Eye diseases - Thai people's health threats and the deterioration that must be prepared for

The increasing number of patients with eye diseases is due to the country’s aging society, as the elderly experience inevitable health problems such as eye degeneration. Other factors include a sedentary lifestyle and overconsumption of sugary foods and beverages in the working-age population, which may lead to high blood sugar levels and subsequently diabetes. Not only that such eye problems can be a cause of sight loss, but they also affect patients’ quality of lives. Therefore, it is crucial to understand the risk factors, watch out for early warning signs, and visit an ophthalmologist for regular eye examinations to protect your eyes.

Thanapong Somkijrungroj, MD., a Retina, Uveitis and Medical Cornea Specialist who is also the Chief of Uveitis Unit at King Chulalongkorn Memorial Hospital and the President of Cataract and Refractive Surgery Society of Thailand, has shared important information about eye diseases, the latest treatment guidelines, and eye care tips for keeping an excellent vision.

Symptoms and consequences: Both Age-related Macular Degeneration (AMD) and Diabetic Macular Edema (DME) are caused by abnormal blood vessels growing into the macula and lead to visual impairment.

The abnormalities in AMD occur beneath the macula. AMD can be classified into two types: dry AMD and wet AMD. The latter is also known as Neovascular Age-Related Macular Degeneration or nAMD, and is more common in people aged 55 and above.

On the other hand, the abnormalities in DME, which are driven by high blood sugar levels, occur within the macula and result in retinal swelling or widening. DME can be found in any age range and is the number one cause of vision loss in people with diabetes.

Risk factors

Although some of the risk factors for AMD, such as aging, are unavoidable, others such as smoking are preventable. Regarding DME, the risk factors are associated with diabetes duration, high blood sugar levels, high blood pressure, obesity, and gestational diabetes.

Medical development and greater efficacy 

Around 10 years ago, the main treatment procedure for eye diseases like AMD and DME was laser. Although it was often unable to improve vision, it helped slow down the progression of the diseases. Recent advancements in medical technology have enabled new treatment approaches that yield greatly improved results. Particularly, a group of medicines called “anti-VEGF” which reduces new blood vessel growth (neovascularisation) or oedema (swelling) demonstrates the visual improvement. To ensure the treatment outcomes, patients are required to inject the medicine into the vitreous. However, each medicine differs greatly in terms of its injection frequency.  Some can be as often as once every 1-2 months, which poses significant burdens for patients and caregivers, especially travel distance and cost for those living far from the hospital or upcountry. In addition, the caregivers of visual-impaired patients may need to take some time off from work to take the patients to the hospital.
 

"The treatment innovation for AMD and DME has undergone an excellent development. Recently, a medicine with a new mechanism of action has been approved by the Thai Food and Drug Administration. The medicine acts as a dual pathway inhibitor; it inhibits both VEGF and ANG 2, which play an essential role in disease pathogenesis. It helps reduce the proliferation, leakage and inflammation of blood vessels, as well as strengthen the retinal vein. From an ophthalmologist's point of view, this mechanism of action is deemed a significant therapeutic change, as it allows longer dosing interval, i.e. less frequent injection, when compared to the previous treatment options. A clinical trial ,  shows that the new medicine is administrated to 80% of patients every 12 weeks (or 3 month-interval), while 60% of patients every 16 weeks (or 4-month interval). It can be said that the innovative treatment can deliver better outcomes for patients”, Dr. Thanapong explained.

According to a clinical trial that conducts with more than 2,300 patients and the real-world evidence data collected in the US of approximately 70,000 doses7 of the injection, the innovative medicine which already received US FDA’s approval does not show any differences in terms of side effects as compared to those previously available medicines. "In Thailand a number of AMD patients have had the opportunity to use this innovative treatment option since it was recently approved in the country. This innovative medicine is suitable for all groups of patients, namely those who have never received any medication before, those who experience drug-resistance, as well as those who prefer to reduce the dosing intervals. This innovative treatment shines a new hope for AMD and DME patients," Dr. Thanapong said.

For DME patients who receive the new innovative treatment and monitor their blood sugar levels carefully, there is a tendency that the symptoms can improve within 3 - 5 years with a strong possibility to discontinue the medication. AMD patients, on the other hand, are less likely to discontinue the medication, their quality of lives can be improved by the reduction of dosing intervals.

In the future, there will be continuous development to deliver new innovation and technologies in treating eye diseases, such as longer-acting medicines, medicines with different mechanisms of action than the existing ones, implantable devices which release the medicine right into the eyes and reduce the frequency of injections to 1 – 2 times a year, AI-aided treatment planning to investigate individual patient’s responsiveness, etc. All of these technologies result in a better quality of life for patients.

Eye disease prevention

Dr. Thanapong said, "Both AMD and DME involve the abnormalities of retinal veins that are likely to happen spontaneously and may affect only an individual eye. Some cases do not report any physical pain at all, and their affected eyes appear normal from the outside without any visible symptoms. As a result, these eye diseases are considered silent health threats to most patients because they assume that blurry vision is caused by changes in vision or eyeglass lens."

It is crucial for the high-risk groups who are prone to develop AMD and DME to establish healthy habits, keep their medical conditions in check, wear eye protection glasses when exposed to strong wind or bright light, avoid rubbing or pressuring eyes, refrain from smoking, maintain a healthy weight, and control theblood sugar levels.

Recommended ways to assess visual impairment

"Everyone can detect visual impairments by following these easy techniques. Close your eyes one at a time, and then look at door frames or window frames. If they appear distorted lines or blurry, you need to visit an ophthalmologist as soon as possible. For people aged 45 and above, it is important to schedule regular eye exams at least once a year to ensure that you will receive timely treatment and reduce the risk for vision loss. The importance of eye health is fundamental to quality of life," Dr. Thanapong concluded.

Thanapong Somkijrungroj, MD., a Retina, Uveitis and Medical Cornea Specialist who is also the Chief of Uveitis Unit at King Chulalongkorn Memorial Hospital and the President of Cataract and Refractive Surgery Society of Thailand.