AGIS Update - Racial influence on Glaucoma Outcome
Summary of the Advanced Glaucoma Intervention Study, by a staff reporter

The Advanced Glaucoma Intervention Study (AGIS) is an ongoing US trial following the long-term clinical course and prognosis of patients with advanced glaucoma randomized between 2 standard surgical strategies. The stated goals of AGIS are 2-fold: to compare 2 surgical management strategies for glaucoma inadequately controlled by medical treatment; and to clarify the clinical course and prognosis of open-angle glaucoma after the initiation of surgical intervention. It is also hoped that the study might identify factors that predict outcome, to assist the ophthalmologist in planning treatment.

The follow-up analysis of AGIS has indicated unexpected effects of race on treatment response and visual outcome, prompting a recent report of 4- to 7-year data comparing the outcomes for the 2 major racial groups included, African Americans and Caucasians.

'The interactions of race with treatment outcome and with failure of initial inter-vention were not postulated but rather discovered in the course of data analysis,' and were found to be independent of differences in iris pigmentation between the racial groups. For black patients, the findings clearly favour use of the ATT management sequence. In whites, out-come variables indicate an initial advantage for ATT, which usually reverses to show a better outcome with TAT over the 7-year follow-up period. Considering the data as a whole, the authors of the report believe that the TAT sequence should be preferred for white patients without life-threatening health problems, an approach that differs from current standard practice.

The lack of concordance of visual field preservation with mean reduction in IOP in black patients was unexpected and indicates that factors other than IOP may play a role in determining the integrity of visual function in blacks. The demon-stration of an interaction between race and treatment has important implications for the study of glaucoma management.

Economics of Glaucoma
From the second International Symposium on "The Challenges and Controversies of Ophthalmology & Visual Sciences in the Next Millenium", Hong Kong, 20-23 August 1998

Speech delivered by:-
H Dunbar Hoskins, Jr. 
University of California
USA

Hong Kong 'Lifeline Express'
An Interview with:-
Dr Dennis Lam
Chairman
Department of Ophthalmology & Visual Sciences
The Chinese University of Hong Kong
Prince of Wales Hospital
Shatin, NT
Hong Kong

Millions of people in China suffer from reversible blindness, including more than 4 million people with cataracts. It was for this reason that the Better Hong Kong Foundation established a mobile hospital train to travel throughout China to perform eye surgery for the needy.

The Hong Kong 'Lifeline Express' is a 3-carriage hospital train donated by the Hong Kong people to the people of mainland China to commemorate the reunification of Hong Kong with China on 1 July 1997. Since then, the hospital train has been shuttling amongst remote areas of the mainland, providing free medical treatment to patients blinded by cataracts.

By the end of July this year, the Hong Kong Lifeline Express had provided its services at Fuyang City in Anhui Province, the Yi Minority Autonomous Region at Liangshan in Sichuan Province, Huangpi County at Wuhan City in Hubei Province, and Longyan City and Sanming City in Fujian Province, restoring the eyesight of more than 2,200 patients with cataracts. The hospital train is currently providing free medical service at Jinhua City in Zhejiang Province. Without the arrival of Hong Kong Lifeline Express, these blind people were likely to have lived in darkness for the rest of their lives.

Hong Kong Lifeline Express not only provides free operations for poverty-stricken cataract patients, but also enables medical practitioners in Hong Kong and China to work together and benefit from an exchange of expertise. This helps to foster close ties between the ordinary people of Hong Kong and China.In the past year, more than 10 Hong Kong medical practitioners volunteered to work on the hospital train and 2 ophthalmologists from the mainland were invited to take a training course in Hong Kong to enhance their micro-surgical techniques. After completing the training course, they will work for the Hong Kong Lifeline Express to help cataract patients on the mainland.