journal of Ophthalmology) over the last ten years (2010–2019).

The PubMed database was developed by the National Center for Biotechnology Information (NCBI). PubMed is a free search engine that contains more than 30 million citations and abstracts from 4,800 indexed biomedical journals [2, 3]. "Glaucoma" was the keyword to search the database.

A more fractional division of papers using several characteristics was suggested to analyze publications in the National Journal of Glaucoma and the British Journal of Ophthalmology over the last ten years (2010–2019). These characteristics were in line with the personal aims of studying specialized literature. This division aimed to determine and compare major trends in studying glaucoma in Russia and abroad. The following nine groups of articles were defined:

"Theoretical Papers" – articles on glaucoma etiology, pathogenesis, and course (without addressing their current implementation);

"Practical Papers" – articles on studying and supporting practical activities of ophthalmologists;

"Surgery" – articles on current trends in glaucoma surgery;

"Therapy" – articles on current trends in glaucoma medications;

"Pediatrics" – articles on studying glaucoma in children and adolescents;

"Social Economics" – articles on studying the lifestyle of individuals with glaucoma, their income, and expenses, social care issues;

"Informatics and Medicine" – articles on introducing computer technologies and programs into identifying and monitoring glaucoma patients;

"Diagnosis" – studying diagnostic techniques for glaucoma used in daily practice;

"Somatic Comorbidities and Glaucoma" – articles on studying associations between somatic comorbidities and glaucoma.

The total number of articles on glaucoma published in domestic (n=213) and foreign (n=301) journals over the last ten years was 514.

Results 

Primary sections in the PubMed database are Books and Documents, Clinical Trials, Meta-Analysis, Randomized Controlled Trials, Review, and Systematic Review [3]. Figure 1 illustrates general trends in all sections in 1970–2019.

Рис. 1. Общая тенденция в изучении глаукомы с 1970 по 2019 г. Fig. 1. Overall trends in studying glaucoma in 1970–2019

Figs. 2 and 3 illustrate trends in studying glaucoma over the same period by individual thematic sections. Books and Documents were excluded since this section usually contains information on issues duplicating earlier published data.

Рис. 2. Тенденция в изучении глаукомы с 1970 по 2019 г. по разделам Clinical Trial, Meta-Analysis, Randomized Controlled Trial, Review, Systematic Review Fig. 2. Trends in studying glaucoma in 1970–2019 (Clinical Trial, Meta Analysis, Randomized Controlle

Рис. 3. Тенденция в изучении глаукомы с 1970 по 2019 г. с учетом индивидуального подхода Fig. 3. The trend in the study of glaucoma from 1970 to 2019, taking into account the individual approach

Notably, statistical data on several sections have been provided since not 1970 but later. Thus, statistical data on Clinical Trials have been provided since 1975, Meta-Analysis since 1993, Randomized Controlled Trials and Reviews since 1975, and Systematic Reviews since 1999. This phenomenon is accounted for by the improvement of databases and consecutive development of conceptual search fields of the PubMed engine.

The analysis of charts shown in Figs. 2 and 3 demonstrates a steady increase in publications on glaucoma since 1970. Peaks values on Clinical Trials and Randomized Controlled Trials sections were seen in 2000–2009. The number of publications in other sections continues to grow.

We suggest that a mild reduction in the number of publications in Clinical Trial and Randomized Controlled Trial sections in 2010–2019 is accounted for by redistribution of interests from a collective approach (which was the practice in clinical trials) to an individual (personalized) approach to glaucoma diagnosis and treatment [4–6]. Therefore, we analyzed PubМed data by this combination of characteristics.

As Fig. 3 illustrates, there was significant growth in the publications on studying glaucoma considering personalized approach precisely in 2010–2019.

The priority areas in studying glaucoma were discovered over a shorter period (2010–2019) on the example of the Russian National Journal Glaucoma (which focuses on studying this disease) and the British Journal of Ophthalmology. Table 1 shows the distribution of the articles of these journals by conditional groups.

Таблица 1. Распределение статей по группам Table 1. Paper distribution by groups

Several priority areas in studying glaucoma were identified based on these findings. The "theoretical papers" group ranks first both in the domestic and foreign journals (33.3% and 26.2%, respectively), followed by the "surgery" group (20.7% and 17.9%, respectively).

The following positions were distributed differently in the domestic and foreign scientific literature. Glaucoma medications ("therapy," 15.9%), daily practical activities of ophthalmologists ("practical papers," 9.9%), and current diagnostic algorithms ("diagnosis," 8.4%) are of great importance in domestic publications over the last decade. Meanwhile, foreign publications pay great attention to diagnostic tests ("diagnosis", 17.7%), social-economic aspects of glaucoma management ("social economics", 12.3%), and glaucoma medications ("therapy", 9%). We suggest that this distribution is accounted for by many factors, including social-economic factors and technological innovations.

We decided to focus on papers on surgical procedures and glaucoma therapy given significant differences between domestic and foreign publications (15.9% and 9%, respectively; see Figs. 4 and 5).

Рис. 4. Анализ хирургического направления в изуче- нии глаукомы с 1970 г. Fig. 4. Surgical management in studying glaucoma beginning from 1970

Рис. 5. Анализ терапевтического направления в изуче- нии глаукомы с 1970 г. Fig. 5. Therapeutic management in studying glaucoma beginning from 1970

As Fig. 4 illustrates, the interest in glaucoma surgery is still predominant in Russian publications from 1970 until now, although its growth rate reduced by 2019. Fig. 5 shows that the interest in glaucoma therapy was predominant in foreign publications until 2000. However, there has been significant growth in publications on glaucoma medications in Russian journals over the last decade.

Notably, a growing interest in glaucoma based on the analysis of PubMed citations began in the 1990s. Historically, this phenomenon aligns with a widespread introduction and study of automated perimetry [7]. The first automated perimeter, Octopus-201, was developed by Swiss INTERZEAG in 1974. In 1985, A. Heijl and C. Krakau developed software for another automated perimeter, Humphrey Visual Field Analyzer. The mean period of the practical implementation of any new device is 5 to 10 years [8, 9]. Therefore, the beginning of the active clinical trials of automated perimeters coincides roughly with the early 1990s and growth in PubMed searches for relevant scientific literature.

The history of optical coherence tomography (OCT) began in the mid-1990s when the first experimental OCT machines were developed in the RAS Institute of Applied Physics due to advances in fiber optic broadband interferometry and femtosecond optics. In 1991, the J.G. Fujimoto group (Massachusetts Institute of Technology, Cambridge, MA, USA) firstly demonstrated the possibility of receiving retina scans by OCT [10–12].

The history of the development and introduction of Heidelberg retinal tomography began in 1986 when Heidelberg Engineering GmbH introduced the first laser scanning system, Heidelberg Retina Tomograph (HRT), on the world market. This discovery also determined the area of researches and growth in the number of publications on the morphometry of optic nerve head (ONH).

Fig. 6 illustrates the evolution of the interest in studying glaucoma according to the PubMed service and given the emergence of novel diagnostic tools (log scale).

Рис. 6. Тенденции в изучении глаукомы с 1970 по 2019 г. с учетом современных технологий (log) Fig. 6. Trends in studying glaucoma in 1970-2019 given modern technologies (log)

As Fig. 6 shows, studying the functional status of glaucoma using automated perimetry has gained the most popular since 1970. However, novel technologies have switched the interest to ONH morphometry. Therefore, studying anatomical structures using OCT currently attracts strong interest.

The information provided on significant trends in studying glaucoma is somewhat contingent, e.g., there is no categorization by glaucoma types and stages, combined requests are not created and studied, etc. However, charts provided demonstrate a correlation between science and technological progress, illustrate preferences of today's ophthalmologists to studying morphometric parameters in glaucoma, and show the transformation of interest in treating glaucoma. These phenomena determine current trends in studying glaucoma.

Conclusions

1. The interest in studying glaucoma is growing worldwide.

2. Primary studies on glaucoma are similar in Russia and foreign countries, i.e., theoretical aspects (etiology and pathogenesis) and improving surgical techniques.

3. A growing interest in an individual approach to study glaucoma probably accounts for a mild reduction in requests for Clinical Trial and Randomized Controlled Trial sections in 2010–2019.

4. Since 1970, the interest in glaucoma surgery has been predominant in Russian publications. Since 2010, there has been an increase in domestic published data on its conservative treatment. This phenomenon is probably accounted for by the greater availability of IOP-lowering medications in Russian regions.

5. The analysis of PubMed citations demonstrates that ONH morphometry in glaucoma is the most promising diagnostic modality.


About the authors:

1Lidiya A. Zaporozhets — C. Sc. (Med.), ophthalmologist; ORCID iD 0000-0003-2634-2829.

2Vladimir N. Alekseev — Dr. Sc. (Med.), professor of the Department of Ophthalmology; ORCID iD 0000-0001-8963-7945.

3Evgeniy A. Egorov — Dr. Sc. (Med.), Professor, Head of Acad. N.P. Nesterov Department of Ophthalmology of the Medical Faculty, President of the Russian Glaucoma Society; ORCID iD 0000-0002-1132-8031.

2Elena B. Martynova — C. Sc. (Med.), associate professor of the Department of Ophthalmology.

2Yuriy A. Alekseev — postgraduate student of the Department of Ophthalmology.

1Leningrad Regional Clinical Hospital, 45, Lunacharskiy pass., St. Petersburg, 194291, Russian Federation.

2I.I. Mechnikov North-Western State Medical University, 41, Kirochnaya str., St. Petersburg, 191015, Russian Federation.

3Pirogov Russian National Research Medical University, 1, Ostrovityanov str., Moscow, 117437, Russian Federation.

Contact information: Lidiya A. Zaporozhets, e-mail: Lidia-zap@mail.ru.

Financial Disclosure: no authors have a financial or property interest in any material or method mentioned. 

There is no conflict of interests. 

Received 06.05.2021.


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