(by Nicola Simonetti and Donatella Tansella) Four eye diseases, in particular, to keep an eye on and focus on: glaucoma, diabetic retinopathy, maculopathies, keratoconus.
A "band" of thieves of sight that has already "robbed" more than 60 millions of people in the world (30 million have already taken all the visual capital making them blind). If there had been adequate prevention and / or early diagnosis, the marauders would have been "arrested" before doing irreversible damage.
The international and national organizations have acknowledged the urgency to intervene and promote various initiatives to avoid this race for blindness which, unfortunately, is becoming increasingly participated even by the youngest.
Two the most recent and qualified initiatives, with visits and controls offered free to the citizens.
- The universities of Verona (prof. Giorgio Marchini) and of Chieti-Pescara (prof. Leonardo Mastropasqua), with the CAMO (Centro Ambrosiano Oftalmico, dir.Lucio Buratto) and the patronage of the Ministry of Health, organized the "month of prevention "During which special specialist centers, distributed throughout Italy, will be available for free visits. For reservations, visit www.curagliocchi, it
- At the same time, the International Agency for the Prevention of Blindness-IAPB Italia Onlus, with the support of the Italian Parliament, launches the National Campaign for the Prevention of Retinal and Optic Nerve Diseases with free high-tech eye checks which, by the 2021, will involve all the Italian regions. Free tours will be made in a hi-tech truck equipped with 4 laboratories. Information www.vistainsalute.it
In the Abruzzo Region, a telemedicine model will be tested to prevent and control diabetic retinopathy: through a high-resolution photograph of the fundus, taken in outpatient clinics and diabetes centers, which is transmitted in real time to a reading center, where doctors ophthalmologists, remotely, will be able to diagnose the presence of the disease and the subsequent control. This will reduce waiting lists, make life easier for diabetics, allowing them to undergo regular eye exams that can save sight.
The campaign is promoted by the International Agency for the Prevention of Blindness-IAPB Italia Onlus, thanks to the support of the Italian Parliament which, with the latest budget law, wanted to give an incisive response to the great need for visual prevention in the population. The initiative has received the patronage of the Ministry of Health, the Higher Health Institute, the Italian Ophthalmological Society, the State-Regions Conference, the National Association of Italian Municipalities (ANCI), as well as the Parliamentary Intergroup for the Protection of View.
“Sight - says the president of IAPB Italia onlus, lawyer. Giuseppe Castronovo - it is a precious asset, an enormous heritage that we inherit and must preserve from an early age. More than 80% of the information we receive from the environment reaches us from it. Neglecting it could irreparably compromise the autonomy and independence of the person ". Hon. Paolo Russo, president of the Parliamentary Intergroup for the Protection of Eyesight who sponsored the initiative, stressed that "... this campaign is a concrete way to help patients but also a modern way to direct policy towards strategic choices that help prevention paths".
Keratoconus is the leading cause of corneal transplantation.
It is - says Lucio Buratto, ophthalmologist, scientific director of the Ambrosiano Oftalmico and Neovision Center - a progressive disease of the cornea that can cause a reduction, even very serious, of vision. There is a thinning and deformation of the cornea, which tends to become exhausted and protrudes forward, sometimes so evident that it assumes a conical shape.
Usually, the pathology affects both eyes but, often, this happens asymmetrically.
The cornea can be called "the most important lens in the eye" of which it constitutes the anterior part, being a convex-shaped structure formed by transparent fabric.
The cornea, to allow good vision, must have perfect transparency and regular shape. Alterations of one and / or of the other characteristic compromise, in a more or less relevant way, efficiency and ability to see.
A transparent cornea with regular curvature, working "together" with a transparent lens and a healthy retina, allows one eye to see clearly, as long as, of course, the other structures are also normal).
The cause of keratoconus is not known. It is not a hereditary disease even if familiarity is found and, therefore, it is to be suspected if one or more family members are affected, which requires systematic control.
Sometimes keratoconus occurs during growth, in association with allergies, especially when these lead to eye rubbing (it is recommended to avoid it). I suspect any refractive defect with astigmatism that increases over time.
The rate and extent of progression of corneal deformation are extremely variable. Generally, they are more pronounced in the very young and delayed by the "stiffening" of the cornea over the years.
The affected subject perceives a worsening of the visual capacity, usually myopia and, especially, perception of a blurred and deformed image (the light sources are seen as having a luminous tail) that disturb the usual activities.
Specialist examination, corneal topography survey (corneal thickness measurement), OCT (detects some features of the anatomy), aberrometry (provides information on visual quality) are necessary for diagnosis.
When the visual capacity cannot be improved with conservative procedures, corneal transplantation or "keratoplasty" offered by the donor is used.
In Italy they need more than 6.000 which are successful with 95% after one year and 60% after 10.
The national network that deals with donations is valuable. The "Eye Banks" collect 12.000-15.000 corneas / year.
It can be used, but early to avoid transplantation - says Buratto - at the corneal cross-linking (CXL): the cornea, imbibed with riboflavin, is irradiated by ultraviolet light source that strengthens and stabilizes the disease.
Glaucoma is considered the first cause of irreversible blindness in the world and, in the chronic form, it does not even give symptoms: in general, too high an eye pressure "silently" damages the vision. First appear small dark "spots" (scotomas) on the periphery of the visual field which then can be progressively narrowed to a telescope ("tubular") vision and, in the worst cases, complete blindness.
In Italy, an estimated one million glaucoma patients: 3,5% of people between the ages of 40 and 80 years. It would therefore be necessary to promptly identify cases of glaucoma that have not yet been diagnosed, or about half a million people, in Italy.
Diabetic retinopathy (diabetics, worldwide, are 422 million; in Italy 3,2 million).
If 1-type diabetes is diagnosed after 30 years, the prevalence of diabetic retinopathy is approximately of 20% after 5 years of non-properly controlled disease, of 40-50% after 10 years and over 90% after 20 years. Diabetic retinopathy is the leading cause of blindness in working age in Italy and in 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%.
The WHO writes: "Diabetic retinopathy is an important cause of blindness and occurs as a result of accumulated long-term damage to the small blood vessels of the retina.
Maculopathies are very important cause of loss of central vision in the most advanced countries, including Italy. Among the acquired maculopathies (AMD), the most widespread is age-related macular degeneration, which generally occurs after the 55 years and is the main cause of legal blindness in the western world. Two types of AMD are recognized: the dry form (atrophic), characterized by a slow and less aggressive evolution, and the wet form (called exudative), which can also be an evolution of the first. This is why it is very important to carefully monitor the onset and evolution of retinal pathology. Currently there are no specific therapies for dry AMD.
The wet form (exudative or neovascular) is less common, but it is more aggressive and more rapidly evolving. It is characterized by the presence of new retinal blood vessels in the macula (center of the retina). All maculopathies must be diagnosed promptly and, when possible, specific treatments (intravitreal injections of anti-VEGF) can be used. Timely diagnosis is important and, therefore, it is always necessary to resort to periodic eye examinations.