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Apr 19, 2021
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How not to go blind because of covid

How not to go blind because of covid

Photo: Alexander Shcherbak / TASS

How does the pandemic affect vision? A large-scale study conducted in 8 European countries, including Russia, showed that people with ophthalmic problems are at increased risk due to covid. Their vision may not only deteriorate; in some cases, the threat of its complete loss is not excluded. The reason is a sharp decline in the level of control. For example, in our country, due to the pandemic, almost half (43%) of the interviewed patients were unable to attend the scheduled appointment. And in almost a quarter (22%) of Russian patients, planned appointments were canceled …

Glaucoma is among the most dangerous diseases for eyesight requiring constant monitoring. Despite the great breakthroughs in its study and treatment, the mystery of the origin of this mysterious ailment still worries representatives of world science.

“Every day, patients ask us about the cause of glaucoma, hoping that by eliminating it, they can heal. But science does not yet have an unambiguous answer. – told “SP” ophthalmologist, candidate of medical sciences, senior researcher at the Research Institute of Eye Diseases Regina Poleva… – It is well known that this is a multifactorial disease. Numerous studies have confirmed systemic and local vascular risk factors for the development of glaucomatous optic neuropathy. For example, such as impaired blood flow (hemodynamics), ischemia and vasospasm at various levels (in the vessels of the eyeball, brain, vertebrobasilar), arterial hypotension, etc. the ratio of intraocular, arterial and cerebrospinal fluid pressure. Thus, given that glaucoma is a polyetiological disease, the study of the causes of its occurrence, the nature of the course and treatment requires the attention of not only ophthalmologists, but also neurologists, cardiologists and other specialists. “

However, despite the controversial nature of glaucoma, today ophthalmologists already have ample opportunity to control it. Opportunities that allow maintaining and even significantly improving the patient’s quality of life, give him the main thing – the hope to see this world on his own. In the arsenal of doctors – the most modern drug, laser, surgical methods of treatment. According to Regina Polevoy, the modern protocol for the treatment of early forms of glaucoma offers laser treatment as a priority. However, says the doctor, “cases are puzzling when adequate treatment, including laser or surgery, has been carried out, but the expected result has not been achieved. It is upsetting when patients admit non-adherence to the medication regimen and doctor’s recommendations, or seek help too late. Often, a patient comes to an ophthalmologist when one eye has already been lost (blindness), and the other also has serious impairments. On the other hand, it is surprising and at the same time pleasing when we have been observing patients with high intraocular pressure (ophthalmic hypertension) for more than ten years, but they have no deterioration of visual functions ”.

Do I need to talk so much about glaucoma today, to popularize it? Certainly yes – I am sure and ophthalmologist, candidate of medical sciences, member of the expert council on Glaucoma of the All-Russian public organization “Association of ophthalmologists” Sergey Golubev… According to him, “until now, about half of humanity is convinced that cataracts and glaucoma are about the same thing. However, if the cataract can be removed, and the person will see again, sometimes even better than before the operation, then with glaucoma everything is much more complicated. Despite the blurred clinical picture, glaucoma is a “swindler,” a “recidivist thief,” who “steals” a person’s vision, and does it very quickly and successfully ”. Defects of vision, which develop gradually, make it difficult to drive a car, recognize familiar faces, lead to a significant increase in the risk of injuries, including such serious ones as a hip fracture.

Today, the world still highly appreciates (and uses) the achievements of our national school of glaucomatology. It is believed that in the Soviet Union an ideal system of dispensary observation of patients with glaucoma was created (order of the USSR Ministry of Health in 1976). The Association of Ophthalmologists is actively advocating for its revival today. And the efficiency of our modern doctors is evidenced by the fact that the detection rate of glaucoma in Russia is 1.5-2 times higher than the average European indicator. “Since we diagnose her better,” Sergei Golubev is sure. Although these figures in themselves are certainly not a reason for pride. There are a lot of patients with glaucoma. And around the world, approximately 15% of patients with aggressive forms of glaucoma do not yet respond to any of the known treatments. And this, alas, is the road to blindness.

At a press conference within the framework of World Glaucoma Week, experts once again recalled the importance of early diagnosis of this complex and insidious disease. Diagnosis of glaucoma is a combination of studies of intraocular pressure (IOP), visual fields, assessment of the optic nerve head, history and risk factors. Patients 40+ need to have their vision checked at least once a year. The need for regular monitoring increases if someone from close relatives has already been diagnosed with a similar diagnosis (heredity is the cause of glaucoma in 30% of patients, especially in the female line). A possible option is to undergo genetic testing for glaucoma (blood test).

Having discovered a problem on time, you can significantly slow down the pathological process with the help of laser treatment, as well as regularly using eye drops, which help to long-term and effectively normalize intraocular pressure. Today, ophthalmologists and glaucomatologists prescribe various medications for the treatment of glaucoma, based on the individual characteristics of its course. The most effective of them are drugs that act on two “targets” at once: on the one hand, they reduce the production of intraocular fluid, on the other, they increase the uveoscleral outflow.

“Using simultaneously two mechanisms of action of one molecule allows us to reduce IOP and to do it quite effectively. First of all, original drugs have a proven hypotensive effect. Generics do not always correspond to their declared properties. In our practice, we are guided by the results of multicenter clinical trials that confirm the hypotensive efficacy and safety (tolerability) of each drug for the treatment of glaucoma, ”emphasized Sergei Golubev.

But “low pressure” glaucoma is also not uncommon. It is known that in Japan, for example, such patients are the overwhelming majority. This is the case when low IOP numbers can be misleading. Therefore, doctors assess the real state of the optic nerve, focusing not only on intraocular pressure. “The treatment strategy for low-pressure glaucoma is more complex as the patient needs more careful selection of antiglaucoma drops. Surgery for low-pressure glaucoma is also possible. “

Important

Over the past 40 years, the number of patients with glaucoma in the world has almost doubled. In 2020, there were 3.6 million new cases of the disease. At the same time, at the initial stage, about half of people are unaware of the disease, since “glaucoma does not hurt.” In an international survey, more than two-thirds (67%) of Russian respondents confirmed that glaucoma control during the pandemic remained as important for them as it was before it. Nevertheless, more than 30% of the respondents admitted that they violated the regimen without medical supervision and less often used antiglaucoma drops prescribed for them.

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