Discussion


Admittedly there are far more definitions of glaucoma, or descriptions of the required observations necessary to diagnose a patient's condition as glaucoma, out there than are listed in this work. It is stated here, though, that the items collected here were simply sequentially selected, without intentionally favoring either determinability of them as professional-reader oriented or lay-reader oriented. Breaking the two collections of professionally and publicly oriented glaucoma definitions / pathognomonics into the 16 categories employed in this presentation was, of course, quite a crude process. It is also very true that numerous items listed within particular categories here could also be very properly listed in some of the others, but each has been uniquely categorized here for simplicity. There may be some room for argument as to the choice of placing a given item on one side or the other of the professional/public dividing line, but it would seem that in most cases items are quite distinctly worded and located for primarily either one or the other readership. Additionally, some of the collected items claim to be actually more specific definitions of 'primary open-angle glaucoma' (POAG), as opposed to claimed distinguished "disease" entities such as 'angle-closure glaucoma' (ACG) and 'normal-tension glaucoma' (LTG). Damagewise glaucoma is glaucoma, and the artificially separated categories ophthalmologists come up with are hypothesized on questionable facts of an ever-gyrating elevated-IOP theory; they are not based on unbiased statistical differences in groups of physiological parameters or really distinct anatomy. Treatment solutions, furthermore, in their varying degrees of success, don't establish such distinctions either. So, in practical terms, any claimed POAG definitions/pathognomonics may be lumped here with their general cousins. The intent of this exposition of the extremely disparate characterizations of glaucoma out there in written form today, is, as stated in the introduction, to demonstrate the extreme example the glaucoma specialty of ophthalmology has both perpetrated and evolved of mismatched improved supply characterizations versus obsolete demand ones of the single service it provides.
I believe we can say that most of the differences in these two sets of characterizations, which are both determined by the supply side, represent a deliberate delay in a dragged-out, ongoing change of the characterization of glaucoma within the medical establishment, but one which began some 150 years ago and which is a change that does not favor the vast majority of clinical glaucoma specialty practices, glaucoma diagnostic-instrumentation companies and glaucoma-pharmaceutical companies in existence today. It is also very easy to believe that most glaucoma-research money out there today is directed to researchers who can produce papers supporting maintenance of most of the elevated-IOP theory as to the etiology of glaucoma.
Looking, then, at the number of items in each category which fall on the two sides of the professional/public division, we have the following:



Number of Definitions/Pathognomonics in Each Category

Category

Professional

Public
1. Triad 0 3
2. Modified Triad 2 0
3. Elevated-IOP Theory 0 19
4. Modified/Questionable IOP Theory 4 3
5. Multifactor IOP Theory 7 5
6. IOP Theory Degenerated / Cause Reversal 3 0
7. IOP Only Risk Factor 1 0
8. Dyad 5 1
9. Visual-Field Defect Not Explained by Other Disease 1 0
10. Optic Neuropathy 5 0
11. Collection of Unspecified Number of Signs 0 1
12. Neurotoxin-Caused 0 1
13. As Used to Categorize "Glaucoma" in Clinical Studies 2 0
14. As Related to Population Screening 1 0
15. Official Recognition of Reality's Sneak-Theft of the Elevated-IOP Theory 1 0
16. Definition Advertised but Not Produced 1 4



Now let us examine the above 16 items for large differences between the number of entries from sources meant for inhouse reading and that from sources meant for public consumption. The most striking mismatch is clearly that of category 3, showing that the medical supply side wants the public demand side to continue to totally accept the long-lived, high-medical-cost full Elevated-IOP Theory, while totally recognizing that this antiquated theory is very dead. Two other categories give significant indications: Category 8 shows that the medical world, while wanting the public to accept the triad ("characteristic" nerve damage, "characteristic" visual-field defects, raised IOP) of glaucoma-diagnosis requirements that are needed to support the lucrative Elevated-IOP Theory, fully recognizes that only the dyad (only the first two items of the triad) today constitutes a responsible definition/pathognomonic of glaucoma. Category 10 shows that this wealthy brotherhood also really chooses to see glaucoma as fitting into the common tissue-inherent "disease" paradigm of medicine as a 'neuropathy', but hasn't figured out yet, in such instance, how to have the public do that also and yet maintain in its collective mind that IOP has to build up first before one is allowed to find "primary" glaucoma. Further, less distinctively indicated trends are apparent in the data of the above table. The number of entries on each side of Categories 1 and 2 seem to show that the traditional glaucoma triad is being modified only for inhouse use. The Category 6 picture admits gross degeneration of the elevated-IOP theory within the profession, which is not advertised to the public. Categories 13 and 14 (more of the latter could've been found) indicate medicine's use of one definition in its research studies, while imposing a different one on the public. The existence of the National Eye Institute (USA) item in category 15 establishes that, after 150 years of glaucoma medicine, there is now a large study underway to either update glaucoma etiology to reality or else bury it in another 150 years of history, depending on the legitimacy of the study. Lastly, Category 16 shows that often medical information intended for the public never really gets to the point.



Conclusion


Strictly scientific methods, of course, are not claimed in this survey of the radically variant conceptions of "glaucoma" available in the world today. It appears, however, that casual collection and rough analysis of a considerable number of these conceptions does reveal some definite patterns in the application of them to medical research, clinical medicine and the public's awareness of health concerns, revealing a decided lag in updating the public, which situation the public has every right to believe stems from concern for the monetary interests of medical professionals and medical diagnostic-instrument and pharmaceutical firms.
If you have any desire to copy this document, you should do so immediately, in case sufficient action is threatened to force its removal. No permissions have been solicited for excerpted copyrighted material used in it, since selective permission would've destroyed the basic intent of the survey. This author claims no copyright on any of it, of course.




Different Beat

raych@tsoft.net

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