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 www.giornatamondialedellavista.it 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. 

The eye diseases prevention campaign by IAPB Italy has started

A large high-tech road vehicle will cross Italy’s main urban areas, providing free eye examinations. The first stop is in Varese, then Milan will follow. The objective is to prevent blindness

The free eye examinations campaign in urban areas promoted by the International Agency for the Prevention of Blindness – IAPB Italy has started. A mobile clinic will provide high-tech check-ups, offering an opportunity to make early diagnosis to prevent blindness. 

The campaign sets off between 21 and 23 September in Varese, and will come to an end in 2021, reaching the main urban areas of every Italian region.

Mr. Michele Corcio, Vice President of IAPB Italy, opens the first event in Varese

The IAPB large mobile clinic is a 100 sq. metres high-tech road vehicle, equipped with four diagnostic stations. Onboard the unit, doctors will be able to provide high-tech check-ups free of charge, offering an opportunity to make early diagnosis to prevent blindness. The available exams are aimed at an early detection of the main retinal and optic nerve diseases and are reserved for patients over 40 years of age. 

The IAPB large high-tech road vehicle will be present in Milan from today, 24 September, through to Thursday 26, in Piazza Melchiorre Gioia. Then it will reach Lodi, from 27 to 29 September, in Piazza Castello. The campaign will continue onto Abruzzo (L’Aquila, Pescara and Teramo), and Campania (Naples, Salerno and Nola). 

The ribbon-cutting ceremony in the presence of Mr. Giulio Gallera, Regional Minister of Health for Lombardy.

In every region, the tour will also be preceded by an informative forum open to the general public, which will be attended by members of the medical-scientific community, managers of regional health care services and from civil society. 

The opening ceremony took place in Varese on 21 September, in the presence of Mr. Michele Monti, President of the Commissione Permanente Sanità e Politiche Sociali (Permanent Commission on Health and Social Policies). On that occasion, Mr. Michele Corcio, Vice President of IAPB Italy, stated that: “This is a ‘manifesto’ initiative, which helps people and encourages institutions to invest in health prevention.”

Mr. Tiziano Melchiorre, Secretary-General of IAPB Italy, and Mr. Francesco Boccia, Minister of Regional Affairs and Autonomies

Institutions were also present today at the Milan event, with Mr. Francesco Boccia, Minister of Regional Affairs and Autonomies, and Mr. Giulio Gallera, Regional Minister of Health for Lombardy, both accompanied in the picture by Mr. Tiziano Melchiorre, Secretary-General of IAPB Italy.

Find out when you can book an eye exam near you by visiting the following website: https://iapb.it/vistainsalute/

WHY BOOK AN EXAM?
Glaucoma, diabetic retinopathy and maculopathies are a set of pathologies that overall affect more than 3 million people in Italy. Such diseases can cause blindness and their incidence is destined to increase as the population ages. Retinal and optic nerve diseases are often asymptomatic in the early stages, while they are very difficult to treat once they have fully developed. These pathologies can damage the optic nerve, and once any damage has been done, it cannot be fixed. That is why early diagnosis will become increasingly important and is the reason that prompted IAPB Italy to launch such a vast prevention campaign. 


The blindness of inaction

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On 11 June 2019 the Parliamentary Intergroup for Sight Prevention was presented in Rome at the Chamber of Deputies. Its objective is to bring eye health prevention to the heart of Italian health policies, with the ambitious goal of saving the sight of Italian citizens through good health-care practises

This initiative was promoted by a group of MPs in the wake of a number of awareness campaigns run by the International Agency for the Prevention of Blindness – IAPB Italy, which carried out a screening for retinal and optic nerve pathologies at the premises of Italy’s lower and upper chambers. 

At least three million Italians are affected by eye diseases that compromise the retina and the optic nerve, such as diabetic retinopathy, glaucoma and age-related macular degeneration, each affecting about one million people. 

Paolo Russo MP, President of the Parliamentary Intergroup for Sight Prevention, has stated that “prevention is an absolute necessity.” Dr. Marco Verolino, Head of Ophthalmics at the Ospedali Riuniti Area Vesuviana ASL Napoli 3 Sud, added that “today the best cure for problems of the visual system is still prevention.” 

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Amongst the speakers was also Mr. Giuseppe Castronovo, President of IAPB Italy, who stated: “Prevention is maybe the noblest word. […] If we are talking about the prevention of blindness, then it becomes a wonderful word, especially for me, since I lost my sight at the age of nine to a World War II shell. […] We always insist that people must go to an ophthalmologist for an examination. […] Prevention needs to be in place from birth and maybe, if possible, even before (from gestation).”

Prof. Filippo Cruciani, scientific advisor of IAPB Italy, explained that “researchers are committed on various fronts and they have produced some results, but we especially need to invest in prevention, both in primary and secondary terms. Primary prevention basically means lifestyle, while secondary prevention consists of early diagnosis, when diseases are still in the asymptomatic stage. Unfortunately prevention is still not widespread in Italy.

Speakers:

Paolo Russo MP, President of the Parliamentary Intergroup for Sight Prevention (FI)
Giuseppe Castronovo, President of IAPB Italy
Guido De Martini MP, Member of the Social Affairs Committee of the Chamber of Deputies (Lega)
Dr. Marco Verolino, Head of Ophthalmics at the Ospedali Riuniti Area Vesuviana ASL Napoli 3 Sud
Prof. Filippo Cruciani, scientific advisor of IAPB Italy

Videochat with the ophthalmologist

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On 10th May Prof. Paolo Nucci, Director of the University Ophthalmology Clinic-S. Giuseppe Hospital in Milan, will answer questions on pediatric ophthalmology during the IAPB Italy Facebook streaming

prof._paolo_nucci-mi-web.jpgLet’s shed light on sight. The main topics in contemporary ophthalmology are periodically discussed on videochat by the International Agency for the Prevention of Blindness-IAPB Italy.

A number of high profile experts have been invited to take part in the initiative.

The episode scheduled on 10th May 2019 will be dedicated to pediatric eye diseases on Facebook streaming: prof. Paolo Nucci, Director of the University Eye Clinic of San Giuseppe Hospital and Professor at the University of Milan, is going to answer your questions live.

The presenter of the videochats with the ophthalmologist is always Ms Livia Azzariti, one of RAI’s (Italy’s public national broadcaster) most renowned journalists for medical-scientific news programs.

HOW TO ASK YOUR QUESTIONS

You can put your questions, concerning the main topic of the interview, to the guest expert writing a post directly on our Facebook page. All the pertinent questions will be selected and the guest ophthalmologist of each episode will answer them during the video interview, which lasts 30 minutes, usually from 11 to 11:30 a.m.

You can also send an email to videochat@iapb.it at least one day before each episode.

PREVIOUS EVENTS

caporossi-e-azzariti-videochat-15_aprile_2019-web.jpgThe previous episode was with Prof. Aldo Caporossi – Director of the Ophthalmology Dept. at the A. Gemelli University Hospital in Rome – who talked about astigmatism and keratoconus on 15th April 2019 by Facebook streaming.

The episode of the 1st April was dedicated to macular diseases, first cause of central blindness in the most developed countries worldwide: Dr Monica Varano, Scientific Director of IRCCS Fondazione G.B. Bietti (Foundation in Rome), talked about them by Facebook streaming.

The episode of 20th March 2019 was dedicated to glaucoma on Facebook streaming with Prof. Gianluca Manni, University of Rome “Tor Vergata” (watch again).

The episode of 8th February was dedicated to the dry eye: Dr. Alessandro Lambiase, Professor of Ophthalmology at the Sapienza University in Rome – who in the past also worked with the Nobel Prize winner Rita Levi Montalcini performing research on neurorigeneration -, answered the questions live (watch again).

Prof. Francesco Bandello, Chief of the Department of Ophthalmology at San Raffaele Hospital in Milan, spoke about diabetic retinopathy: on 19th November 2018 during a live streaming on IAPB Italy’s Facebook page.

The previous 19th September episode was dedicated to the cataract, with the guest being Dr. Matteo Piovella, President of the Italian Society of Ophthalmology (SOI). This interview can be viewed on the IAPB Italy Facebook page, where previous episodes are also available.

Prof. Emilio Balestrazzi, former Director of Ophthalmology at the Polyclinic A. Gemelli in Rome (Università Cattolica), spoke about retinal detachment on 25th June 2018 (watch the video-chat again), whereas the very first videochat was held on 30th May with Prof. Filippo Cruciani (former professor of Ophthalmology at Sapienza University in Rome and Senior Consultant of the National Centre for Vision Rehabilitation) (watch again).