唯一的时间是现在。每个“现在”都是独一无二的。负责人问自己，“我现在如何表现得很好？”每个人的答案都不同，因为正如每一种情况都是独一无二的，每个人都与其他人不同。但是肯定有一些算法可以帮助我们找到正确的答案。不幸的是,不,因为没有正确的答案。在这种情况下，只有一个答案是我们当时可以得出的结论。没有书面指南可以适当地适用于每一个独特的情况。不幸的是，我们的医生被一个谬论所欺骗：“对鹅有好处的东西对公鹅有好处。“用医学术语来说，“正常的发现是好的，异常的发现是不好的。“这太简单了，而且经常是错误的。好的临床医生知道护理必须个性化才能达到最佳。所谓的正常发现给出了粗略的指导，有时适用于群体，但对个人来说往往是错误的。考虑眼内压（IOP）。15mmHg的正常眼压对一些人有利，对另一些人不利，30mmHg的异常IOP对某些人有利，对另一些人不利。我们被标准分布曲线神圣性的神话所轰炸，以至于很难独立和具体地思考。此外，不幸的是,医生倾向于为病人做决定，通常基于对特定患者不相关或不重要的规范数据。我们这样做并不奇怪，当我们想要帮助时，所以我们默认了看似简单的东西，安全(非思考)的方式，我们不必对结果负责。总得有人来决定,否则我们将生活在一个无政府状态的世界。也是如此。因为我们中没有人知道我们需要知道如何采取适当的行动，我们向所谓的“专家”寻求建议。“对于我们来说，要照顾好人们，我们必须考虑别人的建议。所以我们期待专家，正如我们应该。然而,专家有时是对的，有时是错的。记得VonGraefe在1860年推荐手术虹膜切除术治疗所有青光眼,艾略特建议肩膀之间的芥末石膏治疗青光眼，Becker基于色调学结果的治疗，我们报告说，青光眼穿透性环流疗法100％成功，Lichter建议不要进行激光小梁成形术,很多人认为Cypass很棒,研究人员在高级青光眼干预研究中指出，通常在12mmHg左右的IOP优于通常在20mmHg左右的IOP。都错了.这些指南的作者做得很好，是提供一个通用框架，眼科医生可以在该框架上悬挂证据，以便能够评估证据的有效性和重要性。他们一丝不苟地为所有眼科医生提供了宝贵的服务，他们中没有人个人有充分的时间或技能。在他们自己的实践中，作者考虑有效信息是否与被考虑的特定人相关。考虑相关性的过程至关重要，总是。相关性是基于特定的独特患者，独特的医生和独特的情况。作者在这方面可以提供的唯一指南是提醒我们所有人在所有情况下考虑与所有患者的相关性，从病人的角度来看。比对眼科医生的服务更重要的是，周到地使用这些指南对患者的好处。我们需要,还,记住诊断是通用的，在每个诊断中都有差异。例如，初级开角的诊断意味着什么？尽管经过了最周到的治疗，一些受影响的人会迅速失明，而另一些人即使没有治疗也会保持视力。Chandler综合征的诊断是什么意思？在某些情况下，手术效果很好，and,在其他方面,差。所以一个人从不指导诊断和治疗，而是在人身上，目标是那个人的健康。以前的欧洲青光眼协会指南在国际上使用。很高兴EGS再次提供更新，有用的信息。准则是一个切实可行的，鼓舞人心的贡献。
The only time is now. Every \"now\" is unique. Responsible persons ask themselves, \"How can I act well now?\" The answers will differ for every person, because just as every situation is unique, so is every person different from every other person. But surely there must be some algorithm that will assist us in coming to the right answer. Unfortunately, no, for there is no right answer. There is only an answer that is as appropriate as we can conclude at that moment in that situation. No written
guidelines can apply appropriately to every unique situation.Unfortunately we physicians have been suckled on a fallacy: \"What\'s good for the goose is good for the gander.\" Phrased in medical terms, \"normal findings are good, and abnormal findings are bad.\" This is too simple, and often wrong.Good clinicians know that care must be personalized for it to be optimal. So-called normal findings give rough guidance, sometimes applicable to groups, but frequently wrong for individuals. Consider intraocular pressure (IOP). A normal IOP of 15 mmHg good for some and bad for others, and an abnormal IOP of 30 mmHg is good for some and bad for others. We are so bombarded by the myth of the sanctity of the standard distribution curve that it is hard to think independently and specifically. Also, unfortunately, doctors are prone to decide for patients, often on the basis of normative data that is not relevant or important for the particular patient. That we do this is not surprising, as we want to help, and so we default to what seems to be the easy, safe (non-thinking) way, in which we do not have to hold ourselves accountable for the outcome.Somebody HAS to decide, or else we would be living in an anarchical world. Also true. And because none of us knows as much as we need to know to act appropriately, we seek advice from so-called \"experts.\"For us to care for people well it is essential that we consider what others recommend. So we look to experts, as we should. However, experts are sometimes right and sometimes wrong. Remember that von Graefe in 1860 recommended surgical iridectomy for all glaucoma, Elliot recommended mustard plaster between the shoulders for glaucoma, Becker based treatment on tonographic findings, Weve reported 100% success with penetrating cyclodiathermy in glaucoma, Lichter advised against laser trabeculoplasty, many thought Cypass was great, and the investigators in the Advanced Glaucoma Intervention Study indicated that an IOP usually around 12 mmHg was better than one usually around 20 mmHg. All wrong. What the authors of these
guidelines have done excellently, is to provide a general framework on which ophthalmologists can hang pieces of evidence, so as to be able to evaluate the validity and the importance of that evidence. In doing this meticulously they have provided a valuable service to all ophthalmologists, none of whom individually have either the time or the skill to be fully informed. In their own practices the authors consider whether valid information is relevant for the particular person being considered. That process of considering relevance is essential, always. And relevance is based on the particular unique patient, unique doctor and unique situation. The only
guideline the authors can provide in this regard is to remind us all to consider relevance with all patients in all situations, and from the patient\'s perspective. Even more important than the service to ophthalmologists is the benefit to patients that will result from thoughtful use of these guidelines.We need, also, to remember that diagnoses are generic, and that within every diagnosis there are differences. For example what does a diagnosis of primary open angle mean? Some of those affected will rapidly go blind despite the most thoughtful treatment and others will keep their sight even without treatment. What does a diagnosis of Chandler\'s Syndrome mean? In some, surgery works well, and, in others, poorly. So one never directs diagnosis and treatment at a condition, but rather at the person, the objective being the wellness of that person.The previous European Glaucoma Society
Guidelines are used internationally. It is good that the EGS is again providing updated, useful information.The
Guidelines are a practical, inspirational contribution.
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