Let us look into each other's eyes

Ep.1 - Flying flies and retinal problems: what you need to know

Because we see these corpuscles moving in our field of vision and therefore they are not, how should we say, elements that help us to see better. It actually ruins the blood vessels.
That is, the small blood vessels flowing over the retina become like leaky faucets.
That it is the photographic film of the eye comes off its bed.
And the relationship between a patient and their ophthalmologist is crucial.

Maddalena Guiotto

Flying flies, a strange word for a pathology. Eyes fly, they multiply, but unfortunately they do not go away. This is a pathology linked to degeneration of the vitreous, technically called myodesopias. Other pathologies with similar symptoms are those affecting the retina. We talk about this today with Dr Vittorio Piccardo, specialist in ophthalmology, and Carmelo Chines, editor of L'oculista italiano. The reference point for doctors, ophthalmologists, pharmacists and, of course, for all those fascinated by the magic of vision. Welcome to our practice Thank you. Thank you Dr Picardo.

Vittorio Picardo

What diseases have these symptoms? In the meantime, it is a troublesome symptomatology. The pathologies affect both the vitreous humour and the retina. Why? Because we see these corpuscles moving in our field of gaze and therefore they are not, as it were, elements that help us see better many times if they are large they get confused. There is meanwhile a natural situation that can be that of the myopic patient, a bit like me and like you who I am seeing wears myopic glasses, as well as in older people. At this point I refer to me that they can have something called posterior vitreous detachment. Then we could better explain that gelatinous humour that we have inside our eye and that is attached behind, behind the eye, on the optic nerve and in front, behind the lens. With old age, imbalances, a little bit of hydration and nutrition, a little bit of various other diseases can create problems, so this vitreous unhooks from this important posterior attachment and starts to move. In this case we could speak of flying flies, as in benign. On the other hand, in the case of vitreous degeneration, in the myopic, let's say, who wears glasses, as well as mine, they can be a sign that in some way should alert the patient to go to the ophthalmologist, an Italian ophthalmologist we could say so if we want to smile for a moment, but in fact the vitreous humour, that is, this humour that lies in front of the retina can also become dirty.
I am referring, for example, to haemorrhages, trauma, the tennis ball. Something that can worry both the mother for her son who goes to play football in the afternoon and the people who produce and play sport more competitively, so the symptomatology is apparently the same. But the genesis, the origin of these diseases, of these situations can be in the vitreous itself. This gelatinous humour that is here, in this space between the crystalline lens and the retina, but also precisely being the container of something that is poured in, a bit like an open tap, the capillary that breaks and this basin that slowly gets dirty. After this little introduction, I think it might be nice for everyone to hear the opinion of a colleague who has been interested in these pathologies, both of the retina and the vitreous, for a long time. The Professor Scipione RossiHe is a colleague who works here in Rome, and I would certainly ask him as the first important question for people what specifically these diseases of the retina and also those of the vitreous are. In particular, I would also like to refer to maculopathy as these diseases are, how they are divided if there is also a timing for diagnosing them and for being able to treat them.

Scipione Rossi
Thank you for the question, it is very interesting. Let's say that diabetes, as everyone knows, is a disease that we say is related to poor glycaemic control. And how does it ruin the retina? Why does it ruin the retina? And what are the phenomena that occur inside the retina? It actually ruins the blood vessels, i.e. the small blood vessels that flow on the retina become like leaky faucets, and so you can see small haemorrhages coming out of these open faucets or even the loss of transudate, i.e. fluid that accumulates in the retinal layers. Obviously, both the one and the other of the phenomena that I have just mentioned, if they occur in the central areas of vision on the macula, let us say, you get damage, there is a lot of damage. So the treatment of diabetic retinopathy and diabetic maculopathy, i.e. that which affects the centre of the diabetic's retina, consists in making sure that the accumulation of exudation, of exudation from these vessels is reabsorbed as soon as possible. This type of procedure, therefore, can be procedures that until a while ago were performed simply by laser treatment, i.e., these leaky taps were closed, let's say, with the laser, but the laser obviously also produced scars, in short, which could be right in some cases, but if they were too close to the centre of vision they could ruin the vision itself.
So, over time, intravitreal therapies came about, i.e. what are intravitreal therapies? They are injections of special substances that actually manage, thanks to the pharmacological effect that these substances have, to ensure that the exudation, this transudation, that occurs in retinopathy and diabetic maculopathy, is reabsorbed, or at least is reabsorbed, for as long as the drug lasts.

Dr Chines back to the flying flies.

Carmelo Chines
Certainly the name is not the most suitable to identify a pathology, but the effect is exactly that of having a fly in front of the eye, a moving body, and especially in bright light. We think perhaps looking at snow, a white wall, indeed sometimes we say always look at a white wall, and perhaps the ophthalmologist can understand what difference and what, above all, suffering the patient may have Why see these bodies pass in front of him not understanding their origin? Because it could be a trauma while playing football, falling after an accident or a whiplash injury, that shock at the vitreous level that detaches these particles and they start to move in front of our eye. That is the sensation. And that is what to do. Certainly not to lose heart, but to find solutions, perhaps talking first of all with the ophthalmologist and then with the pharmacist, and to find products that can reduce the incidence of these flying flies or we always recommend a healthy Mediterranean diet, an important hydration because in any case in the vitreous there are those substances in our body so more or less comparable to articular cartilage where however the vitamins derived for example from anthocyanidin can be then a blueberry extract, rather than something else, they help stabilise this vitreous because, to all intents and purposes, it has to be strengthened exogenously, i.e. by taking substances or using sunglasses with suitable filters, especially in bright light, when outdoors, when walking the dog or even when doing sport, because it is important from a psychological point of view not to think of ourselves as sick, but rather as people who have discovered something and share this presence within our eye and our brain.

Maddalena Guiotto
Of course, because there are always repercussions in people's lives when there is something wrong with their eyes: when you can't see well, your outlook on life changes too

Vittorio Picardo
To say that after all our eyes until they are sick we don't know we have them because it is natural to open our eyes in the morning to see everything around us from the clock to the mobile phone, the television, the newspaper. But then when you have a problem the fear becomes so great.

Maddalena Guiotto
So, Dr Picardo Dr Chines was talking about these symptoms. Then he helps us to understand when it is really important and urgent to go to the ophthalmologist, what are the symptoms that are a bit of a wake-up call.

Vittorio Picardo
So the symptoms we have said are these flying flies as Dr Chines rightly said. And this sensation is even more pronounced inside a very bright environment, i.e. outside. Or against a light wall or at least a light surface, such as a sheet of paper or a computer screen. But are these flies as annoying as those in summer? Yes, they are annoying, certainly, but they must also perhaps be a wake-up call. Always because, as we have said before, this gelatinous humour, this vitreous humour is in perfect contact with the retina, that membrane that is usually compared to the film of a camera, it receives the light signal, transforms it into an electrical signal and sends it, transports it to the brain, where it is then processed in a superior function which is our image, the one we see, his face, my hand, in short anything. So the answer is always go to the ophthalmologist, It's always better to be told you have nothing than Why did you come late?
Why? Because these symptoms that we were talking about earlier, which a diet can certainly help to combat or at least balance in some way, as well as hydration, can in fact be the first sign of much more serious pathologies, such as retinal rupture, in which case flying flies are easily accompanied by symptoms that are flashes of lightning, as we call them in another word from the Greek Phosphenes. In fact, all medicine is very much contaminated, unfortunately, by the etymology of words that come from the Greek and therefore phosphenes, which can be precisely the signal of an alarm bell this retina begins to tear. And if this retina tears more and more and changes let's say in its relationship with this gelatinous humour, this blessed or cursed vitreous, but in short it serves. In fact, one can even arrive at those serious cases that are retinal detachment, therefore a pathology that unfortunately transfers the patient from an eye clinic or from being in front of a laser treatment to an operating theatre. So, as you see, situations can change overnight in just a few moments.
The moment this retina is detached what is done? It is that the doctor changes his gown. Let's say that instead of having the famous white coat of the examination that we see all over the place, he puts on the green overall, goes into the operating theatre, puts on the gloves and unfortunately has to force the patient to undergo surgery. So it would be a good idea if another nice young colleague, Tommaso Candian, who works at St. Anthony's Hospital in Padua, could help us a bit to better understand all the problems that revolve around a clinical situation such as retinal detachment, which requires us to go to the operating theatre.

Tommaso Candian

Thank you for the invitation, thank you for the opportunity to be here, and thank you for being able to talk about retinal detachment which is one of the most important complications that can occur in the eye that if not treated promptly can lead to blindness. The retina, which is the photographic film of the eye, detaches from its bed. To treat this pathology we have three methods. The first method is a conservative para-surgical treatment by laser, a small drop of eye drops. The patient feels nothing. We have a laser that uses thermal energy to stitch the film back onto the retina. If this does not happen in the early stages we move on to a true retinal detachment. We have to intervene surgically. But what is the beauty of the third millennium that this surgery has become mini-invasive, highly technological. We use microscopes of three-dimensional systems and we have two systems to attack. The first system is 'ab esterno', bringing the eye close to the photographic film. The first system is through a cerclage or through small sponge leads, always bringing it closer. If this is not possible, we have another, more modern technique that we young surgeons like and it involves, through two extremely small probes, smaller than insulin needles, going into the eye, illuminating the inside of the eye, removing the material inside the eye and inserting tamponade media such as gas or silicone oil that go to re-attach the retina.

Maddalena Guiotto
Dr Chines, but then from the patient's point of view, how do you do it?

Carmelo Chines
So I can say how I did it because I am a patient and I too have been to an Italian ophthalmologist and I have to say that it was not an immediate awareness because, as to say, one maybe standing in front of the computer does not know if it is actually a side effect or not. And so either on the advice of the ophthalmologist he used an artificial tear, for some time, just to see if it was something maybe even an eyelash entering the eye. Then right from the first interactions they ask you: but do you have a foreign body sensation and then say I was guided both in presence and remotely to know better. In my opinion, the relationship that exists between a patient and their ophthalmologist is fundamental and so when I discovered this presence let's put it this way. I have to say it wasn't always there, I considered them almost seasonal things then being an allergic person when I sneezed especially in spring and summer and I saw these things moving around... from that moment on I started to become aware of what the risks of underestimating this, how should I say, this signal could be, so everything Dr Picardo told us to expand the investigation. And being able to recognise what can be unexpected consequences and that if the patient doesn't know them beforehand what they might be up against, without panicking of course. But this was crucial for me personally to learn a different dialogue with my ophthalmologist and above all to start taking supplements to make my vitreous toughen up. But of course it is knowledge that is the most important thing for us patients so that we can really, how should I put it, answer to ourselves first and know what is happening to us.

Maddalena Guiotto

So thank you to our guests for explaining the origin of flying flies, of this really annoying ailment, but also and above all for giving us tips on how to treat this type of problem and also to immediately recognise what are the symptoms to look out for, because they are perhaps harbingers of other problems such as retinal detachment, for which there are always solutions. In our podcasts we look at each other in the eye, we always try to give answers to your questions. Leave a comment, stay tuned and see you next time.