Tonometry tests, a webinar with specialist guests on local TV channels, a dedicated website and informative leaflets distributed in 160 supermarkets: these are the initiatives promoted by the International Agency for the Prevention of Blindness – IAPB Italy to combat glaucoma, “the silent thief of sight”…

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The telemedicine experience of “Linea Verde”, a toll-free consultation service

linea verde

“Line Verde”, a toll-free eye health consultation service provided by IAPB Italy, is an example of telemedicine. After being active for several years, it proved its worth during the hardest months of the Covid-19 pandemic in 2020. In this interview, Sara D’Angelo and Martina Genzano, two ophthalmologists in charge of the service, describe their experience during the Covid-19 emergency period.

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The National Center on Low Vision at the World Ophthalmology Congress

Congresso Mondiale Oftalmologia

Spotlight on vision rehabilitation during the Live program. Italy sets the international standards on rehabilitation but doesn’t provide the same level of service everywhere in its national territory. “Training, multidisciplinarity, and telerehabilitation are at the heart of both our research activities and our collaboration with the WHO”, says Dr. Filippo Amore, director of the center.

The biennial edition of the World Ophthalmology Congress was held between 26 and 29 June 2020 and it was the first to be organized online as a virtual experience.

The National Center on Low Vision gave two presentations at the Congress: the first focused on the curricula for vision rehabilitation operators; the second revolved around the state of vision rehabilitation in Italy.

“Those two areas are connected,” explains Dr. Filippo Amore, director of the National Center and guest speaker at the Congress. “Through the National Center on Low Vision – which has recently been confirmed as a WHO Collaborating Center for the third triennium in a row – Italy has set the international prerequisites in the field of vision rehabilitation and for the curricula which are recognized by the WHO as the gold standard for the training of vision rehabilitation operators. At the same time, our country lacks the necessary professional skills – in terms of the number of operators and training courses – and resources that would make rehabilitation available to visually impaired people who could really benefit from it, and that’s at least one million people”.

“The international effort of the Center also stems from a desire to help our country. Through scientific research, technological innovation, and training, we wish to extend the best practices in vision rehabilitation both to other low vision centers in Italy and to the national health systems of foreign countries, in the latter case thanks to our collaboration with the WHO”.

“We are currently working on the adoption of remote rehabilitation techniques, to cater to the needs of people who cannot access rehabilitation services near home. We contributed to the development of a software called Eye Fitness, which provides a home-based training platform that can be remotely controlled by our operators”.

These same topics were also discussed during one of the main sessions of the Congress Live program, in front of a virtual audience of 130 experts from all over the world.

“Participating in one of the leading international events in the field of ophthalmology is a great recognition of our work and our multidisciplinary approach, which brings together psychological and ophthalmological assistance, training of the residual vision and also in the use of optical, digital and electronic aids. For us, this was also an opportunity to stress that vision rehabilitation is and should be considered an integral part of eye care. When nothing else can be achieved through surgery or medicines, there’s still a lot that visually impaired people can do to safeguard and regain their personal autonomy. This has been our message since the foundation of the National Center in 2007, and it’s a message that is gathering increasing scientific evidence and international support”.

Collaboration with the WHO reconfirmed

World Health Organization

The WHO has reconfirmed the National Center on Low Vision as a reference point in the field of vision rehabilitation for the third triennium in a row.

From May 2020 until May 2023, the National Center on Low Vision and Vision Rehabilitation at the Gemelli hospital in Rome will work alongside the WHO with two different objectives: setting the standard parameters to assess the quality of eye care in countries around the world and conducting a study on the benefits of vision rehabilitation on elderly patients affected by cognitive decline.

“These are two fairly unexplored areas and the National Center, as a WHO Collaborating Center, will pave the way forward”, explained director, Dr. Filippo Amore. “In regard to the assessment parameters, we will provide the WHO with a new tool: a set of guidelines, which the WHO will pass on to its member states so as to assess the state of eye care services around the world more coherently”. The second aspect deals with the possible benefits of vision rehabilitation in elderly patients with cognitive decline. Even though the relationship between sensory deficit (vision/hearing impairments) and cognitive impairment is well documented, there is no evidence of the benefits that sensory rehabilitation can bring in terms of reducing, halting, or inverting the progression of the degeneration. “This is an important aspect,” Dr. Amore explained, “which needs to be demonstrated in order to state that, as we strongly believe, rehabilitation is an integral part of eye care and deserves to be enhanced in different courses of treatment”.

It is not the first time that the National Center, headquartered at the Gemelli Polyclinic hospital in Rome, has collaborated with the WHO. In fact, this is the third 3-year based collaboration period that has just started, and the WHO has entrusted the National Center with a leading role.

“This is an important achievement,” Dr. Amore said, “a confirmation of the quality of the work we have done so far in setting, among other tasks received by the WHO, the international standards in vision rehabilitation and the training path that must be undertaken by health professionals who will deliver vision rehabilitation services”.

“However, such recognition is not a finishing line, but rather an incentive,” added the director. “The National Center on Low Vision has a leading role in the field of vision rehabilitation, both in Italy and around the world, and this is a role that comes with specific responsibilities. The first is continuing research by combining the delivery of vision rehabilitation services and studies aimed at their improvement, while preparing patients to be taken on by other specialized centers in Italy. The second task is to draw the attention of the general public and the decision-makers to the importance of rehabilitation itself, and on the limited means we currently have at our disposal in Italy”.

“The National Center is a rare pocket of excellence, since it combines the multidisciplinary competences of psychologists, ophthalmologists, orthoptics, etc. In this way, we can help our patients accept the consequences of vision impairment and regain their personal autonomy, even when surgery and medicines cannot grant any further improvement. The message we want to send out is this: rehabilitation is an integral part of care, together with prevention and treatment. It is a fundamental resource for patients who have lost a considerable portion of their sight, even when their vision impairment is irreversible. Therefore, it is important to develop a network of rehabilitation centers all over our national territory, with specialized and multidisciplinary staff. With the National Center, Italy has set the gold standard in this field internationally, however, our country needs trained personnel and consistent investment in order to make rehabilitation available throughout our national territory”.

How to overcome the COVID aftermath: video contents by the National Center on Low Vision

Filippo Amore

The long period of mandatory social distancing will be particularly hard on people affected by vision impairment. This is why the operators at the National Center on Low Vision and Vision Rehabilitation – the only WHO collaborating center for vision rehabilitation – have launched a video initiative to remain close to their patients. “We wish to be useful, even if from a distance,” stated Dr. Filippo Amore, ophthalmologist and director of the National Center, which was inaugurated ten years ago at the Gemelli hospital in Rome by the Italian branch of the International Agency for the Prevention of Blindness-IAPB Italy. “We want to allow our patients to refresh their rehabilitation training program and show what a great opportunity this is to reclaim one’s autonomy, and also for people who have never heard about this possibility”.

“The main reason is that undertaking a vision rehabilitation program has helped our patients be better prepared for the challenges of the COVID-19 pandemic. Both psychological counseling and knowing how to use the many optical and digital aids available today were points of strength that helped fight back against loneliness, sadness, and social isolation”.

“Anybody who is familiar with vision impairment knows that there is no magic formula because lost vision cannot be recovered. However, not enough people are aware that there’s an aspect in which we can still make a big difference: personal autonomy”.

“Many visually impaired people have started to live again thanks to rehabilitation. But many more could also learn how to benefit from it”.

“Together with our patients,” Dr. Amore concludes, “In these videos, we look for solutions to real problems of their everyday lives: how they can solve these issues by themselves or when it is necessary how to seek the help of others. With their contribution and that of the talented operators at the National Center on Low Vision, we will look for the best strategies that can make a difference in granting patients the freedom to engage in relationships, satisfy their needs, attend to their personal matters and look after themselves independently, thus building confidence and self-empowerment, and achieving a fulfilled sense of living, that visually impaired people are fully entitled to”.