Many people neglect regular eye examinations with an ophthalmologist. It seems that if there are no problems, then there is nothing to worry about. However, such levity is fraught with serious problems.

For example, few people notice the first symptoms of the so-called common among the elderly. idiopathic macular rupture. However, when the vision is seriously impaired, only a complex operation can save it. Today, fortunately, new technologies have emerged that give hope to such patients. But the problem is that they are inaccessible.

What is a macular gap?

– Let’s start with what macula is. It is known that the human eye consists of three shells – fibrous, vascular and retinal. Inside the eye is lined with retina. Macula is the central zone of the retina. Macula is responsible for clear and clear vision. Sometimes it happens that a hole or a through defect is formed in the central part of the retina – it is called idiopathic macular rupture (IMR). This disease leads to a significant reduction in central vision, distortion of the image, to the difficulty of 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 (72% of cases) than in men. The risk of its occurrence increases with age, after about 40 years. And if WRI is diagnosed in one eye, then, according to modern data, in 10–15% of cases, a gap may occur in the second eye over 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 body to the retina, gender, age (people mostly over 60 years of age are at risk). At the same time, heredity does not matter.

– What are the first symptoms of this disease?

– They are not always. And if there are, not all notice them. Often this is a boon during routine examinations, when examining the fundus and conducting optical coherence tomography, which, alas, is not done in all regions and is often paid. After all, you have to wait in line for a study, which sometimes stretches for months, and patients need help urgently.

When there is a rupture of the retinal tissue in the very center, patients often do not notice anything – because we look with both eyes. You can conduct an elementary test. Look at the usual tile on the wall, alternately closing his eyes (each ophthalmologist has a special test for this, it is called the Amsler test). If you see that the lines become wavy, curved, blurred, you need to immediately contact a specialist. In the later stages, the curvatures become visible, even if one does not close one eye; when reading the text, some letters fall out or “jump”. In addition, a fixed dark spot appears in front of the eye. Vitreoretinal surgeons deal with surgical treatment of retinal pathology.

– Probably, these are rare specialists?

– In the 1990s there were only a few specialists throughout the country. Today, vitreoretinal surgeons are becoming more and more. Our doctors had the opportunity to attend conferences devoted to the issues of vitreoretinal surgery, to train in the leading institutes of the country, to study abroad. Clinics buy special equipment – therefore, the specialty becomes widespread.

– Is IMR treated?

– The treatment in the early stages (when the vitreous body is only beginning to exfoliate from the retina, pulls it in the central region, but has not yet reached the point of rupture) helps surgery – vitrectomy, which belongs to the class of high-tech. Tiny punctures are made in the sclera, and then the vitreous body is removed along with the film, which is attached to the retina and pulls it. Such an operation prevents further rupture. Of course, it requires very expensive equipment, most of the consumables for which are made only abroad. When a retina is broken, such an operation is also done, but the larger the gap, the higher the risk that it may not close.

– What then can help?

– Today, there are several worthy methods to help the patient with such a serious disease. One of them, effective and safe, is the use of the patient’s own plasma to close the macular hole. For the first time, three years ago, she was conducted by the deputy director for medical work of the MNTK named after S.N. Fedorov, Dmitry Olegovich Shkvorchenko, together with an ophthalmologist, a graduate student of the MNTK, Yevgenia Alexandrovna Krupina. The method is based on the use of autologous platelet-rich blood plasma (PRP). The bottom line: the patient is taken into the tube with blood from a vein, centrifuged, resulting in a plasma enriched with platelets. This fluid is applied to the macular hole, and it forms a blood clot that tightens the edges of the gap. Closing the gap can be achieved in 100% of cases. This has been shown by the practice of carrying out such operations in 152 patients in the IRTC. These are very impressive results. The method began to gradually replicate with us. Dmitry Olegovich performs 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 therapeutic properties of plasma have been known for a long time – it is also used in cosmetology, maxillofacial surgery, and traumatology.

– Is this operation free for patients?

– Any high-tech treatment of the retina 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, while they need help urgently. The longer a person waits, the less chances he has to restore his sight. In Moscow, this problem is less pronounced, but in the regions it is highly relevant. The operation is expensive, from 50 thousand to 150 thousand rubles. When I began to deal with such patients who need help urgently, I decided to create a foundation. I attracted my friends and relatives to raise funds. On March 13, 2017, our foundation appeared, and the first operation for its funds was conducted on June 24 at the Moscow Eye Surgery Center clinic. Our first patient was Tatyana Vasilyevna, in whom the disease of the macula developed against the background of occlusion of the retinal vein. She waited a long time for the quota, and then decided to do the operation for a fee. A woman brings up three grandchildren – her daughter-in-law died of cancer. When I offered her to operate on the fund, she couldn’t believe her happiness for a long time. Of course, we would like to help a huge number of patients. We can do such operations, there is no need to send patients abroad. But it all depends on the availability of funds in the fund 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 is owned by Alisher Usmanov. I wrote a letter. Maria Melnichenko, the head of this program, answered the very next day and invited me to talk. Further, the Usmanov Foundation studied our activities, and we began to cooperate. Our foundation spent the first charity week of vitreoretinal operations in the summer of 2017, and then, together with the Special Look program, we managed to spend another two weeks of charity. The first was able to operate on 9 patients. In the second, which took place in November 2017, another 14 in three clinics in Moscow: the “Eye Surgery Center”, the ophthalmology clinic of Professor Kurenkov and the ophthalmology department of the K + 31 clinic under the supervision of SI Abramov. The third week passed quite recently in Perm, in the clinic “Three-Z” – this is the first region in which we went, we operated on for 13 people for free. While our opportunities are still limited.

– Your foundation has another activity …

– Yes, and it is today the main thing. This is education assistance. We consider the educational task to be the main activity of our foundation. We have already created the Vitreoretinal Surgeon School, where doctors with a small surgical experience learn from experts, gain experience, learn about the nuances that cannot be read in books. We conduct master classes for surgeons, participation in them is free for them. There were already 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 in our surgical technology from our colleagues from other countries, but technology comes from abroad, and this is an opportunity to learn about all the new products from the industry first hand.

– Does your foundation participate in social projects?

– Yes, to improve the quality of life of families with visually impaired or blind children with such a serious illness as retinopathy of prematurity, in September 2018, the project “School of Conscious Parenthood” is launched in Samara.

The head, the initiator of this direction is Petrachkova Marina Sergeyevna, the 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 leadership of the clinic, the chief physician, Professor Andrey Vladimirovich Zolotarev and the psychologist L.V. Frantsuzova, a psychological support system was developed for families with a visually impaired or blind child.

– What new items do you think are particularly promising?

– We have high hopes for gene therapy. The world has already created gene therapy drugs that are injected into the eye for the treatment of blindness caused by retinal diseases, for example, luxourne with pigment retinitis. In Russia, there is a group of scientists led by Marianna Ivanova who conduct research in the field of ophthalmogenetics. The first phase of research, with the support of the Soyedinenie Foundation for the preparation of a group of patients with hearing loss and loss of vision (Usher syndrome) for the possible use of gene therapy, ended last year. Research is being conducted on the treatment of retinitis pigmentosa – our foundation plans to take part in them. Gene therapy and stem cell therapy in our country are not yet fully developed, but work is underway, these methods open up tremendous possibilities for treating patients.

We are looking for any opportunities 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 an eye examination at least once a year by an ophthalmologist, and always with a thorough examination of the fundus with a wide pupil. And you need to try to quit smoking, monitor blood pressure, eat right – for example, the 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.