Szemészet, 2004 (141. évfolyam, 1-4. szám)
2004-06-01 / 2. szám
Szemészet 141. évfolyam (2004) 233 A SZEMÉSZET ÉS A LÁTÁSKUTATÁS VÁRHATÓ JÖVŐJE I./ Foreseeable future developments in ophthalmology AND VISION RESEARCH I. The history of the approximation to an enigma: Primary open angle glaucoma - an example for epistemological reflections Balder P. Gloor Zurich, Switzerland Although three facts delimit Glaucoma since almost 150 years, namely elevated intraocular pressure, optic atrophy and field loss, theories and hypotheses on glaucoma and its cause became again misty about 40 years ago since population studies seemed to show, that there are primary open angle glaucomas without elevated pressure. This provoked such an amount of new research but also speculations outside the facts, that it became tempting to analyse the 200 hundred year long history of the still ongoing way to come to an understanding what glaucoma may be. This is the history of separating angle closure glaucomas, secondary glaucomas, congenital and developmental glaucomas from primary open angle glaucoma, which at time remains the main question. Although the disease may be easy determined at its endpoint, it poses severe problems before full development and for screening. This led to intensive debates about defining the primary criterium for diagnosis: Excavation, nerve fibre loss, field loss or intraocular pressure? This history of glaucoma is not only fascinating by its facts, but at least as much because it also illustrates the winding path to come to scientific knowledge: Hypotheses dying and rising again; theories leading to the invention of more or less perfect tools - occasionally measuring devices reassembling the bed of Prokrustes - to measure parameters and damage (tonometers, perimeters, devices to measure the change of the papilla and the nerve fibre layer); byways and missconcepts, which have nevertheless positive side effects (e.g. indentation tonometry which lead to new insight by tonography); beloved ideas influencing sensory perception (“the green papilla”); wrong ideas leading to surgical procedures which work nervetheless (iridectomy, laser trabeculoplasty); long and many times ideological battles until a scientific fact is acknowledged (50 years long dispute on production and outflow of the aqueous); gigantic mistakes by giants (Alfred Vogt not recognizing the importance of gonioscopy); useful or misleading animal experiments; the role of scientific and paramedical journals; the importance of the language of publication and its influence on impact factors; the growing role of the big companies since the introduction of the beta-blockers, the use of unproved hypotheses as selling arguments of the pharmaceutical companies and the involvement of the clinicians and the researcher in the big business. To summarize: The main steps in the history of the approximation of the disease covered by the name “glaucoma” are presented. This history also shows, that what is assumed to be an ongoing collection of scientific facts, is only a more or less adequate reflection of these facts, influenced by the general stand of sciences, the spirit of time and its predominant trends, the character of individual scientists, the powers determining society, the coming and going of generations and many other circumstances. In this way history of glaucoma becomes an epistemological example to show how scientific knowledge is acquired. Egy rejtély megközelítésének története: Primer nyitott zugú glaucoma- példa az ismeretelméleti reflexiókra Balder P. Gloor Zürich, Svájc Bár szinte 150 év óta három tény határozza meg a glaucomát: az emelkedett szemnyomás, az opticus atrophia és a látótérveszteség, a glaucomára és okaira vonatkozó hipotézisek mintegy negyven évvel ezelőtt ismét rejtélyessé váltak. Ennek 3 June 2004 - Foreseeable future developments in ophthalmology and vision research I.
