There are still no treatments that can stop glaucoma, but scientific research is making a lot of progress in terms of understanding the factors that cause this ocular pathology and the therapeutic approach that can be more effective. Glaucoma and the various therapies available was one of the themes at the center of the XII National Congress of Aimo (Italian association of ophthalmologists).
A disease seeking treatment
Glaucoma affects about 1.2 million people in Italy and is the second leading cause of visual impairment and blindness in our country. Furthermore, according to recent estimates, 50% of patients do not know they have it and 20% run the risk of losing their sight. For the moment there are still no therapies able to stop glaucoma, a disease caused by the increase in the internal pressure of the eye and, in some cases, by the reduction of the blood supply to the optic nerve. “Unfortunately, at the moment there are no definitive therapies against glaucoma – explained the vice president of the Italian Association of Ophthalmologists, Lorenzo Galli. “Fortunately, the studies are progressing, even if they are complex since we are not talking about a disease, but about a group of diseases that often recognize different causes, so arriving at an etiological therapy is not so immediate”.
Not just eye drops
To control the evolution of glaucoma and in some cases free the patient from the ‘slavery’ of drops for life, however, today there are increasingly performing tools to be used. “A recent English study – said the Aimo vice president – shows how patients treated with laser therapy have more benefits in the long term than those treated with medical therapy. On the other hand, medical therapy, which certainly remains one of the solutions, presents some compliance problems for the patient, who is forced to wear eye drops every day of his life that in the long run can change the eye, or rather the conjunctiva, making it more surgery is complex “.
Alternatives to eye drops
In addition, eye drops, in the worst cases, have sometimes important side effects that once again affect the patient’s compliance. But what are the other alternatives to consider? “There are several”, replied Galli: from the long-time administration of drugs, through intraocular injections, to lasers in its various forms, up to minimally invasive surgery, which is a ‘step ahead’ of traditional surgery. The aim is undoubtedly to get to better modulate the approach we have towards the patient for the ‘cure’ of glaucoma “.
The importance of neuroprotection
By now, scientific research has amply demonstrated that the causes of the onset of glaucoma are many and, even if the main risk factor is the increase in intraocular pressure, there are numerous other mechanisms responsible for the damage to the optic nerve, which is why in a percentage of patients, even if well compensated from a pressure point of view, glaucoma continues to progress. Among the causative factors under study, mitochondrial dysfunction, the activation of inflammatory processes, some genetic characteristics and oxidative stress have emerged, all factors that cause a progressive death of the retinal ganglion cell. For this reason, while we continue to intervene pharmacologically with eye drops capable of reducing eye pressure, research has continued with the aim of identifying new therapeutic tools capable of preventing the death of Retinal Ganglion Cells through active molecules. neuroprotective. Among the various molecules studied as neuroprotective agents, coenzyme Q10 and citicoline appear to be the most eligible for neuroprotective treatment precisely because they are considered to be those with the greatest scientific evidence.
Personalized therapies
But what is the future of glaucoma therapies? “The future will be represented by increasingly ‘tailor-made’, that is, personalized therapies – explained Galli. For each patient, the best therapy will be chosen for him, in an approach that can be of collaboration between doctor and patient himself. The doctor will be able to propose different therapies to the patient, informing him of the strengths and weaknesses of each. And this will be a revolution, because glaucoma has always been a ‘paternalistic’ area in which the doctor tends to tell the patient ‘do this therapy’, not having the patient the means to become aware of his particular situation, if not following of an eye examination that intercepts glaucoma, which as we know does not give symptoms. In the future, with increasingly personalized therapies, doctor and patient will instead be able to think together about the different chances “.
Minimally invasive surgery
As for minimally invasive surgery, the ophthalmologists in Congress stressed that the interventions are now faster than in the past and with a better recovery. “A minimally invasive glaucoma surgery takes about 20 minutes – said Galli. It enters the eye with a needle, without going deep, and is done under local anesthesia. A laser treatment lasts even less, about 10 minutes, and the anesthesia is superficial, just long enough to allow the doctor to place a lens on the eye ”. On the other hand, these are techniques that have ‘simply’ a functionality from the point of view of blood pressure lowering and that however – added Galli – “in some cases can be decisive, without the need to then resort to traditional surgery”.
Doing prevention
Although glaucoma is a disease that occurs with age, prevention is always important. “Playing ahead of time on glaucoma is very important – recalled the vice president of Aimo – especially in the context of a disease like this, at risk of causing serious damage, the sooner it gets, the better. Glaucoma appears in most cases over the fourth decade, therefore a two-year eye check is recommended for the age group between 40 and 50 years; after the age of 50, an annual check-up would be desirable. And if there is familiarity with glaucoma, around the age of 30 you can begin to have checks even on an annual basis. But I want to address a final and important message to patients – concluded Galli – the visit must be strictly ophthalmology, a simple vision measurement is not enough and it must be a doctor to evaluate these aspects “.
.