Protecting the retina, saving sight

Preventing and dealing with age-related macular degeneration (AMD): a meeting devoted to the leading cause of blindness in industrialized countries

Organized by Novartis, the meeting aimed to take stock of the prevention and treatment of AMD. IAPB Italy, the Italian Society of Ophthalmology and the University of Rome Torvergata were present at the event.

Wet (or exudative) AMD – a chronic and degenerative disease that gradually damages the retina – is the main common cause of severe vision impairment and blindness in people aged over 65, affecting an estimated 20-25 million people all over the world. According to WHO’s estimates, this number is destined to grow, due to both the current state of patients and the increase in life expectancy.

Being affected by AMD can be a tragic and distressing experience, as recounted by a patient at the event. A professional painter, she experienced total central vision loss in the left eye early in 2000, when drug development had not yet reached today’s level. The outcome was different when, ten years later, after experiencing the same symptoms in the right eye – “a strong blow inside the eye” – she rushed to the hospital and received a timely treatment. After a few sessions, the eye was healed

The lesson to be learned from this experience is that what matters is not only the pharmacopoeia, but also individual behaviour. Being examined for an early diagnosis is up to patients. And being examined before the onset of any symptoms is crucial.  

“The importance of eye health is underestimated – said Mr. Tiziano Melchiorre, Secretary-General of IAPB Italy – and so are chronic and degenerative eye diseases, which lead to blindness, and their social burden, which includes reduced mobility and personal autonomy, an increased risk of accidents and the rise in the number of cases of depression. It is mandatory to keep people informed, speed up the diagnostic process and promote access to treatment, in order to prevent blindness and contain as much as possible the tragic consequences of visual impairment. Furthermore, it is important to increase awareness among patients and their families about the progression of diseases such as AMD, reminding them about the importance of following the prescribed treatments with consistency and promoting access to vision rehabilitation services.”

Dr. Marco Piovella, president of the Italian Society of Ophthalmology (SOI) has stressed that, “AMD has to be diagnosed as early as possible, since it is not curable. Timely therapeutic strategies include the monitoring of pathological fluid, so to prevent healthy photoreceptors from being damaged and contain vision loss. When treatments are successful, we speak of disease ‘control’ and patients need to be accurately informed about the risks of disease progression, also increasing their awareness about the importance of being consistent in following treatments over time. In Italy, 70% of the population is not treated or treated only partially, which nullifies therapeutic results. There are several reasons why this happens, some of them of a social nature – such as insufficient patient awareness of the disease – and others, which are more related to the structural and managerial limits of the national health system – such as excessive bureaucracy and limited finances.”

“It is important to treat not just symptoms, but also the underlying cause of the illness. In AMD, damage to the retina is due to retinal fluid leaking out of abnormal blood vessels in the back of the eye – said Prof. Federico Ricci, Director of the Chronic and Degenerative Eye Disease Department at the University of Rome Torvergata. In an ophthalmologist’s therapeutic arsenal, there are several classes and generations of drugs: some were synthesized more than ten years ago, others are molecules which have been recently developed. New drugs have a superior control ability over the retinal fluid than first generation drugs, and need to be injected less frequently to keep the retina dry. This is the case of Brolucizumab, a humanized single-chain antibody fragment of small dimensions, which is characterized by an excellent tissue penetration profile and high capacity to eliminate the liquid from the retina, thus keeping the retinal tissue in optimal operating condition. Brolucizumab is the only anti VEGF to have proven its efficacy in pivotal trials for eligible patients, with a three-month treatment interval immediately following the initial three monthly loading doses, in about 50% of cases. The drug was in fact recently approved by the FDA with this posology, called a fixed regimen, which also allows a precise planning of therapy over time “.

Italy’s first Ophthalmic Telemedicine regional network

The first regional network in ophthalmic telemedicine will be available in Abruzzo, thanks to IAPB Italy and the Centro Nazionale di Alta Tecnologia in Oftalmologia, with the aim to “move images, not patients”. The news was shared during the Free Eye Examination in the City Squares Campaign, which is still ongoing in Pescara (19-21 October), Teramo (22-24 October) and L’Aquila (25-27 October)

The prevention campaign for retinal and optic nerve diseases has reached Abruzzo. Local residents aged over 40 will be able to undergo an eye examination free of charge inside the IAPB large high-tech road vehicle, a 100 sq. meters wide mobile diagnostic unit, equipped with four different labs. These check-ups will be available from today in Pescara (19-21 October), then they will move on, first to Teramo (22-24 October) and then to L’Aquila (25-27 October). This initiative will tour the rest of Italy and will be ongoing until 2021. Click here to check the upcoming dates and locations.

The first ophthalmic telemedicine project in Italy was announced during the opening conference of the Abruzzo Free Eye Examination Campaign. The project has created a network of diabetes and ophthalmic health centres across the Abruzzo region. Each diabetes centre will also photograph the fundus of the eye of its patients. “The pictures will be sent to the Centro Nazionale di Alta Tecnologia in Oftalmologia – Director Leonardo Mastropasqua explained – so that we will be able to make an instant diagnosis and treat the patient immediately, with consequential advantages for the regional administration and the local healthcare units (ASL), in terms of reducing costs and waiting lists.” This project aims at “moving images, not patients, bringing us closer to the UK, where 82% of patients are diagnosed in this way.”

This is a multidisciplinary project that will improve the efficiency of healthcare services, save economic resources and bring constantly controllable results,” said Ms. Nicoletta Verì, Regional Health Minister of the Abruzzo Region.

“Images will be sent to a reading centre for a preliminary analysis and early detection of eye disease – explained Mr. Michele Corcio, IAPB Italy vice president , during the conference. The aim of all these initiatives is an early diagnosis of illnesses that could lead to blindness. Diseases such as glaucoma, maculopathies and retinopathies are extremely treacherous since they produce no symptoms in the early stages, even though the optic nerve is being damaged. They are extremely serious, if not treated, but, paradoxically, can be effectively treated if diagnosed in time. For this reason, it is important to undergo regular check-ups even in the absence of symptoms.”

A positive response was also received from Parliament, with the introduction of preliminary support to IAPB Italy’s three-year campaign in the 2019 Stability Law. Paolo Russo MP, an ophthalmologist and president of the parliamentary intergroup ‘Protection of Sight’ confirmed that there is a need “for a new ‘New Deal’ to protect sight. Italy is already a world champion in ophthalmology. We must also become so in prevention. The paradigm must change: our objective is not just treating illnesses, but preventing them from arising and developing further.”

Today is World Sight Day

IAPB Italy, “Seizing the opportunity of free eye examinations”. A conference on sight and environmental pollution at the Presidency of the Council of Ministers

“GUARDA CHE È IMPORTANTE! Inquinamento ambientale e salute visiva” (“Look, it is important! Environmental pollution and eye health) is the title of the conference organized by IAPB Italy on World Sight Day. The event was held this morning, Thursday 10 October, at the Multifuncional Hall of the Presidency of the Council of Ministers starting at 10 a.m.

The central message was the importance of being examined by a specialist in ophthalmology for an early diagnosis of diseases, such as glaucoma and diabetic retinopathy, which, if treated in time, can be cured, but if not, can lead to blindness. These illnesses will also become more widespread as the average age of the population increases.

GUARDA CHE IMPORTANTE! (Look, it’s important!) is the appeal addressed to people to take advantage of free eye examinations. 

The Italian Society of Ophthalmology (SOI) has supported IAPB Italy and Italian ophthalmologists have made 30,000 eye examinations available across Italy to people who have never been to a specialist before. You just need to visit the website and book an appointment directly with the closest ophthalmologist to you featured on the map. In September 2019 the prevention campaign for retinal and optic nerve diseases was also launched. An IAPB mobile diagnostic unit and other high-tech tools will reach the main urban centres of every Italian region from now until 2021. 

Mr. Giuseppe Castronovo, President of IAPB Italy, dreams of “living in a world without people suffering from blindness or visual impairment and such a dream will only be realised through one course of action: prevention. IAPB Italy has done a great deal to raise people’s awareness and will keep on doing so. Our sight is too precious a gift to take for granted. We need to take care of it, and undergo regular check-ups before experiencing any symptoms”.

Dr. Matteo Piovella, President of SOI, echoed him at the conference by saying that “every year more than 7,000 ophthalmologists save the sight of 1,700,000 people.” Such figures highlight the excellence of ophthalmology in Italy but also at the fragility of our sight and the constant need to take care of our eye health. “The eye – added Mr. Piovella – is our weakest organ and at 40 years of age, it is old. This is an important topic that affects everybody. We need to keep talking about it by stressing that sight problems are not just a memory from the past. On the contrary, blindness will be on the rise if people don’t accept responsibility for taking care of their eyes.”

Two panel discussions closed the event: “Environmental pollution and its effects on general health and eye health” and “Protecting sight in a polluted environment”. Representatives from the Italian Ministry of Health, WHO experts, researchers from the Italian Institute of Health and many authoritative ophthalmologists and specialists in occupational medicine from various Italian universities attended them.