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You know the woodworm that gnaws the furniture? Work slowly, day after day. At first we don’t even notice its presence. From the outside everything looks perfect and the wood is not damaged. But in the meantime the pet works and, when you see the first “holes”, many of the damage has already been done.
Glaucoma – there are different types and therefore an ophthalmologist’s diagnosis is always required – behaves the same way. It “gnaws” a pinch of sight every day, in imperceptible motion. And when you realize that something has been lost, the damage is already done. In short, arriving early is essential, as the experts recalled on the occasion of the World Week for the prevention of the disease.
The impact of Covid-19 on the disease
Stefano Miglior, president of the Italian Glaucoma Study Association (AISG) recalls that degenerative pathology generally involves both eyes, causing permanent damage to the optic nerve, which over time can lead to low vision and blindness. Unfortunately, 50% of patients do not know they have it and 20% are exposed to the real risk of losing their sight. It mainly affects people over 40 years old: in Italy 1 million 200 thousand people suffer from it.
“It is an experience shared by all ophthalmologists – explains Miglior – that in the first lockdown many clinics and hospital wards were closed and many patients were unable to carry out checks at their reference centers and even if there was the possibility of go out for proven reasons strictly related to health. Patients disoriented and afraid of the risk of contagion have skipped check-ups and sometimes even interrupted drug therapy, and renounced surgery. Surgical therapy, which is often reserved for the most complicated cases, has been drastically reduced, putting patients at risk of experiencing sometimes devastating worsening of their visual field “.
On the care front, the ophthalmologist has several drugs available, from prostaglandin derivatives to beta-blockers, to alpha-stimulants, to carbonic anhydrase inhibitors, all of which can be used in the form of eye drops. Two classes of molecules are on the horizon, Rho-Kinase inhibitors and nitric oxide.
As for the diagnosis, Miglior explains that “the diagnostic methods of glaucoma are always non-invasive. The diagnosis o the diagnostic suspicion is always based on the ophthalmological clinical evaluation by the ophthalmologist and will be based on the observation of the state of the optic disc during a normal eye examination, on the result of the visual field examination and on the measurement of ocular pressure “. Further tests, such as OCT, must then be indicated on a case-by-case basis.
Five rules for detecting and controlling the disease
AISG experts remember five simple rules to keep in mind in case of glaucoma.
– The healthy individual must be examined by the ophthalmologist at least bi-annually starting from the age of 40 (those who have a positive family history for glaucoma must begin to be examined at a young age).
– Short-sighted people are advised to be examined as early as 20 years of age, but it is true that those who are short-sighted will tend to be visited more frequently and earlier, especially for visual problems.
– It must be realized that in the most appropriate management of glaucoma it is necessary to obtain a reduction in ocular pressure that is clinically significant and whose absolute value depends on various factors (stage of the disease, basal values of ocular pressure, concomitant risk factors, expectation of patient life and speed of any worsening of functional visual field damage over time).
– It should be known that when glaucoma worsens it means that the ocular pressure is not optimal and must be further lowered, which often involves the need for surgery.
– Never forget that today it is possible to try to obtain a greater resistance of the nervous structures that are damaged during the course of the disease with specific neuroprotective molecules, whose use, in support of the traditional and necessary hypotonic therapeutic strategy, could help to slow down any progression functional damage.
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