“Eye does not see, heart does not hurt”. So goes an old adage but those with visual problems could easily deny it because when you don’t see well you suffer, and how. Patients suffering from chronic, degenerative and disabling diseases such as age-related macular degeneration, glaucoma and retinopathies know this well. The theme was at the center of attention in a meeting organized today in Milan entitled “Protecting the retina, saving sight”.
Older, more maculopathies
As an effect of the lengthening of life and the increasing stress to which the eye is subjected, the number of patients affected by ocular pathologies increases with a consequent deterioration in the quality of life and costs that impact on the national health system. In the context of eye diseases, wet (or exudative) senile maculopathy is the leading predictable cause of severe vision loss and blindness in adults over 65 with an estimated impact in 20-25 million people worldwide.
The causes of wet senile maculopathy
The onset of this pathology is linked to the increase in a protein, called VEGF (Vascular Endothelial Growth Factor), which stimulates the abnormal formation of blood vessels in the eye. These, in turn, lose fluid which accumulates and modifies the natural structure of the retina, damaging and threatening the survival of the photoreceptors. Photoreceptors are specialized neurons that capture light and transform it into electrical signals for the brain, allowing vision. “The diagnosis of maculopathy – he explains Matteo Piovella, president of the Italian Ophthalmological Society – must be precocious because unfortunately there is no cure for this disease. Prompt therapeutic strategies include the control of the pathological fluid in order to prevent damage to other photoreceptors in addition to those already compromised, thus maintaining the status quo in terms of sight ”.
The risk of disease progression
In case of success we talk about “control” of the disease and the patient must be carefully explained the risk of disease progression to sensitize him on the importance of maintaining the therapy over time. “In Italy – continues Piovella – as much as 70% of the population does not receive or partially receives the therapy, thus nullifying the curative result. The causes are many, some social such as the patient’s lack of awareness of the disease; others are structural and organizational, such as too much bureaucracy and the few resources available to health facilities ”.
Available therapies
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 works by inhibiting the proliferation of new blood vessels within the retina and stemming the loss. of retinal fluid. “In the ophthalmologist’s therapeutic armamentarium – he says Federico Ricci, director of the Chronic Degenerative Ophthalmic Diseases Unit of the University of Rome Tor Vergata – there are different classes and generations of drugs, some were synthesized over 10 years ago and others are molecules developed in recent times which, compared to those of the first generation , have a superior ability to control the retinal fluid, consequently requiring a lower frequency of injection to keep the retina dry.
This is the case of brolucizumab, a small, single-chain humanized antibody fragment characterized by excellent tissue penetration and a high capacity to eliminate fluid from the retina, therefore the tissue in optimal operating conditions. Brolucizumab is the only anti-VEGF to have demonstrated its efficacy in pivotal studies, for eligible patients, with a three-month treatment interval immediately following the initial three monthly loading doses in approximately 50% of cases. The drug was in fact recently approved by the FDA with this posology defined as a fixed regimen which also allows a precise programming of the therapy over time “.
The impact on daily life
As a chronic degenerative eye disease, wet senile maculopathy often has a devastating impact on the lives of patients and caregivers. “Eye health is underestimated as are chronic, degenerative eye diseases that lead to blindness and the associated social burden, which involves reduced mobility and individual autonomy, the risk of accidents and an increase of cases of depression ”, he declares Tiziano Melchiorre. general secretary of IAPB Italia Onlus. “It is necessary to inform people, speed up the diagnostic process and facilitate access to therapies in order to prevent blindness and limit the drama of visual impairment as much as possible. Furthermore, it is important to raise awareness among patients and their families on the progression of diseases such as age-related macular degeneration, the importance of adherence and persistence to the treatments prescribed by specialists and facilitate access to visual rehabilitation services “.
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