(by Nicola Simonetti) Diabetic retino and maculopathy are the most common microvascular complications of diabetes mellitus (DM) and are the leading cause of non-traumatic blindness in adults aged between 20 and 74 years, in addition to being the fifth cause of preventable blindness and severe visual impairment. In April, 2016 NCD Risk Factor Collaboration * presented the results of the largest epidemiological survey ever conducted on diabetes based on 751 population studies, covering 146 countries with 4,4 millions of participants over a period of 34 years (1980-2014).
The data presented are alarming: the number of diabetics has quadrupled from 108 million in 1980 to 422 millions in 2014 and, if this trend is confirmed in the coming years, 2025 are expecting 700 millions of patients with a consequent economic collapse of all health systems.
In Italy, according to this study, we have moved from 2,4 millions of diabetics in 1980 to 4,3 millions in 2014. The reasons for this epidemic are due to the increased longevity and life expectancy, the increase in obesity and overweight, the higher levels of urbanization, sedentary life and a diet rich in sugars.
In 2010 more than a third of Italian diabetics had signs of diabetic retinopathy and about one in ten had severe abnormalities, including diabetic macular edema (EMD): a condition that leads to loss of vision central but, unlike retinopathy, tends to stabilize over the course of the natural history of the disease.
At national level, there are no data on prevalence and incidence in diabetic patients of legal blindness (visual residual not higher than 1 / 20 in the best eye), nor a registry of subjects with diabetes mellitus (DM). Epidemiological findings show, however, that the presence of diabetic retinopathy (RD) is found in about a third of diabetic individuals, and about 2% of patients with diabetes develops a severe form of this complication.
More specifically, as reported by the Italian Ophthalmology Society and the Italian Diabetology Society, when diabetes mellitus (DM) is diagnosed over 30 years of age, the prevalence of diabetic retinopathy (RD) varies between 21% in individuals with diabetes occurring from less than 10 years and 76% in those with more than 20 years from the diagnosis of diabetes: on average the 30-50% of the diabetic population is affected by retinopathy in the form of varying severity.
Official data indicate that individuals with diabetic retinopathy (RD) in 2012 were at least 625.000. The cumulative incidence of retinopathy over a five-year observation period also varies from 35% to 60%, depending on whether they are elderly patients treated with diets alone or young people with 1 type diabetes. We can hypothesize an estimate based on a simple calculation starting from the ISTAT data: if 5,5% of 60 millions of Italians suffer from diabetes mellitus (DM) and if about 30% of them develop diabetic retinopathy (RD ), the latter would affect about a million individuals in our country, of which 220mila would develop diabetic macular edema (EMD).
The epidemiological considerations lead, therefore, to outline a worrying scenario: the progressive increase in prevalence does not seem, in fact, to match an adequate offer of services for the prevention and treatment of RD.
Throughout the month of February, 30 eye care centers of excellence, with dozens of specialists, will be available for free visits and diagnoses aimed at discovering maculopathy and retinopathy, serious complications of diabetes; pathologies that undermine sight and can lead to blindness.
This large screening campaign to identify a disease that involves serious complications at an early stage is carried out with the participation of public and private centers, with the contribution of universities and scientific societies and with the sponsorship of municipal and ministerial bodies.
In this way a new concept of health care is achieved; the achievement of an optimal health condition both for the individual and for the community, where the task is not only of the State, but of the society as a whole that contributes to ensuring psychophysical well-being with careful prevention and incisive therapy . From the ancient nineteenth-century Welfare State is moving to the Welfare Community with the active and conscious participation of the whole society in its many forms.
And of course the information, capillary and complete, plays a fundamental role. The February campaign, which is sponsored by the Ministry of Health, also aims to make a model of collaboration begun in recent years between the public health managers and the 30 eye centers that have joined the initiative, making available for free both their specialists are the expensive and up-to-date equipment.
Promoted by the Ambrosian Ophthalmic Center of Milan (of which Dr. Lucio Buratto is scientific director) and by the San Raffaele Hospital of Life Health University of Milan (of which Professor Francesco Bandello is an ordinary ophthalmologist), screening aims to identify the "submerged" cases that often, coming too late to the specialist's observation and diagnosis, become much more difficult and burdensome to treat.
At the base of a mobilization that starts from the front line of opticians and pharmacists and passes from the network of family doctors, there are numbers of a red alert on diabetes, so that the World Health Organization has spoken of "pandemic": in the world diabetics are 443 million, and it is estimated that they will rise to 700 millions in 2025.
In Italy, according to ISTAT, diabetes affects 5,5% of the population, about 3,2 millions of people. Many of them - if not diagnosed and treated in time - risk serious visual impairments and even blindness. We must save them from the darkness.
February, month of prevention against diabetic maculo and retinopathy The 30 centers for free visits
The month of Maculo Prevention and Diabetic Retinopathy promoted by the Ambrosian Ophthalmic Center of Milan (CAMO) together with the IRCSS San Raffaele Hospital of Milan will start Monday 4 February 2019 and will end Thursday 28. This important free initiative was sponsored by the Ministry of Health, the City of Milan and the Italian Ophthalmology Society.
The Centers where screening can be performed are 30, distributed throughout the national territory. 8 in Lombardy, 4 in Puglia and Tuscany, 3 in Campania, 2 in Piedmont. And then Liguria, Veneto, Umbria, Marche, Lazio, Abruzzo, Molise, Sicily and Sardinia.
A free screening carried out by qualified medical-ophthalmic teams; equipped with state-of-the-art equipment and software such as the artificial intelligence of Eye Art; a computer that uses an algorithm capable of processing millions of data on ophthalmological diseases and equipped with a very sensitive camera capable of noticing even the slightest signs of the onset of the maculopus and diabetic retinopathy.
The 30 centers:
- ABRUZZO - CHIETI / PESCARA - Ophthalmology Clinic "G. d'Annunzio "- Via dei Vestini 1
- CALABRIA - CATANZARO - University "Magna Grecia" OU of Ophthalmology - Viale Europa
- CAMPANIA - SALERNO - AOU Saint John of God and Ruggi d'Aragona - SC of Ophthalmology - Largo City of Hippocrates
- CAMPANIA - NAPLES - UOC Ophthalmology Hospital of the Hills - Via Leonardo Bianchi
- CAMPANIA - NAPLES - Cardarelli Cardio Surgery - via Cardarelli 9
- LAZIO - ROME: GB Bietti Foundation for Ophthalmology Rome - Via Livenza 3
- LIGURIA - GENOA - UOC University Ophthalmology - DiNOGMI University of Genoa - IRCCS San Martino Polyclinic Hospital - Viale Benedetto XV 5
- LOMBARDIA - MILAN: Neovision Eye Clinics. C.so Vercelli 40 - Via Procaccini 1 - Viale Restelli 1
- LOMBARDIA - MILAN: CAMO - Ambrosian Center Ophthalmic - Piazza della Repubblica 21
- LOMBARDIA - MILAN: Ophthalmology University Vita-Salute IRCCS San Raffaele Hospital - Via Olgettina 60
- LOMBARDIA - LEGNANO: Ophthalmology Operative Unit - ASST Ovest Milanese - Ospedale Nuovo di Legnano - Via Papa Giovanni Paolo II CP 3
- LOMBARDIA - VARESE - Circus Hospital Fondazione Macchi Oculistica Clinic of the University of Insubria - Viale Borri 57
- MARCHE - ANCONA - Ophthalmology University of Ancona - Via Conca 71 - Ancona
- MOLISE - CAMPOBASSO - Campobasso Hospital - Contrada Tappino
- PIEMONTE -ALESSANDRIA - S. Antonio and Biagio Hospital and C. Arrigo - Via Venezia 16
- PIEDMONT - CUNEO - Cuneo Hospital - Via Michele Coppino 26
- PUGLIA - CANOSA (BT) - "Fallen in War" Hospital - Via G. Bovio, 81
- PUGLIA - BARI - Ophthalmology Division Hospital of Venus Bari - Via Hospital of Venus 1
- PUGLIA - BARI - Bari Polyclinic University Ophthalmology Clinic - Piazza Giulio Cesare 11
- PUGLIA - LECCE - Vito Fazzi Hospital - Piazzetta Muratore
- SARDINIA - SASSARI - Ophthalmology Clinic AOU Sassari - Viale San Pietro 43
- SICILY - CATANIA - Ophthalmology University of Catania Policlinico Rodolico - Via Santa Sofia 78
- TUSCANY - AREZZO: Ophthalmology Division of the Hospital of Arezzo - Via Pietro Nenni 20
- TOSCANA - CARRARA - Massa and Carrara Ophthalmology Complex Operating Unit - Monterosso Polysecial Center "Achille Sicari" - Piazza Sacco e Vanzetti 1
- TOSCANA - SIENA - Ophthalmology University of Siena Policlinico S. Maria Alle Scotte - Viale Bracci 16
- TUSCANY - FLORENCE - Ophthalmology University of Florence - Largo Brambilla 3
- UMBRIA - PERUGIA - Hospital of Perugia - Santa Maria della Misericordia Hospital - Via Sant'Andrea delle Fratte
- VENETO - VERONA - Verona Integrated University Hospital Piazzale Aristide Stefani 1