Professor Jerzy Szaflik, an eminent ophthalmologist, talks about new methods of treating eye diseases: glaucoma, cataracts, and macular degeneration (AMD). What are the achievements of the latest ophthalmology?

Diabetic retinopathy is one of the causes of eye disease

  • Prof. dr hab. n. med. Jerzy Szaflik:Yes. Eye changes caused by diabetes are difficult to treat. The effects of the therapy are periodically good, but not very permanent. Until recently, we only had laser, diet and insulin therapy to treat diabetic lesions. New possibilities are offered by injections into the eye. On the other hand, when the eye is blind due to strokes, when retinal detachments occur, we perform the procedure of excision of the lesions - vitrectomy. Surgery of the interior of the eye is developing dynamically, although we do not yet have the therapeutic success that we would expect.

What are the other causes of blindness conditions?

  • J.Sz.:Ophthalmic diseases are largely age-related. Environmental pollution also has a significant impact on the organ of vision, and diseases such as diabetes, glaucoma or side effects of medications, etc., are additional factors that aggravate vision problems. Usually, glaucoma, cataracts, and macular degeneration appear later in life. A strong risk factor for glaucoma is heredity. Attempts are being made to treat genetically determined diseases, e.g. retintis pigmentosa (blindness resulting from the destruction of retinal pigment cells), a method of genetic engineering.

Why is glaucoma dangerous?

  • J.Sz.:Most of its types in the first period are asymptomatic. Changes - irreversible damage to the optic nerve - are elusive for the patient. When he begins to notice them, they are already well advanced. We have no influence on the occurrence of glaucoma, but we can treat it effectively. Patients predisposed to glaucoma in their thirties should undergo an ophthalmological examination. When detected in time and properly treated, it allows for normal functioning. Most often, drip treatment and systematic control are sufficient. Sometimes the disease process progresses and there is a need for a surgical procedure.

Patients predisposed to glaucoma approxIn their 30s they should undergo an eye examination.

Which test will detect changes in the optic nerve first?

  • J.Sz .:Such a chance is offered by OCT optical coherence tomography. It is a modern method of imaging the structures of the retina and the optic nerve. It allows for constant monitoring of changes and capturing even a slight loss of nerve fibers.

What is the reason for these changes?

  • J.Sz .:The main cause of glaucoma is too high pressure in the eyeball in relation to the pressure needed, but for one patient the pressure of 25 mm Hg may be acceptable, and in other glaucomatous symptoms will result in pressure lower than 20 mm Hg. The thickness of the cornea is important in assessing the actual pressure. If the cornea is thicker, the test result may be inflated, and if the cornea is thin - it may be underestimated.

What You Should Know About Glaucoma?

What about pharmacological treatment of glaucoma?

  • J.Sz .:In recent years, many new drugs have been introduced that give a more effective effect and are more convenient, because they are used once a day. A better therapeutic effect is given by drugs that combine two preparations in one drop. Despite this, drip treatment of glaucoma (life-long) still has a negative effect on the surface of the eye (conjunctival reactions, corneal changes, etc.). Surgical treatment is the treatment of choice in the event of persistent redness, burning sensation or discomfort when administering the drops. Despite more perfect diagnostic methods, less and less burdensome medications and less and less invasive treatments, the results of glaucoma treatment are not entirely satisfactory.

What is the surgical treatment of glaucoma?

  • J.Sz.:In order to lower the pressure inside the eyeball, we use various types of laser treatment and surgical procedures. Modern glaucoma surgery uses new generations of microimplants implanted into the eye, resulting in more effective lowering of pressure with less surgical trauma.

>>>On the next page you will read about the treatment of cataracts, macular degeneration (AMD) and the new therapy for keratoconus.

Surgery also helps with cataracts?

  • J.Sh .:Cataracts are caused by clouding of the lens, which causes progressive deterioration of vision, including blindness. Thanks to microsurgery, we can effectively deal with this problem by replacing our own lens with an artificial one. This treatment is perfected and safe thanks to the latest techniques that allow it to be performed with minimal interference with the eye tissue. 2-3 small incisions in the cornea are enough,main is about 2.2 mm. Ultrasound is used to remove the opaque own lens through this incision. The size of the implanted lens is in the order of 12-13 mm. Through the main incision, we insert a flexible and rollable lens into the eye - there it unfolds and obtains the correct shape. This procedure is performed under minimal anesthesia, the so-called drip. Most of the cuts do not require sewing and are self-sealing.

Is cataract surgery safe?

  • J.Sz .:Yes, and it improves vision in a short time. Any vision problems after this procedure is usually due to additional eye conditions such as macular degeneration (AMD). The implant does not cause any negative effects on the eye tissue. The latest device for cataract surgery is the femtosecond laser, which largely replaces the manual activity of the surgeon and is much more precise than him.

What are the possibilities of the new lenses?

  • J.Sz .:A patient who has always worn glasses, e.g. due to myopia, does not have to wear them after the procedure. If he had a corneal curvature causing poor vision due to astigmatism, a new lens may accommodate this defect. Single vision lens for distance allows you to see well at a distance (without glasses we drive a car, and for work close up we wear glasses), for near - the opposite. There are also technologically complicated lenses from the group of pseudo-accomodation or multifocal, allowing for sharp vision from far and close.

How is Macular Degeneration (AMD) treated?

  • J.Sz .:The disease is most often bilateral, but it does not occur simultaneously in both eyes. So it happens that one eye can see well, while the other is already badly damaged. Until recently, AMD was incurable. It has two forms: dry atrophic and the more dangerous, wet, exudative. In it, we apply treatment directly to the eye - stopping the disease and, in some cases, reversing it, reducing swelling and reducing the amount of subretinal fluid. Visual acuity stops at the level when the patient came to us, and even improves. This is a great progress, although the AMD problem is still serious.
This will be useful to you

New therapy for keratoconus

One of the greatest achievements in recent years is the treatment of a rare disease - keratoconus. Corneal dystrophic changes cause changes in its shape and visual impairment. Until recently, the only effective method was corneal transplantation, now there are possibilities of early inhibition of its development. The main cause of the disease is weaknessintercollagenic bonds. They cause the cornea to be too soft and intraocular pressure squeezes its middle part, leading to a change in its shape - the section of the ball turns into a section of a cone in the cornea - which causes irregular astigmatism. Current methods allow for non-surgical strengthening of intracorneal structures and stopping the process of changing the shape of the cornea (cross-linking).

prof. dr hab. n. med. Jerzy Szaflikis the head of the Department and Clinic of Ophthalmology at the Medical University of Warsaw, a long-term national consultant in the field of ophthalmology, the initiator of the construction, and then the director of the Ophthalmology Hospital in Warsaw, owner of the Eye Microsurgery Center "LASER".

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Eye diseases and vision disorders