A mobile unit in three regions for free visits and exams: unexpected first results
(by Nicola Simonetti) The campaign for the prevention of retinal and optic nerve diseases that the Ministry of Health has entrusted to the management of the International Agency for the Prevention of Blindness - IAPB Italia Onlus, on the basis of a three-year funding approved by Parliament in the 2019 Budget Law, it began in three Regions: Lombardy, Abruzzo and Campania (all other Regions will follow within 3 years).
A mobile structure equipped with three clinics and hi-tech diagnostic equipment with very sophisticated equipment has made it possible to carry out a large number of reports of the images of the computerized optical tomography (OCT) and of the photographs of the ocular fundus. The specialist staff has interfaced with local institutions to overcome the stumbling block of long waiting lists for further investigations and any necessary interventions for those who need them. An initiative that has proved invaluable for early diagnosis and prevention as well as allowing the acquisition of data to be used for research and programming of interventions.
The first data showed: "in 40 per cent of the subjects examined (between 40 and 90 years old, average age 63 years) there were signs of ongoing disease or suspected disease or, again, premonition of disease".
This - says the lawyer. Giuseppe Castronovo, President of IAPB Italia Onlus - makes us understand how widespread the threats weighing on our vision and of which unfortunately we are not too often aware of. Vision is a precious commodity, an enormous patrimony that we inherit and must preserve and this campaign goes in the right direction: that of raising the culture of prevention and stimulating the adoption of adequate contrasting measures ".
"First results, unexpected, which demonstrate the usefulness of the initiative and which - said the moderator dr. Marcello Portesi - innovating on the subject, he proves to be a virtuous example of the use of public money.
The professor. Filippo Cruciani - IAPB Italia scientific contact - states that "12,8% of the subjects examined were suspected of glaucoma, age-related macular degeneration in about 6%, the vitreo-retinal interface syndrome in 12,1 %, myopic chorioretinosis in 3,24%, hydrusen (small protein-lipid formations that form under the retina) in 11,35%, atrophy in 4,14%, just to mention the most frequently emerged pathologies ".
Glaucoma, called for the absence of symptoms "silent thief of sight", affects 1 million people in Italy, half of whom do not know they are ill. Prevention is therefore a fundamental element and this campaign traces the way to improve, through an early diagnosis, the evolution of this pathology, as well as in the case of age-related macular degeneration and diabetic retinopathy.
"The set of data, information and ideas that will be collected and systematized with this three-year campaign, will allow us to have a solid platform on which to base new and more effective choices of health policy for visual protection - says the Hon. Paolo Russo, ophthalmologist and president of the Parliamentary Intergroup for the Protection of Sight - the fact that the lengthening of the average life inevitably leads to an increase in the pathologies of sight for which the most effective embankment is certainly prevention, also for the sustainability of healthcare spending ".
Let's focus on three eye diseases
Glaucoma
Glaucoma is considered the leading cause of irreversible blindness in the world: according to the World Health Organization (WHO) it affects 55 million people, while 25 million have already lost their visual abilities because of it. This ocular disease in the chronic form does not even give symptoms: generally too high ocular pressure "silently" damages vision. First, small dark "spots" (scotomas) appear on the periphery of the visual field which can then be progressively narrowed down to a telescope ("tubular") vision and, in the worst cases, complete darkness is reached.
In Italy about one million glaucomatosis are estimated: the disease would affect 3,5% of people aged between 40 and 80. Therefore, cases of glaucoma still undiagnosed should be identified promptly, that is, about half a million people only in our country.
Diabetic retinopathy
According to the WHO, there are 422 million diabetics worldwide. Istat writes (2017) that in Italy the prevalence of diabetes is estimated at around 5,3% of the population (over 3,2 million people); it particularly affects the elderly, i.e. 16,5% of people aged 65 and over. If type 1 diabetes is diagnosed after 30 years of age, indicatively the prevalence of diabetic retinopathy is 20% after 5 years of illness, 40-50% after 10 years and over 90% after 20 years. Diabetic retinopathy is the leading cause of working age blindness in Italy and other economically developed countries.
Retinal damage is generally preventable by controlling diabetes. Furthermore, careful control of blood pressure in those with 2-type diabetes has been shown to reduce the risk of 37% micro-vascular disease, the rate of progression of diabetic 34 retinopathy and the risk of worsening acuity visual of 47%.
In a Diabetes Report, the WHO writes: “Diabetic retinopathy is an important cause of blindness and occurs as a result of long-term accumulated damage to the small blood vessels of the retina. […] Diabetic retinopathy caused 1,9% of visual impairment (moderate or severe) globally and 2,6% of blindness in 2010. There are studies that suggest that the prevalence of all types of retinopathy in people with diabetes is 35%, while that of proliferative retinopathy (dangerous for vision) is 7% ".
maculopathies
Maculopathies are a very important cause of loss of central vision in the most advanced countries, including Italy. Among the acquired maculopathies, the most widespread is age-related macular degeneration (AMD), which generally occurs after the age of 55 and is the main cause of legal blindness in the western world. Two types of AMD are recognized: the dry (atrophic) form, characterized by a slow and less aggressive evolution, and the wet (called exudative) form, which can also be an evolution of the former. For this reason it is very important to carefully follow the onset and evolution of retinal pathology. There are currently no specific therapies for dry AMD.
The wet form (exudative or neovascular) is less common, but it is more aggressive and faster evolving. It is characterized by the presence of new retinal blood vessels in the macula (center of the retina). All maculopathies should be diagnosed promptly and, where possible, specific treatments can be used (intravitreal injections of anti-VEGF). It is important that a timely diagnosis is made and, therefore, recourse to periodic eye exams is always necessary.