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Doctor Tatiana AVANESOVA: “Patients should undergo an ophthalmologist’s check-ups at least once a year.”
Many people neglect regular checkups with an ophthalmologist. It seems that if there are no problems, then there is nothing to worry about. However, such frivolity is fraught with serious problems.
For example, few people notice the first symptoms of the so-called idiopathic macular rupture common among the elderly. However, when vision is seriously impaired, only a complex operation can save it. Today, fortunately, new technologies have emerged that bring hope to these patients. But the problem is that they are not readily available. Tatiana AVANESOVA, the founder and chairwoman of the Foundation for Research and Treatment of Retinal Diseases, vitreoretinal surgeon of the 3Z Ophthalmology Clinic, told the MK columnist how not to blink and miss (in all senses) eye disease and what to do if it was diagnosed.
— Tatiana Andreevna, what is a macular rupture?
— Let’s start with what the macula is. It is known that the human eye consists of three membranes – fibrous, vascular and retina. The inside of the eye is lined with retina. The macula is the central area of the retina. Macula is responsible for distinct and clear vision. Sometimes it happens that a hole or a through defect is formed in the central part of the retina – this is called idiopathic macular rupture (IMR). This disease leads to a significant decrease in central vision, image distortion, difficulty in working at close range and reading. This pathology is quite common – it occurs in 1.7–3.3 cases per 1000 people, and more often in women (in 72% of cases) than in men. The risk of its occurrence increases with age, after about 40 years. And if an IMR is diagnosed in one eye, then, according to modern data, in 10-15% of cases, a rupture may occur in the second eye within the next five years.
— Why is this happening?
— We do not fully know the exact nature of this disease. But there are risk factors. First of all, a special pathological attachment of the vitreous to the retina, gender, age (people are mostly at risk over 60 years old). In this case, heredity does not play a role.
— What are the first symptoms of this disease?
— They are not always present. And even if they are, not everyone notices them. Often this is a find during a routine examination, when examining the fundus and conducting optical coherence tomography, which, alas, is now not done in all regions and is often paid. After all, you have to wait for a queue for a study, which sometimes takes months, and patients need help urgently.
When there is a tear in the retinal tissue in the very center, patients often do not notice anything – after all, we see with both eyes. You can do a rudimentary test. Look at an ordinary tile on the wall, alternately closing your eyes (every ophthalmologist has a special test for this, called the Amsler test). If you see that the lines become wavy, curved, blurry, you need to urgently consult a specialist. In the later stages, the curvatures become visible, even if one eye is not closed; when reading the text, a part of the letters drops out or “jumps”. In addition, a fixed dark spot appears in front of the eye. Vitreoretinal surgeons are engaged in surgical treatment of retinal pathology.
— Perhaps these are rare specialists?
— In the 1990s, there were only a few specialists throughout the country. Today there are more and more vitreoretinal surgeons. Our doctors were given the opportunity to attend conferences on vitreoretinal surgery, train at leading institutions in the country, and study abroad. Clinics buy special equipment, which is why the specialty is becoming widespread.
— Is IMR treated?
— Treatment in the early stages (when the vitreous body has just begun to separate from the retina, pulls it in the central region, but it has not yet reached rupture) is helped by an operation – vitrectomy, which belongs to the high-tech class. Tiny punctures are made in the sclera, and then the vitreous is removed along with the film that attaches to the retina and pulls it. This operation prevents further rupture. Of course, it requires very expensive equipment, most of the consumables for which are produced only abroad. When the retina is torn, such an operation is also done, but the larger the gap, the higher the risk that it may not close.
— What can help then?
— Today, there are several decent methods to help a patient with such a serious illness. One of them, effective and safe, is the use of the patient’s own plasma to close the macular opening. For the first time, three years ago, it was conducted by Dmitry Olegovich Shkvorchenko, Deputy Director for Medical Work of the Fedorov MNTK, together with an ophthalmologist, post-graduate student of
the MNTK, Evgenia Aleksandrovna Krupina. The method is based on the use of autologous platelet-rich blood plasma (PRP). The essence of the method: the patient’s blood is taken into a test tube from a vein, centrifuged, resulting in platelet-rich plasma. This fluid is applied to the macular opening, and it forms a blood clot that tightens the edges of the gap. The gap can be closed 100% of the time. This has been shown by the practice of carrying out such operations in 152 patients at the MNTK. These are very impressive results. We began to replicate the methodology gradually. Dmitry Olegovich conducts demonstration operations at conferences on vitreoretinal surgery with international participation (they were held in Moscow, Sochi and St. Petersburg). Additional consumables for such an operation are small. And the medicinal properties of plasma have been known for a long time – it is also used in cosmetology, maxillofacial surgery, and traumatology.
— Is this surgery free for patients?
— Any high-tech retinal treatment is included in the program of state guarantees and should be provided free of charge. But the reality is that patients often have to wait in line when they need help urgently. The longer a person waits, the less chances he has to restore vision. In Moscow, this problem is less pronounced, but in the regions it is very urgent. The operation is expensive, from 50 thousand to 150 thousand rubles. When I started to deal with such patients who need help urgently, I decided to create a fund. I attracted my friends and relatives to fundraising. On March 13, 2017, our foundation appeared, and the first operation at its expense was carried out on June 24 at the Moscow Eye Surgery Center. Our first patient was Tatyana Vasilievna, whose macular disease developed against the background of retinal vein occlusion. She had waited a long time for the quota, and then decided to have the operation for a fee. The woman is raising three grandchildren – her daughter-in-law died of cancer. When I offered her to undergo surgery at the expense of the fund, for a long time she could not believe her happiness. Of course, we would like to help a huge number of patients. We know how to perform such operations, there is no need to send patients abroad. But it all depends on the availability of funds in the foundation’s account. When I began to look for more opportunities to raise funds, I discovered the Special Look program of the Art, Science and Sport charity foundation, which belongs to Alisher Usmanov. I wrote a letter. Maria Melnichenko, the head of this program, answered the next day and invited me to talk. Further, the Usmanov Foundation studied our activities, and we began to cooperate. Our foundation independently conducted the first charity week of vitreoretinal surgeries in the summer of 2017, and then, together with the Special Look program, we managed to hold two more weeks of charity. In the first, 9 patients were operated on. In the second, which took place in November 2017, there were 14 more in three Moscow clinics: The Eye Surgery Center, the ophthalmological clinic of Professor Kurenkov and the ophthalmology department of the K+31 clinic under the supervision of S.I. Abramov. The third week took place quite recently in Perm, at the Tri-Z clinic – this is the first region we entered, we operated 13 people free of charge. So far, our capabilities are still limited.
— Your foundation has another area of activity …
— Yes, and it is the main one today. This is assistance in education. We consider the educational task to be the main one in the activities of our foundation. We have already created the School of Vitreoretinal Surgeon, where doctors with little surgical experience learn from experts, gain
experience, learn about the nuances that cannot be read about in books. We conduct master classes for surgeons, participation is free for them. There have already been three such master classes – two in Moscow and one in Stavropol. In total, more than 50 surgeons took part in them. In the future, we dream of inviting foreign expert colleagues to participate in our schools. Today we are not lagging behind our colleagues from other countries in surgical technique, but technologies come from abroad, and this is an opportunity to learn about all the new products in the industry firsthand.
— Does your foundation participate in social projects?
— Yes, in order to improve the quality of life of families with visually impaired or blind children with such a serious illness as retinopathy of prematurity, the project “School of Conscious Parenting” is launched in Samara in September 2018. The head, initiator of this direction is Petrachkova Marina Sergeevna, ophthalmologist of the Samara Regional Clinical Ophthalmological Hospital named after T.I. Eroshevsky. She daily deals not only with the treatment of such difficult children, but also communicates with their parents and relatives who are under stress. Together with the management of the clinic, the chief physician, Professor Andrey Vladimirovich Zolotarev and psychologist L.V. Frantsuzova, a system of psychological support has been developed for families with a visually impaired or blind child.
— What novelties do you consider particularly promising?
— We have high hopes for gene therapy. In the world, gene therapy drugs have already been created, which are injected into the eye, for the treatment of blindness caused by diseases of the retina, for example, the drug luxturna for retinitis pigmentosa. In Russia there is a group of scientists led by Marianna Ivanova who are conducting research in the field of ophthalmogenetics. The first stage of research with the support of the So-Unification Foundation to prepare a group of patients with hearing loss and vision loss (Usher’s syndrome) for the possible use of gene therapy was completed last year. Research is also underway on the treatment of retinitis pigmentosa – our foundation plans to take part in the studies. Gene therapy and stem cell therapy in our country are not yet fully developed, but work is underway, these methods open up tremendous opportunities for treating patients.
We are looking for any opportunity to support our projects, the education of doctors. The more qualified, competent doctors we have, the better we will treat our patients. And patients should undergo professional examinations with an ophthalmologist at least once a year, and always with a thorough examination of the fundus with a wide pupil. And you also need to try to quit smoking, monitor blood pressure, eat right – for example, a Mediterranean diet with a predominance of vegetables, fruits and fish significantly reduces the risk of developing diseases of the central region of the retina. After all, human vision is a gift that allows us to see the smiles of our relatives, the beauty of the nature around us and life in general.