In Spain, more than 800,000 people suffer from Age- Related Macular Degeneration (AMD) , a degenerative disease that affects the macula and is the leading cause of blindness. The macula is an area located in the center of the retina, at the back of the eye, which is responsible for direct central vision and for our seeing clearly and in detail.
It is, therefore, a highly disabling condition that generates dependency. “The look is normal and the peripheral vision is maintained, but we will not see if the traffic light is green, nor will we differentiate the number of the bus we want to take or the number of the appointment at the doctor or the butcher shop . “
This is how Andrés Mayor, president of Acción Visión España, describes it, an association that brings together patients who need support to continue with their day to day. Because this disease affects all orders of life and involves a significant loss of autonomy and quality of life.
“You stop driving, reading, watching television, recognizing the faces of your loved ones and the people who greet you on the street and that generates a lot of anxiety and you feel very useless, your self-esteem plummets. You isolate yourself a lot trying not to be a burden to anyone: your partner, your children, your friends ” , says Andrés Mayor.
Historically, two types of AMD have been described, a dry form (less aggressive) and a wet or exudative form (rapidly evolving). However, as argued by Dr. Javier Zarranz-Ventura, specialist in Medical Retina and Vitreo-Retina at Hospital Clínic de Barcelona, it is currently thought that the disease progresses continuously from less severe incipient alterations to complete atrophy of the retinal pigment epithelium, abnormal blood vessels may appear in this course:“These neovessels or neovascularizations are what produce the accumulation of fluid in the retina, and correspond to what were called wet forms.
Their importance lies in the fact that they are very aggressive and can lead to irreversible scars with associated visual loss if they are not treated urgently by intravitreal injections of antiangiogenic drugs (anti-VEGF) ” .
THE IMPORTANCE OF THE TIME FACTOR
And therein lies the key, in early diagnosis and immediate treatment. “The sooner we diagnose and treat this pathology, we will be able to keep our vision in a better state, preventing us from going blind,” says Andrés Mayor. However, according to the Objective AMD report, the time from the first symptoms to diagnosis is, on average, 6.4 months, to which must be added 2.9 more months, which are the time between diagnosis and diagnosis. start of treatment.
More than nine months of waiting, although it is crucial to act as soon as possible. “Once detected, it must be treated urgently by injecting intravitreal antiangiogenic drugs (anti-VEGF) as soon as possible”. This procedure is very effective, as long as a strict guideline is followed that requires a series of initial monthly injections and then a maintenance phase with reinjections for years.
AN INNOVATIVE MODEL OF ACTION
The need to maintain this frequency of reinjections represents a huge challenge for Ophthalmology services in which the care burden has multiplied by 10 in the last decade. Studies show a situation of under-treatment, due to the lack of capacity of the consultations to address the chronic treatment of a very prevalent disease and that, due to the increase in life expectancy, will be much more so. AMD can appear from 50-55 years of age, but its incidence increases with age, being very common from the age of 80.
To respond to this need to optimize treatment, the main scientific and management societies, including SERV, SEO, SECA and SEDISA, with the collaboration of Novartis, have promoted the creation of a new model of Unit of Intravitreal Therapy (IVU).
“It consists of the creation of a care circuit in which the patient comes to the center and in the same visit is evaluated, treated and summoned for the next visit, thanks to the coordination of all the agents involved (ophthalmology, optometry, nursing, pharmacy and administrative staff).
The objective of the UTIV is to optimize the way in which treatments are administered, reducing the number of patient visits to the center, increasing the capacity to treat a greater number of patients and thereby reducing the risk of delays in the treatments administered. , which are the main cause of visual loss in these patients ” , explains dr. Zarranz-Ventura.
This innovative system increases the efficiency of the health system, since it allows to attend 40% more patients. In addition, waiting times and the number of patient journeys are reduced.
Ultimately, the UTIV model improves the flow of care in the follow-up of retinal diseases, something absolutely necessary, in the words of Dr. Javier Zarranz-Ventura because “to obtain good results the treatment must be constant, and for this the reinjections must performed when they play.
With the old model, where the capacity of the services was very limited as the number of visits doubled (an evaluation visit and a treatment visit), delays in retreatments were very frequent, which ultimately caused loss of vision in many patients ” .
This UTIV model will enable us to administer treatments appropriately, performing reinjections when necessary and thereby reducing the risk of delays and under-treatment. All these improvements will undoubtedly improve the prognosis of these diseases.
Thanks to the implementation of these UTIV in several pilot centers, as we have observed in the national study ‘Fight Retinal Blindness Spain’ for the first time we have obtained in real life conditions a number of injections and visits comparable to those described in clinical trials in a series of more than 3,000 eyes treated in our country, which is an achievement in itself ”.
“WE PATIENTS NEED IT TO BE DIAGNOSED AND TREATED IN TIME”
Andrés Mayor (president of the Asociación Acción Visión España)
Sometimes we think that by being older it is inevitable to lose vision and that urban legend must be fought. Every day life expectancy is greater and we have to age with quality of life and that means seeing well for as long as possible. In the UTIV model, this practice is still very anecdotal in Spain, despite the fact that it is considered very appropriate among retina professionals.