The report by Foster and Johnson in this issue of theBJO (p 1277) points to dramatic developments in our knowledge of glaucoma worldwide. Firstly, they continue a trend endorsed by an international committee to use the term “glaucoma” only for people who have suffered injury to the optic nerve as judged by visual field abnormality, combined with enlargement of the cup/disc ratio outside statistical limits for the population studied. This approach is intended to differentiate between those with a true disease and those suspects who are at increased risk—for example, those with higher than normal eye pressure or those with narrow angles. In both the developed and the developing world, we must concentrate limited medical resources on those at greatest risk for loss of function and decreased quality of life. In addition, we must avoid treatment of those who would never have lost vision in their lives, and who may be more threatened by treatment than by their natural course.

With respect to angle closure glaucoma (ACG) specifically, Foster and Johnson summarise recent data that build on previous population research. The pioneering work of Alsbirk,1Hu,2 Shiose,3 and Salmon4 had reinforced the suggestions that people derived from north China, including native peoples of North America and Greenland, had a …