Cataracts in Italy

Pubblicato il

Monday, 9 December 2024

Argomento

Surgical Area

Our population is getting older and older, and cataracts are naturally becoming one of the most frequently encountered diseases in everyday eye care practice.

It is estimated that around 60-70% of people over 70 years of age have some form of opacification of the crystalline lens, a percentage that exceeds 80% in the over-80s.

Blurred and blurred vision, glare at night, difficulty driving, reading or watching television are typical symptoms of the cataract patient.

The resolution of this pathological condition is surgical and the removal of opacified crystalline lens is now an increasingly common procedure in Italy with more than 650,000 interventions per year, one of the highest numbers in Europe, and by 2030 the number could approach one million. Early diagnosis, according to doctors and ophthalmologists, is crucial, and artificial intelligence could in the future revolutionise the way in which screening is carried out.

From a strictly surgical point of view, cataract surgery is among the safest and most frequent procedures worldwide and the most cost-effective. The total and actual costs of a cataract operation, according to a rough estimate, are between 2,000 and 3,000 euros in Italy. At present, the rate that the SSN reimburses health authorities for each cataract operation is around €900 and this health policy choice has important consequences, in particular it is a disincentive for hospitals to allow access to cataract surgery under agreement with the National Health Service and, as a result, it leads to the lengthening of the waiting lists.

The long waiting times cause patients the anguish of helplessly watching their eyesight and quality of life deteriorate, not to mention the fact that an excessive delay in removing the opacified lens can jeopardise a successful outcome of the surgery. Many patients thus end up deciding to turn to private facilities if they can afford to pay for the surgery out of their own pocket.

In Italy, as in all other countries, the reality of waiting lists in ophthalmology has a very strong impact on the weaker sections of the population, who do not have access to treatment outside the National Health Service. Today, at public level, in a manner that differs from region to region, there is a wait of up to 12 months for an eye examination and over two years for cataract surgery.

One aspect, in addition to these issues, is the lack of knowledge by the average cataract surgery patient and, in particular, the technological advances made in the field of intraocular lenses (IOLs), which make it possible to achieve the best refractive result in the post-cataract surgery period, while at the same time correcting presbyopia and/or astigmatism and reducing or completely eliminating the need for glasses in the postoperative period.

According to a 2023 survey, only 38% of respondents in Italy are aware of this potential and only 51% are aware that a new lens will be implanted in the eye to be operated on. The survey data also confirm that the percentage of patients needing spectacles post-operatively has dropped significantly internationally. In fact, it went from 81% before cataract surgery to 45% post-surgery. The 45% of cataract surgery patients also perceive that they feel like a younger person, which has a positive impact on their quality of life.

Finally, a mention of the new developments in congenital cataracts, which were the subject of an Italian study, the result of a collaboration between the University of Pavia, Niguarda Hospital in Milan and the Mondino Foundation in Pavia: Novel molecular, structural and clinical findings in an Italian cohort of congenital cataracts - Lecca - 2024 - Clinical Genetics - Wiley Online Library

Congenital cataract is a rare disease that is one of the main causes of childhood blindness, as it is often diagnosed late, at the age of several months or even years. The diagnostic delay results in worsening symptoms and possible irreversible retinal damage.

In most cases congenital cataract is idiopathic, i.e. it has no known cause, and tends to affect only one eye; while hereditary forms account for about a quarter of cases and often occur bilaterally. In the case of an early diagnosis, the opacified lens is removed. within three monthsfollowed by a period in which special contact lenses or spectacles are used. In growth, there may be a second operation for the implantation of an artificial lens.

In recent years, fortunately, neonatal screening via theexamination of the red reflexwhich is done by means of a light directed at the infant's eye through the ophthalmoscope.

The study, published in Wiley, showed that exome sequencing may be an effective first-level genetic test in the diagnosis of this disorder. Hereditary congenital cataract is caused by alterations in more than 100 geneswhich mostly follow an autosomal dominant inheritance pattern and often encode for lens proteins.

Current practice in diagnostic genetic testing involves the use of Next Generation Sequencing (NGS) panels, which allow molecular screening of a variable number of genes associated with congenital cataract - generally from a few dozen to a hundred - with variable yield. Exome analysis is a next-generation sequencing technique that allows the coding portion of the human genome - some 20,000 genes - to be analysed at the molecular level for disease-causing variants.

This approach allows a person's genes to be sequenced and, once the written 'code' is obtained, compared with a reference sequence free of genetic alterations. In this way, the mutation(s) causing the disease can be identified.