The initiative of prof. Lucio Buratto sponsored by the ministry of health: free visits to centers in Italian regions
(by Nicola Simonetti) Senile maculopathy, a disease that fogs and often completely removes the sight. It is the main cause of blindness that affects over one million people in Italy and occurs every year with 80 thousand new cases. But the risk has been known for 3 out of 10 of the 70 years. But only 11% of those over 54 years know about the risk according to a national demoscopic survey commissioned by the Ophthalmic Ambrosian Center to verify the knowledge of Italians on Age-related Macular Degeneration (DMLE).
It is the disease of old age, of a population whose life expectancy is prolonged more and more but it is a life without quality, compromised by the progressive and unstoppable loss of sight: the faces are no longer recognized, the colors are not distinguished , the newspaper lines appear crooked, driving the car becomes a danger for oneself and others. The World Health Organization, at the end of 2019, in listing the medical-social priorities that must be addressed in the near future and the greatest risks that threaten health has estimated that in the next 30 years the blindness caused by Age-related Macular Degeneration will pass in the industrialized countries from the current 40 million to 120 million: that is, it will triple. (source Lancet Public Health). In fact, according to the WHO, 45% of cases of irreversible loss of central vision are caused by senile maculopathy.
Symptoms are often spent absent in the initial forms. The initial symptom of maculopathy may be the distorted vision of the images (metamorphopsia) linked to the anatomical alteration at the level of the photoreceptors which, being no longer perfectly aligned, create the distortion. Next to this there may be the appearance of a black spot attached to the gaze (scotoma).
“Something had to be done - said Lucio Buratto, Scientific Director of the Ambrosiano Oftalmico Center - in the face of a situation that is becoming more and more a serious social problem. A major awareness campaign was needed throughout the territory that would explain the serious risks of maculopathy to the majority of Italians in their fifties, and make them aware of the need to undergo diagnostic tests that allow to detect the possible presence of maculopathy and we set up the Month of Prevention during which the best ophthalmologist specialists are available free of charge in centers of excellence in hospitals, universities and private individuals, scattered throughout the territory to provide an accurate examination and the necessary therapeutic indications. An initiative of great social and medical commitment that is repeated every year, which has now carried out a large screening on thousands of patients and which, precisely because of the high social mission exercised, has the patronage of the Ministry of Health and the Italian Ophthalmological Society ".
"These prevention campaigns - says Professor Francesco Bandello, Director of the Ophthalmology Clinic of the Vita-Salute University of San Raffaele, who together with Dr. Buratto directs these initiatives - in addition to providing patients with comprehensive information, promote and accelerate the diagnostic process. Getting to the diagnosis quickly in chronic eye degenerative diseases is the most important step. And this step is easy to take because it consists of a non-invasive examination (OCT), which is a kind of CT scan of the retina), which is painless and lasts a few moments. Promoting access to therapies in order to prevent blindness and limit the trauma of visual impairment as much as possible is among the objectives of the screening carried out in the Month of Prevention. It should not be forgotten that the AMD compromises the quality of life, limiting the autonomy of movement and with the discomforts of a seriously defective sight ".
Scientific research for years has been studying the most effective means of treating senile maculopathy. As is known, there are two forms of this pathology: a so-called dry that has a slow but unstoppable progression. Different the so-called wet (or exudative) form which has a lower frequency (about 20% of cases) and against which research has achieved effective therapeutic objectives. The wet form is caused by abnormal blood vessels produced by the VEGF molecule i.e. vascular growth factor, which compromise the visual function of the retina. The therapeutic gold standard for the disease in its wet form is represented by a continuous treatment based on intravitreal injections of anti-VEGF drugs, a class of molecules that acts by inhibiting the proliferation of new blood vessels inside the retina and by limiting the loss of retinal fluid.
There are different classes and generations of drugs, some were synthesized over 10 years ago and others are molecules developed in recent times. The latest achievements, which have also already gained approval from the American Drug Agency, demonstrate a longer duration of action in controlling and inhibiting retinal fluid. "This means - explains Professor Giovanni Staurenghi, Director of the Ophthalmology Complex of the Fatebenefratelli hospital, Sacco di Milano - that the interval between one intravitreal injection and the other could lengthen and guarantee, with the same result, a lower number of annual injections. Furthermore, the reduction of administrations would make it easier for the patient to comply with the doctor's prescription and, for the doctor and health facilities, to manage a high number of patients ”.
On 10 July 2019 the Food and Drug Administration (FDA), the US government body that deals with the regulation of food and pharmaceutical products, approved the use of brolucizumab) for the treatment of exudative senile maculopathy (AMD).
On 16 December 2019, the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) also gave a positive opinion on the approval of brolucizumab for the treatment of wet age-related macular degeneration (AMD).
It is a drug that affects all VEGF-A isoforms. It has the advantage, compared to other drugs, of being a small molecule that penetrates the retina very well. It disappears immediately from the bloodstream, thus reducing the risk of systemic side effects.
Starting from the certainty that the best cure is always prevention this year there are 23 Centers in 13 regions where you can carry out a free examination aimed at detecting these two disabling pathologies that, if not diagnosed in time, can lead to blindness.