Risultati per: Scoperta possibile causa del glaucoma

Nel 2024 6mila diagnosi in Italia, radioterapia strategia chiave

Nel 2024 6mila diagnosi in Italia, radioterapia strategia chiave

Objectives
Glaucoma is a major cause of irreversible blindness in India; however, if detected early, its progression can be either prevented or stabilised through appropriate medical or surgical treatment. We aim to evaluate the cost–utility of various models for population-based glaucoma screening at primary health centres in India. We also assess the potential impact of the implementation of a population-based screening programme on overall costs of care for glaucoma.

Design
Cost–utility analysis using a mathematical model comprising a decision tree and Markov model was conducted to simulate relevant costs and health outcomes over a lifetime horizon.

Setting
Screening services were assumed to be delivered at primary health centres in India.

Participants
A hypothetical cohort of different target population groups in terms of age groups and risk of glaucoma (age group 40–75 years, 50–75 years, 40–75 years age group at high risk of glaucoma, 50–75 years age group at high risk of glaucoma) were included in comparative screening strategies.

Interventions
The exclusive intervention scenarios were 12 screening strategies based on different target population groups (age group 40–75 years, 50–75 years, 40–75 years age group at high risk of glaucoma, 50–75 years age group at high risk of glaucoma), screening methods (face-to-face screening and artificial intelligence-supported face-to-face screening) and screening frequencies for 40–75 years aged population (annual vs once every 5 years screening), in comparison to usual care scenario. The usual care scenario (current practice) implied opportunistic diagnosis by the ophthalmologists at higher levels of care.

Primary and secondary outcomes
The primary outcome was the incremental cost–utility ratio for each of the screening strategies in comparison to usual care. The secondary outcomes were per person lifetime costs, lifetime out-of-pocket expenditures, life years and quality-adjusted life-years (QALYs) in all screening scenarios and usual care.

Findings
Depending on the type of screening strategy, the gain in QALY per person ranged from 0.006 to 0.046 relative to usual care. However, the screening strategies, whether adjusted for specific age groups, patient risk profiles, screening methods or frequency, were not found to be cost-effective. Nonetheless, annual face-to-face screening strategies for individuals aged 40–75 years could become cost-effective in a scenario of strengthened public financing and provisioning, such that at least 67% of those seeking care for confirmatory diagnosis and treatment use government-funded facilities, in conjunction with 60% availability of medications at government hospitals.

Conclusions
Enhancing continuity of care following screening through either strengthening of public provisioning or strategic purchasing of care could make glaucoma screening interventions not only cost-effective, but also potentially cost-saving.

Background
Primary glaucoma patients faced many difficulties that affected their treatment during the COVID-19 pandemic. Glaucoma treatment often starts with prescription eye-drops. However, delays in ophthalmic therapy often occur due to poor awareness of the dangers of glaucoma, which subsequently leads to irreversible visual field defects and eventual blindness.

Objective
This study aimed to explore the social, personal and medical factors that contributed to barriers in the treatment of primary glaucoma during the COVID-19 pandemic, with the overarching goal of providing insights to develop measures that can identify the barriers of the treatment process and prevent consequent adverse outcomes.

Methods
We adopted a phenomenological approach and used purposive sampling to recruit 122 patients into our study. Face-to-face, semistructured, one-on-one interviews were conducted in a private office. The data were analysed using Colaizzi’s seven-step method. In cases where classification was difficult, consensus was reached among the three researchers who formed the core assessment team.

Results
A total of 122 glaucoma patients experienced delayed pharmaceutical treatment during the outbreak. Delays were longer among females and patients over 75 years old, highlighting that treatment delays were a significant issue for glaucoma patients during the COVID-19 pandemic, particularly for older females. Coding of the transcripts yielded three themes (eight subthemes): (1) the impact of social support on glaucoma pharmaceutical treatment: (a) the inability to seek pharmaceutical treatment alone and (b) online reservation and payment requirements; (2) the impact of personal reasons on glaucoma pharmaceutical treatment: (c) fear of being infected with COVID-19, (d) being infected with COVID-19 or coming into contact with COVID-19 patients, (e) being busy with work or life; (3) the impact of medical resources on glaucoma pharmaceutical treatment: (f) abnormal diagnosis and treatment processes, (g) insufficient medical manpower and (h) insufficient communication from medical staff.

Conclusions
To prevent medication delays and potential irreversible damage to the visual field in primary glaucoma patients during health crises, it is essential to further explore personalised strategies for coping with the impact of pandemics. Special attention should be given to glaucoma patients facing significant life burdens, such as the elderly and females, and efforts should be made to increase their awareness of the risks of glaucoma. Future studies could explore the feasibility of providing more support to glaucoma patients, such as online payment and appointment scheduling options, to reduce delays and alleviate patient anxiety.

Obbliga le aziende a contribuire a costi di trattamento delle acque

Dal 9 al 15 marzo la Settimana mondiale della malattia

Introduction
The primary therapeutic approach to glaucoma involves the long-term use of intraocular pressure (IOP)-lowering eyedrops. However, the prevalent use of benzalkonium chloride (BAK) as a preservative in glaucoma eyedrops has been associated with ocular side effects, prompting a demand for alternatively preserved (AP) or preservative-free (PF) eyedrops. Studies comparing various preservatives have shown conflicting evidence concerning the safety of BAK-preserved (BP) eyedrops, some studies indicating no notable concerns and others reporting adverse effects. The current protocol concerns a network meta-analysis enabling systematic investigation of the IOP-lowering efficacy and safety profiles of BP, AP and PF eyedrops in patients with glaucoma for whom randomised controlled trials (RCTs) are available.

Methods and analysis
This study will evaluate the IOP-lowering effects of glaucoma eyedrops, comparing formulations with and without preservatives in patients with glaucoma. A systematic search for RCTs, regardless of language or publication date, will be conducted across three electronic databases (Cochrane search engine, Embase and MEDLINE) from 1 March 2024. Two reviewers will conduct a sequential screening of titles and abstracts, followed by full-text papers, to extract useful data. The two reviewers will also assess the internal validity of studies using the relevant and domain-based risk of bias assessment tool. Overall evidence quality will be assessed using the Confidence in Network Meta-Analysis approach and presented in summarised form with network diagrams. Forest plots will be generated for enhanced visualisation of the included glaucoma eyedrops’ effects, and pairwise effect sizes will be calculated based on available evidence in the network.

Ethics and dissemination
No ethics review or approval is required for this work, as it will synthesise evidence obtained from published studies. A paper presenting the findings will be submitted to a peer-reviewed journal for publication.

PROSPERO registration number
CRD42024498328

Percorso con chef e medici per benessere e cibo consapevole

Introduction
Glaucoma is one of the most common causes of blindness and affects more than 70 million people worldwide. The disease is characterised by the loss of retinal ganglion cells associated with a progressive optic neuropathy, resulting in an impairment of visual functions, for example, visual field loss. Nowadays, the only modifiable risk factor is the increase in intraocular pressure, and its treatment is to lower this pressure by medication, laser treatment or surgery to avoid disease progression. New methods for preventing and reversing vision loss are thus urgently needed. Several small and two multicentre studies have presented evidence that repetitive transorbital alternating current stimulation (rtACS) can lead to long-lasting visual field improvement. This could open a new and inexpensive therapeutic option for optic atrophy. However, the level of evidence for this method is still fairly rather poor, and further trials are needed. Therefore, this clinical trial aims to prove the effectiveness of rtACS compared with sham stimulation in patients with primary open-angle glaucoma (POAG).

Methods and analysis
VIRON (Vision Restoration in Optic Neuropathy) is a national, multicentre, prospective, randomised, placebo-controlled, double-blind trial with three arms. The primary objective is to assess the effectiveness of rtACS in patients with POAG compared with sham stimulation. The primary outcome is the change in mean defect (MD) in the visual field immediately after 10 sessions of rtACS (days 9, 16 and 23) compared with the values of initial perimetry (days –21 to –14 and 0) after applying electrical stimulation with a classical montage, compared with sham and electrical stimulation using individualised montage. Secondary outcome measures comprise a long-term effect with changes in MD at 24 weeks after stimulation, and data from the National Eye Institute Visual Function-25 and quality of life (Short Form 36) questionnaires. The target population are patients with glaucomatous optic atrophy and significant glaucomatous visual field defects (MD of 5–22 dB) due to POAG.
After randomisation, patients received either classical rtACS (group 1), individual rtACS (group 2) or sham stimulation (group 3) in daily 25 min stimulation sessions in two series of five consecutive days separated by a weekend interval. In group 1, active stimulation will be via the routinely applied montage using two electrodes affixed on the right and left side of the head, next to the eyes, with straightforward fixation. In group 2, the current flow will be individually modelled (MRI-based) to target areas of partial visual field defects by optimising electrode positions in conjunction with an optimised visual fixation direction. Group 3 with sham stimulation will serve as control.
The calculated sample size required to achieve a statistical power of 80% for a relevant effect size and allow for dropouts was 300 (100 per group). The trial has already begun with the first patient in July 2023. The planned recruitment period is 24 months with an estimated end of the study in November 2025 (last patient out). An adjusted extension of the study period is planned.

Ethics and dissemination
VIRON was approved by the Central Ethics Committee of the University Medical Center Göttingen (19 October 2022) and those of the individual participating centres (Bonn: 446/23-EP, Hamburg: 2023-200889-BO-bet, Cologne: 23-1487 and Mainz: 2023-17399-§23b). The study protocol complies with the Declaration of Helsinki, the national medicine device regulation (MDR) laws and the international standards of good clinical practice (GCP).
The study protocol (V.5, 24 November 2023) was designed following the Standard Protocol Items: Recommendations for Interventional Trials guidelines and is registered on https://drks.de/search/de/trial/DRKS00029129.
As study initiatior the University Medical Center Göttingen (UMG) is responsible for data ownership and data management of the VIRON study. The study data will be published within 6 months of the study being completed. After the publication of the primary results, all data are anonymised and published in an open-access journal to ensure access to the data for third parties.

Trial registration number
https://drks.de/search/de/trial/DRKS00029129.

Ricerca italiana apre alla diagnosi con un prelievo

Purpose
To investigate the characteristics and publication status of minimally invasive glaucoma surgery (MIGS) clinical trials registered on ClinicalTrials.gov.

Design
A cross-sectional study.

Methods
All 1212 interventional glaucoma trials registered on ClinicalTrials.gov with start dates between 1 October 2007 and 30 April 2024 were included. All trials were categorised into ‘MIGS trials’ and ‘other interventional glaucoma trials’. Based on the anatomical site of action and the research content, MIGS trials were classified into different groups, and intergroup comparisons were conducted. The characteristics and publication status of MIGS trials were comprehensively analysed.

Results
Compared with all other interventional glaucoma trials, MIGS trials had a higher proportion of single-arm trials (p

Farmaco regolatore orexina ruolo chiave anche in psicopatologia

Studio guidato dalle Molinette di Torino. Ruolo rare mutazioni

Objective
Adaptive coping mechanisms (ACMs) are effective ways to cope with stress and anxiety in patients with chronic illnesses, such as glaucoma. This study aimed to assess the proportion of ACM and associated factors among adult glaucoma patients enrolled at the tertiary eye care and training centre in Northwest Ethiopia.

Design
An institution-based cross-sectional study.

Setting
This study was conducted at a tertiary eye care and training centre in Northwest Ethiopia from 15 May 2022 to 30 June 2022.

Participants
The study included a sample of 398 adult glaucoma patients selected using a systematic random sampling technique.

Primary and secondary outcome measures
The participants were diagnosed with glaucoma by ophthalmologists. Optometrists conducted interviews, reviewed medical records and administered a pretested, structured questionnaire based on the Brief Coping Orientation to Problems Experienced inventory. Binary logistic regression was performed to identify associated factors, with significance considered at a p

Più di una malattia può contribuire alla mortalità

Oms invia un team nel Paese ‘per comprendere la situazione’