HI-TECH EYE RESEARCH HAS “LANDED” IN HAWAII: THE THEME WAS DISCUSSED IN A MEETING FROM 29TH APRIL TO 2ND MAY 2018

Holographic displays, robots that assist people during eye examinations, visual field testing performed with a common smartphone: a window to the future was opened during ARVO 2018, an annual event, which – inaugurated on April 29th – ended on May 2nd in Honolulu, Hawaii (U.S.A.). Speakers from all over the world, including researchers with an innovative approach, met with a wide range of experts. The Director of the Italian National Centre for Vision Rehabilitation, Dr. Filippo Amore, also took part in the meeting, presenting research conducted with a futuristic visual device which has been conceived for the visually impaired.

During the event organised by the Association for Research in Vision and Ophthalmology, alongside these groundbreaking themes, participants also discussed “classic” diseases, such as glaucoma, age-related macular degeneration (AMD), seasonal eye allergies and diabetic retinopathy.].

Main source: ARVO

RECOMMENDATIONS IN CASE OF HEAT WAVES AND BULLETINS OF THE MINISTRY OF HEALTH

No to cooling fans with very high temperatures [1]; yes to air conditioners but with the temperature not set too low [2]. These recommendations can be found in the handbook that the Italian Ministry of Health published on the day that the “Estate Sicura 2018” campaign (Safe Summer 2018) was launched, which was accompanied by traditional summer bulletins, reporting on heatwaves in Italy.

The ministerial recommendations – that are included in the National Prevention Plan against the effects of heat on health – are inspired by common sense, but a number of rigorous scientific studies support them. In particular, we would like to mention the following recommendations:

• Don’t go outside during the hottest hours [3]..

• Improve home and work environments: the simplest measure is by shielding any windows facing south and southwest with curtains and adjustable shutters that block the passage of light, but not air. Air conditioning is of course effective, but it must be used with caution and the temperature must not be set too low in comparison to the temperature outside.

• Drink large quantities of fluids: drinking a lot of water and eating fresh fruit are essential to countering the effects of heat.

• Avoid drinks containing alcohol or caffeine.

• Eat light meals.

• Wear comfortable and light clothes, made of cotton, linen or natural fibres. When outdoors, it is useful to wear light hats of a light colour to protect the head from direct sunlight. [We would like to add that it is also important to wear sunglasses with authorised filters. ]

• Ventilate your car before travelling. In this case, set the temperature of the air-conditioning system to a level about 5 degrees lower than the outside temperature, avoiding directing the vents towards the body. If you must travel, avoid the hottest hours of the day and always keep a supply of water in the car. Never leave babies, children or animals in the car, not even for short periods.

• Avoid physical exercise in the hottest hours of the day. In any case, drink large quantities of fluids if you do physical activity. Athletes should compensate the loss of electrolytes with supplements.

• Take care of people who may be at risk by paying them a visit at least twice a day and checking that they don’t show any symptoms of heat disturbance. Check more often on babies and young children.

[1] over 32° C.
[2] between 25° and 27° C, while previously the advice was 24°-26°
[3] On days when the predicted risk is high, time spent outdoors should be reduced in the hours between 11 a.m. and 6 p.m.

Main Source: Ministero della Salute

CONSUMING ORANGES OR ORANGE JUICE ON A DAILY BASIS COULD CONTRIBUTE TO PREVENTING AGE RELATED MACULAR DEGENERATION: CLAIMS SUPPORTED BY AUSTRALIAN RESEARCHERS

That fruit and vegetables help protect our retina, especially the macula, has long been known. However it appears that, above all, oranges may be particularly useful in preventing age-related macular degeneration (AMD), although this is yet to be fully understood. A team of Australian university researchers are carrying out research to this effect, and state that, “drinks that contain flavonoids (such as orange juice) are reasonable to be recommended to patients.”

Reference is made to consuming at least one portion per day, equivalent to a large orange or 200-300ml of squeezed juice. On Original Research Communications the authors explain:

Flavonoids are bioactive compounds found in foods such as chocolate, tea, red wine, fruit and vegetables. […] They can have an antioxidant and anti-inflammatory action. There is also strong evidence that flavonoids positively affect vascular health through improved endothelial function. Therefore, their role seems promising in reversing oxidative stress and associated inflammatory damage, as well as improving vascular function and clinical signs of AMD.

Other studies have already been conducted to try to find ways to prevent age-related macular degeneration. The authors of the study summarize the results as follows:

Age-related macular degeneration (AMD) is the leading cause of blindness and major reduction of sight among ‘elderly adults.’ Current studies suggest that people affected by AMD should consume dark green leafy vegetables daily, follow low-glycemic diets and eat fish (at least twice per week). The study AREDS (Age-Related Eye Disease Study) showed that taking food supplements containing high doses of vitamin C, β.-carotene, zinc and copper could reduce AMD progression by 25%. [1]

The factors to be taken into account – also at a lifestyle level – are many: not only diet (it is also important to consume fish regularly), but also not to smoke and take daily physical exercise. Alongside these modifiable aspects there is one that cannot be changed: genetic predisposition. Anyone who has a first-degree relative affected by AMD has a 3-6 times higher chance of being affected by it. In any case, after the age of 60, it is advisable to undergo at least one eye examination per year.

Main sources: Original Research Communications, Westmead Institute For Medical Research

[1] However the magnitude of this result has been significantly reduced in a subsequent study

Spotlight on vision rehabilitation during the Live program. Italy sets the international standards on rehabilitation but doesn’t provide the same level of service everywhere in its national territory. “Training, multidisciplinarity, and telerehabilitation are at the heart of both our research activities and our collaboration with the WHO”, says Dr. Filippo Amore, director of the center.

The biennial edition of the World Ophthalmology Congress was held between 26 and 29 June 2020 and it was the first to be organized online as a virtual experience.

The National Center on Low Vision gave two presentations at the Congress: the first focused on the curricula for vision rehabilitation operators; the second revolved around the state of vision rehabilitation in Italy.

“Those two areas are connected,” explains Dr. Filippo Amore, director of the National Center and guest speaker at the Congress. “Through the National Center on Low Vision – which has recently been confirmed as a WHO Collaborating Center for the third triennium in a row – Italy has set the international prerequisites in the field of vision rehabilitation and for the curricula which are recognized by the WHO as the gold standard for the training of vision rehabilitation operators. At the same time, our country lacks the necessary professional skills – in terms of the number of operators and training courses – and resources that would make rehabilitation available to visually impaired people who could really benefit from it, and that’s at least one million people”.

“The international effort of the Center also stems from a desire to help our country. Through scientific research, technological innovation, and training, we wish to extend the best practices in vision rehabilitation both to other low vision centers in Italy and to the national health systems of foreign countries, in the latter case thanks to our collaboration with the WHO”.

“We are currently working on the adoption of remote rehabilitation techniques, to cater to the needs of people who cannot access rehabilitation services near home. We contributed to the development of a software called Eye Fitness, which provides a home-based training platform that can be remotely controlled by our operators”.

These same topics were also discussed during one of the main sessions of the Congress Live program, in front of a virtual audience of 130 experts from all over the world.

“Participating in one of the leading international events in the field of ophthalmology is a great recognition of our work and our multidisciplinary approach, which brings together psychological and ophthalmological assistance, training of the residual vision and also in the use of optical, digital and electronic aids. For us, this was also an opportunity to stress that vision rehabilitation is and should be considered an integral part of eye care. When nothing else can be achieved through surgery or medicines, there’s still a lot that visually impaired people can do to safeguard and regain their personal autonomy. This has been our message since the foundation of the National Center in 2007, and it’s a message that is gathering increasing scientific evidence and international support”.

Con le misure di distanziamento è diventato molto più difficile per le persone con disabilità visiva orientarsi e, soprattutto, individuare gli altri come punto di riferimento per muoversi correttamente nell’ambiente esterno. Ecco allora cinque regole da seguire per aiutare le persone con deficit visivo nella quotidianità.

The WHO has reconfirmed the National Center on Low Vision as a reference point in the field of vision rehabilitation for the third triennium in a row.

From May 2020 until May 2023, the National Center on Low Vision and Vision Rehabilitation at the Gemelli hospital in Rome will work alongside the WHO with two different objectives: setting the standard parameters to assess the quality of eye care in countries around the world and conducting a study on the benefits of vision rehabilitation on elderly patients affected by cognitive decline.

“These are two fairly unexplored areas and the National Center, as a WHO Collaborating Center, will pave the way forward”, explained director, Dr. Filippo Amore. “In regard to the assessment parameters, we will provide the WHO with a new tool: a set of guidelines, which the WHO will pass on to its member states so as to assess the state of eye care services around the world more coherently”. The second aspect deals with the possible benefits of vision rehabilitation in elderly patients with cognitive decline. Even though the relationship between sensory deficit (vision/hearing impairments) and cognitive impairment is well documented, there is no evidence of the benefits that sensory rehabilitation can bring in terms of reducing, halting, or inverting the progression of the degeneration. “This is an important aspect,” Dr. Amore explained, “which needs to be demonstrated in order to state that, as we strongly believe, rehabilitation is an integral part of eye care and deserves to be enhanced in different courses of treatment”.

It is not the first time that the National Center, headquartered at the Gemelli Polyclinic hospital in Rome, has collaborated with the WHO. In fact, this is the third 3-year based collaboration period that has just started, and the WHO has entrusted the National Center with a leading role.

“This is an important achievement,” Dr. Amore said, “a confirmation of the quality of the work we have done so far in setting, among other tasks received by the WHO, the international standards in vision rehabilitation and the training path that must be undertaken by health professionals who will deliver vision rehabilitation services”.

“However, such recognition is not a finishing line, but rather an incentive,” added the director. “The National Center on Low Vision has a leading role in the field of vision rehabilitation, both in Italy and around the world, and this is a role that comes with specific responsibilities. The first is continuing research by combining the delivery of vision rehabilitation services and studies aimed at their improvement, while preparing patients to be taken on by other specialized centers in Italy. The second task is to draw the attention of the general public and the decision-makers to the importance of rehabilitation itself, and on the limited means we currently have at our disposal in Italy”.

“The National Center is a rare pocket of excellence, since it combines the multidisciplinary competences of psychologists, ophthalmologists, orthoptics, etc. In this way, we can help our patients accept the consequences of vision impairment and regain their personal autonomy, even when surgery and medicines cannot grant any further improvement. The message we want to send out is this: rehabilitation is an integral part of care, together with prevention and treatment. It is a fundamental resource for patients who have lost a considerable portion of their sight, even when their vision impairment is irreversible. Therefore, it is important to develop a network of rehabilitation centers all over our national territory, with specialized and multidisciplinary staff. With the National Center, Italy has set the gold standard in this field internationally, however, our country needs trained personnel and consistent investment in order to make rehabilitation available throughout our national territory”.

Si riparte. Mercoledì 3 giugno riaprono le visite ambulatoriali al Polo Nazionale Ipovisione e Riabilitazione visiva: un primo passo di ritorno alla normalità.

Tutte le informazioni sono disponibili a questo link.

The long period of mandatory social distancing will be particularly hard on people affected by vision impairment. This is why the operators at the National Center on Low Vision and Vision Rehabilitation – the only WHO collaborating center for vision rehabilitation – have launched a video initiative to remain close to their patients. “We wish to be useful, even if from a distance,” stated Dr. Filippo Amore, ophthalmologist and director of the National Center, which was inaugurated ten years ago at the Gemelli hospital in Rome by the Italian branch of the International Agency for the Prevention of Blindness-IAPB Italy. “We want to allow our patients to refresh their rehabilitation training program and show what a great opportunity this is to reclaim one’s autonomy, and also for people who have never heard about this possibility”.

“The main reason is that undertaking a vision rehabilitation program has helped our patients be better prepared for the challenges of the COVID-19 pandemic. Both psychological counseling and knowing how to use the many optical and digital aids available today were points of strength that helped fight back against loneliness, sadness, and social isolation”.

“Anybody who is familiar with vision impairment knows that there is no magic formula because lost vision cannot be recovered. However, not enough people are aware that there’s an aspect in which we can still make a big difference: personal autonomy”.

“Many visually impaired people have started to live again thanks to rehabilitation. But many more could also learn how to benefit from it”.

“Together with our patients,” Dr. Amore concludes, “In these videos, we look for solutions to real problems of their everyday lives: how they can solve these issues by themselves or when it is necessary how to seek the help of others. With their contribution and that of the talented operators at the National Center on Low Vision, we will look for the best strategies that can make a difference in granting patients the freedom to engage in relationships, satisfy their needs, attend to their personal matters and look after themselves independently, thus building confidence and self-empowerment, and achieving a fulfilled sense of living, that visually impaired people are fully entitled to”.

This article marks the beginning of a new partnership for the dissemination of news on eye health prevention between IAPB Italy and Pazienti.it.

The Italian medical news website Pazienti.it interviewed Prof. Gianluca Manni (ophthalmologist and Head of the Glaucoma Centre at the Polyclinic Hospital of the University of Rome Tor Vergata) on glaucoma and how to become aware of it.

This is the first in a series of articles that will stem from the new partnership between the International Agency for the Prevention of Blindness-IAPB Italy, and Pazienti.it. IAPB Italy will provide and assess medical scientific content while working side by side with Pazienti.it to improve the dissemination of news that help raise public awareness and promote health prevention.

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First data of the IAPB Italy’s campaign now available: 40 percent unaware of being at risk

The results of the first 555 recorded check-ups were presented at the Chamber of Deputies. IAPB Italy’s large mobile clinic has reached nine cities and checked 1,800 people in two months and will cover the whole of Italy between 2020 and 2021. The aim of this initiative is to promote a healthcare model centered on prevention and early diagnosis, which employs telemedicine, builds a national database and raises awareness among citizens and institutions on the risk of eye diseases that can cause low vision and blindness.

Today, Tuesday 17 December 2019, a conference was held to discuss the preliminary results of the retinal and optic nerve disease prevention campaign run by IAPB Italy.

The conference took place at the Press Office of the Chamber of Deputies and was attended by Mr. Giuseppe Castronovo, President of the International Agency for the Prevention of Blindness-IAPB Italy; Prof. Filippo Cruciani, scientific advisor to IAPB Italy; and Paolo Russo MP, ophthalmologist and President of the Interparliamentary Group for the Protection of Sight.

Funded by the 2019 Budget Law, the campaign delivered 1,800 free eye examinations in two months. The check-ups were performed inside a 100sqm mobile clinic that has reached nine Italian cities so far and which will travel across the whole of the country between 2020 and 2021.

The analysis of the first 555 medical reports carried out remotely by tele-diagnostics showed that 40% of the subjects were affected by a full-blown disease, presented early pathological symptoms or displayed warning signs that required further examination.

“These data derive from a random and unstructured sample – Mr. Castronovo and Prof. Cruciani explained. However they represent well the level of risk and the unquestionable importance of early diagnosis.”

Retinal and optic nerve diseases such as glaucoma, diabetic retinopathy and age-related macular degeneration are asymptomatic in the early stages. For this reason, only early diagnosis can prevent the onset of silent but irreparable damage to the eye nerve cells, on which our vision depends.

The aim of IAPB Italy’s initiative is not just to provide an opportunity for people to undergo an eye examination. Its true and ambitious objective is to promote a new diagnostic model for Italy’s regions, which is focused on prevention and early diagnosis. IAPB Italy intends to build such a model by raising awareness among citizens and institutions on the increased risk of blindness (due to aging) and capitalizing on the experience with tele-diagnostics during its campaign, in order to create a national database for retinal and optic nerve diseases.

FIND OUT MORE ABOUT DATA, INFOGRAPHICS AND STATEMENTS

“Italy is leading an international effort to determine the standard for professional skills and abilities in the field of vision rehabilitation, which is an integral part of eye care”, says Dr. Filippo Amore, director of the National Center on low vision. The conclusive virtual meeting of leading international experts will take place on Wednesday, 4 March. Soon afterward, a number of Italian and international specialists will leave for Morocco to introduce vision rehabilitation services in the country and put into practice the work that has been developed over the past three years.

For the past six years, the National Center of Service and Research for the Prevention of Blindness has been working in collaboration with the WHO to define and develop the international standards for vision rehabilitation.

In particular, the objective of the WHO’s mandate since 2016 has been the development of a set of curricula aimed at professional figures working in the field of vision rehabilitation (i.e. ophthalmologists, psychologists, orthoptists, O&M instructors, pediatric neurologists, etc.).

Dr. Amore explained that “Our aim has been to identify the criteria and prerequisites for the training of a number of health professionals who are involved in the vision rehabilitation of adults and children.”

This aim will be achieved on 4 March, during a teleconference where some of the world’s leading experts on the subject will convene to approve the curricula that have been drafted by the National Center.

“Rehabilitation is an integral part of care,” Dr. Amore continues. “Even when a patient’s sight is almost completely lost to an acute or chronic disease, a rehabilitation program helps them face and overcome their grief, and partially recover their autonomy. The culture and practice of vision rehabilitation are still under development both in Italy and around the world, but are not well rooted yet. Thanks to the WHO’s mandate, we are paving the way in this field.”

The drafting and reviewing of the curricula have lasted three years. “We started from a close review of the existing literature and available data,” explained Dr. Simona Turco, project manager of the curricula initiative. “We then made a list of the essential and higher-level skills which are deemed indispensable for the delivery of vision rehabilitation services in each of the three settings/levels of care identified by the WHO: the primary level, or the first point of consultation; the secondary level, where outpatient treatment is provided by specialists; and the tertiary level, usually a highly specialized health center with a leading national role also for research programs.

The first draft of the curricula was extensively reviewed, with many international experts suggesting modifications and integrations. These changes were in turn analyzed by specialists, in a collaborative effort. The final curricula draft that resulted from this process will eventually be reviewed and approved during the 4 March teleconference.

On the path that has been traveled since 2013 – when the WHO’s first mandate assigned the National Center to develop the international standards for vision rehabilitation – a key factor has been the ability to adapt requirements, tools, and skills to the capacity of health systems in middle- and low-income countries.

The task received from the WHO was to develop a set of curricula for vision rehabilitation operators. “It was difficult to find the right balance, due to the obvious differences in available equipment, territorial organization and therapeutic priorities among various countries, but it was worth it,” Dr. Amore concludes. In March 2020, the National Center will launch a new project for the introduction of vision rehabilitation services in Morocco. This assignment is part of the WHO’s mandate and will be the first opportunity to implement vision rehabilitation standards and the newly approved curricula on the ground.