The treatment of glaucoma, which aims to reduce intraocular pressure and the resulting damage to the optic nerve, has been “re-evaluated” and “revolutionized” in recent times. The laser, which came after therapy with daily eye drops, has jumped “to the forefront” of treatments together with new formulations of “slow-release ocular drugs”, which can be administered months later. “The traditional therapeutic approach had a series of problems.” As Stefano Gandolfi, director of the Ophthalmology Clinic of the University of Parma, past president of the Italian Glaucoma Society (Sigla), elected member of the Glaucoma Research Society and in the steering committee of the World Glaucoma Association, illustrates to Adnkronos Salute the latest news on the treatment of the pathology which is “the second cause of blindness in the world. The first is cataract”. (VIDEO)
The use of eye drops, traditionally the first step in glaucoma therapy, presents a first critical issue which is self-administration. It is a “particularly complex procedure and can lead to therapeutic catastrophes – warns Gandolfi – because the drop is administered, but the drug does not enter and, in fact, the patient is not treated”. Then there is therapeutic adherence to consider, because the eye drops must be instilled “at different times of the day”, which is not easy to maintain over time, “especially if another person has to do it. To try to bypass these problems – explains the specialist – laser treatment has been re-evaluated as the first therapeutic option: instead of starting with eye drops and then moving on to the laser, the path is reversed using some treatment modalities that provide a biological effect of the laser, stimulating the tissues that filter away the liquid from the eye to function better, through the energy that is administered, stimulating the stem cells to regenerate the tissue”.
In terms of drugs, “there are innovations in conveying a medicine inside the eye – describes Gandolfi – which no longer involve using eye drops as a vehicle, but slow-release systems which last 1-2 months after administration, or, through a microinjection inside the eye itself, allow us to continue with controlled pressure for several months. And this is another Copernican revolution because, instead of prescribing the drug, we give the prescription to the patient and then rely on his ability to do so. treat ourselves, by administering these slow-release systems, we, as specialists, govern the treatment and the therapeutic path inevitably becomes more reliable. The first slow-release systems were registered about a year ago in the United States and will probably be registered from now on this year within the European Union by the EMA”, the European Medicines Agency.
“Glaucoma – recalls Gandolfi – It is a chronic progressive disease that affects the optic nerve“, due to an increase in intraocular pressure which “creates damage without causing symptoms”. Hence the definition of “silent thief of sight”. Since there are no symptoms, “the diagnosis of glaucoma is almost always accidental, that is, it is found internally of a routine eye test or done for other reasons”. From here it is clear that “it is a disease that must be looked for” and that it is “very insidious, because it does not make itself felt” until it has “corroded the tissues to the point such that the person sees the world he can perceive through his sight as ‘restricted'”. In summary, glaucoma is a “disease that does not cause disturbances, but must be looked for and diagnosed early, because once a piece of view, this is not recoverable. Everything we do is to slow down and stop the worsening.”
Glaucoma is linked to ageing, but risk factors are “familiarity, high myopia and serious cardiovascular comorbidities – lists the expert – It should not be looked for in children, where it is very rare, with particular congenital forms”. On average, the disease “affects approximately 2 in 100 people after the age of 40 and 5-6 in 100 after the age of 70”. Glaucoma has a “strong family history”, so the disease “must be looked for in blood relatives, in the event that a parent or siblings have the pathology: in fact, there is a genetic predisposition and some genes involved are known. Also at risk are the highly myopic, that is, above 10 diopters, and people with serious cardiovascular problems are therefore not hypertensives, but rather “patients with” serious vasculopathies, for example.
Also at the congress of Siso, Italian Society of Ophthalmological Sciences, “we discussed the many innovations regarding glaucoma – reports Gandolfi – such as slow-release systems, systems that allow a diagnosis that is as cellular as possible, new surgical techniques, increasingly less invasive, which find a place within of the increasingly less final glaucoma treatment path”. Access to these procedures is “complex, because these minimally invasive interventions involve the use of devices which, at the moment, are reimbursed separately only in one region, in Lombardy. In the rest of Italy they are devices which the Regional health service buys on top of the rate that is paid for glaucoma surgery and therefore it is clear that they must be negotiated and this obviously creates an obstacle because it is an extra cost that each health company finds itself having to face. On this, Sigla, how Scientific Society of Glaucoma – concludes the specialist – contributes to creating these paths”.
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