(by Nicola Simonetti) Killer are three irreversible diseases (glaucoma, diabetic retinopathy, maculopathies) that a prevention based on non-invasive annual specialist visits could have avoided.
So it is not even in Italy where, on the initiative of the International Agency. Prevention of Blindness - Italy onlus, eye screening was carried out among parliamentarians, finding "among those who underwent the examinations - commented Dr. Marco Verolino, head of ophthalmology at Ospedali Riuniti Area Vesuviana - ASL Napoli 3 Sud, who was the coordinator - that 65 percent do not perform a full fundus eye examination on a regular basis once a year and that 35 percent only have a fundus examination as a result of visual disturbances. If we consider he continued - that, in this case, it is a segment of people who, for various reasons, should be particularly warned, we can understand how much still remains to be done in the field of prevention "(ItalianHealth Policy Brief (IHPB). CEIS-University of Rome Tor Vergata). A premise - this - to the constitution of the parliamentary intergroup.
“We need to act with determination, also intervening - said the Hon. Paolo Russo, president of the Parliamentary Intergroup and himself an ophthalmologist - on the legislative level and the answer can only come from the fact of promoting the adoption of health policy choices that make possible new management models - systematic and structural - that allow to face this specific health sector according to the indications and suggestions of the international scientific community. Considering that in our country we have uncommon scientific-technological potential and skills, which in any case must be put into a system in a synergistic way - he continued - not intervening would be a grave fault ".
There are essentially four areas in which the Intergroup will operate:
- promotion of health policies that put sight protection and eye disease prevention at the center of the country's health agenda;
- launch of legislative and political initiatives able to urge the Government and Regions to adopt measures that can guarantee to all citizens and throughout the territory better prevention and better treatment of eye diseases, as well as access to services visual rehabilitation;
- creation of favorable conditions for a wider adoption of the screening activities aimed at achieving an improvement in the levels of assistance and a reduction in costs for the National Health Service;
- to give impetus to initiatives for standardization and centralization of clinical data that allow for the optimization of knowledge and synergies between the various health facilities in the country.
Technical advisory body of the Parliamentary Intergroup will be the same International Agency for the Prevention of Blindness-IAPB Italia onlus, which is already heavily involved in numerous awareness-raising initiatives and which, beyond what has already been done at the Chamber and Senate, is getting ready to launch other projects on a national scale with the support of the ItalianHealth Policy Brief (IHPB).
“Prevention - said, at the conference held in Rome - the lawyer. Giuseppe Castronovo, president of IAPB Italia onlus - is a duty of every person: among other things, it allows you to avoid many eye diseases and considerable suffering, as well as an important increase in public spending. For this reason, citizens must periodically go to the ophthalmologist and bring their children there. As Leonardo da Vinci said, sight is the master of the senses. This is why we must never neglect it: only in this way can we always have light in life ".
The emergence of new and more effective management paradigms for optic-retinal pathologies could produce healthy contributions to the sustainability of health spending. As an example, it is sufficient to recall that, according to a prospective study developed in the 2017 by the CEIS (Center for Economic and International Studies-University of Rome Tor Vergata), diabetic retinopathy, in the absence of an improvement in the welfare situation, will generate an increase in health expenditure of 4,2 billion euros in the 2015-2030 period.
"The research is committed on several fronts and some results have already been given - emphasized Prof. Filippo Cruciani, IAPB Italy's non-profit scientific referent - but what we must especially focus on is both primary and secondary prevention. Primary - he continued - basically means lifestyle while the secondary consists in early diagnosis, when the disease is still asymptomatic; unfortunately the attitude to prevention is still very low in our country ”.
The three diseases under observation:
Il GLAUCOMA, the leading cause of irreversible blindness in the world: it affects 55 million people, while 25 million have already lost their visual abilities because of it (one million are in therapy and the same number in Italy are at risk but they ignore it). “This is epidemic 3.0, a disease of the second and third age 'which, in 2020 - it is expected - will affect 80 million people worldwide.
Glaucoma attacks the optic nerve and can lead to blindness and is - says the Italian Association for the Study of Glaucoma - a new, silent threat to the world population. The treatment of glaucoma is very expensive and already has a significant impact on national health expenditure which, in the future, will be further burdened by the socio-welfare costs of supporting such a large slice of the population that it will no longer be self-sufficient because it is blind ".
A subtle disease that, in the chronic form does not even give symptoms while too high eye pressure is "silently" damaging the vision. First warning are small dark “spots” (scotomas) on the periphery of the visual field (the one that can be seen without moving the head) that narrows gradually until reaching a telescope vision (“tubular”) and, in worst cases, l complete darkness. If not treated in time, the form leads to no loss of visual function.
Objective to reach, therefore: to immediately identify the ignored cases of glaucoma: they are half a million in Italy; when the affected ones will notice at least the 40% of their visual capacity will already be lost.
The prevalence of the disease increases with age and often occurs before the age of 40. At this age and, in any case, when the first signs of presbyopia appear (blurred near vision) or there is familiarity, it is necessary to undergo an eye check that includes the measurement of ocular pressure. But only 21% of Italians have had a vision check in the last 5 years.
La DIABETIC RETINOPATHY: Six out of a hundred Italians suffer from diabetes but in three out of 10 of them the disease has, in some way, also affected the retina (an "extension" of the brain whose nervous tissue captures and transmits visual stimuli in the center) and, in the absence of therapy and adaptation of life rules, in perspective, it will irreparably damage it as a result of damage accumulated over time in the small blood vessels of the retina. It affects 42 and 1/2 million people worldwide and is the leading cause of blindness in working age and, if type 1 diabetes is diagnosed after the age of 30, it is 20%; 5-40% after 50 years of illness, after 10 years and more than 90% after 20 years. Damage to the retina is preventable by controlling diabetes. Also testing blood pressure in type 2 diabetic reduces the risk of micro-vascular disease by 37%, the progression rate of diabetic retinopathy by 34% and the risk of worsening of visual acuity by 47%.
This pathology, if it does not improve the welfare situation, will increase the health expenditure of 4,2 billion euros in the 2015-2030 (univ. Tor Vergata Rome).
maculopathy: 200 is interested in millions of people around the world; one million in Italy. Among the acquired, more widespread age-related macular degeneration (AMD); in the over 55 it is the main cause of legal blindness in the western world. Two forms of AMD: the dry (atrophic) with slow and less aggressive evolution for which there is no specific therapy, and the moist (exudative), sometimes evolution of the first. Therefore, onset and evolution of retinal pathology should be followed.
The humid, less common, but more aggressive, more rapid evolution, presents new retinal blood vessels in the macula (center of the retina).
Any maculopathy should be diagnosed early (periodic visits required) to resort to intravitreal anti-VEGF injections (against, that is, growth factors involved in angiogenesis, formation of new blood vessels invading the retina).