Features of therapy selection in patients with glaucoma and “dry eye” syndrome

J.G. Oganezova, E.A. Egorov Pirogov Russian National Research Medical University, Moscow, Russian Federation Along with the main focus of antiglaucomatous therapy — a reduction of IOP, there is a need to support the function of the optic nerve and retinal ganglion cells (RGC). In the prescription of neuroprotective therapy, the possibility of maintaining the functional activity of the RGC it should be considered primarily. Increased energy demand causes greater vulnerability of RGC in regulation violation of intracellular Ca2+, metabolic stress with increased IOP or vascular disorders. Currently, a toolkit of ophthalmologist has a variety of drugs for antihypertensive and neuroprotective therapy. In the presence of contraindications or insufficient effect of the first-choice drugs, it is switched to the second-choice drugs or combination therapy. In this situation, it is preferable to prescribe antiglaucomatous drugs with both pronounced antihypertensive and neuroprotective properties. Such drugs include a representative of selective alpha2-adrenergic agonists —brimonidine. In addition to neuroprotective effect, brimonidine has a double mechanism to reduce the level of IOP: at the same time, it reduces the production of water moisture and activates an uveoscleral outflow. 0.2% solution of brimonidine (Luxfen) contains in its formulation composition a moisturizing component — polyvinyl alcohol, due to which the problem of protecting the eye surface can be solved by prescribing more than one drug containing a preservative for a long period. Key words: POAG, neuroprotection, alpha-agonists, dry eye syndrome, brimonidine, Luxfen. For citation: Oganezova J.G., Egorov E.A. Features of therapy selection in patients with glaucoma and “dry eye” sydrome. RMJ “Clinical&nbsp;ophthalmology”. 2018;4:186–189.<br

Modalities for the treatment of primary open-angle glaucoma

J.G. Oganezova1, S.V. Simonova2 1Pirogov Russian National Research Medical University, Moscow, Russian Federation 2State Budgetary Institution “Research Institute for Healthcare Organization and Medical &nbsp;Management of Moscow Healthcare Department”, Moscow, Russian Federation Meta-analysis demonstrates that the number of patients with glaucoma worldwide is estimated to be 65.5 million in 2020 and 111.8 million in 2040. Glaucoma requires careful evaluation of the risks and benefits of topical medications for a certain patient considering ocular status and disease stage, potential drug intolerance, allergic reactions, and long-term glaucoma treatment complications. Therefore, the primary goal is to sel ect a medication with excellent IOP-lowering effect and neuroprotective properties whose components prevent complications including dry eye syndrome. The article presents experimental and clinical data fr om different years on drugs with similar activity. Among these agents, selective alpha2-adrenoreceptor agonists are the most promising medications. Clinical trials on brimonidine demonstrate its direct neuroprotective effect which is independent of its IOP-lowering effect (i.e., cell survival improves even in ocular hypertension until IOP is well-controlled). When switching to brimonidine, greater IOP-lowering effect can be explained by its dual action, i.e., a decrease in aqueous flow and an increase in uveoscleral outflow. Luxfen ( 0.2% brimonidine) contains polyvinyl alcohol. The benefits of polyvinyl alcohol presence in ophthalmic solution are its moisturizing and protective effects on the ocular surface. Polyvinyl alcohol prevents dry eye in long-term treatment when adding brimonidine. Keywords: glaucoma, primary open-angle glaucoma, neuroprotection, dry eye syndrome, compliance, alpha2-adrenoreceptor agonists, brimonidine. For citation: Oganezova J.G., Simonova S.V. Modalities for the treatment of primary open-angle glaucoma. Russian Journal of Clinical Ophthalmology. 2019;19(3):159–162. About authors: 1Janna G.&nbsp;Oganezova — MD, PhD, Assistant Professor of the Department of Ophthalmology, ORCID iD 0000-0002-4437-9070; 2Simona V.&nbsp;Simonova — Head of the organizational and methodological department of ophthalmology of the Moscow Healthcare Department, ORCID iD 0000-0002-1271-1630. 1Pirogov Russian National Research Medical University. 1, Ostrovityanova str., Moscow, 117997, Russian Federation. 2State Budgetary Institution “Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department”. 9, Sharikopodshipnikovskaya str., Moscow, 115088, Russian Federation. Contact information:&nbsp;Janna&nbsp;G.&nbsp;Oganezova, e-mail:&nbsp;[email protected].&nbsp;Financial Disclosure:&nbsp;no authors has a financial or property interest in any material or method mentioned. There is no&nbsp;conflict of interests. Received&nbsp;18.02.2019. </p

Modern approaches to the therapy of computer visual syndrome

Zakharova M.A.1, Oganezova J.G.2 1 S. Fyodorov Eye Microsurgery Federal State Institution, Moscow 2 Pirogov Russian National Research Medical University, Moscow In the modern world, computers and electronic devices have become universal tools that are actively used not only in professional activities, but during the rest. However, doctors noted the growth of &nbsp;pathological changes in the organs and systems of the human body, induced by work at the computer. It is computer syndrome, which includes changes in the skeleto-muscular system, carpal tunnel syndrome and computer vision syndrome (CVS). According to the estimates of different researchers, working with a computer for more than three hours a day leads to the development of the CVS in its different manifestations in 64-90% of users. At the same time, the risk of developing a CVS increases with increasing duration of work at the computer. Long-term work behind the computer monitor can be considered as a stress regime for the organ of vision, which is accompanied by a disturbance of the oxidation-antioxidant balance with the formation of free radicals that contribute to the damage of biological membranes, causing tissue hypoxia and the release of inflammatory mediators. Therefore, CVS treatment should be comprehensive and include traditional methods of treatment and use of anthocyanozides. This article discusses an integrated approach to treatment of the CVS, it focuses on the effectiveness of drugs containing anthocyanozides.&nbsp; Key words: computer vision syndrome, anthocyanozides, bilberry extract, complex treatment of computer visual syndrome. For citation: Zakharova M.A., Oganezova J.G. Modern approaches to the therapy of computer visual syndrome //&nbsp;RMJ “Clinical ophthalmology”. 2018;1:50–54.<br

IOP-lowering effect and tolerability of prostaglandin analogues in primary open-angle glaucoma and ocular hypertension as risk factors for glaucoma progression

A.V. Belogurova1, E.N. Eskina1, J.G. Oganezova2 1LLC “Сlinic “Sphere”, Moscow, Russian Federation 2Pirogov Russian National Research Medical University, Moscow, Russian Federation Glaucoma is still one of the leading causes of irreversible low vision and blindness worldwide. Effective treatment for primary open-angle glaucoma (POAG) is an important issue in modern ophthalmology. Topical IOP-lowering agents are prescribed to control glaucoma and to normalize IOP. 60% to 80% of glaucoma patients receive exactly medical treatment, i.e., daily instillations of eye drops. Preservative-containing antiglaucoma drops induce secondary “dry eye” syndrome, conjunctival hyperemia, thereby reducing the patient’s adherence to treatment and, in some cases, provoking self-abolition of antiglaucoma drugs by patients. The article reviews the data on IOP-lowering effect and tolerability of preservative-free tafluprost 0.0015% in patients with POAG and ocular hypertension who have switched from preservative-containing prostaglandin analogues. Preservative-free tafluprost characterized by high IOP-lowering efficacy keeps the IOP under control when switching to this agent. Tafluprost has also good tolerability in terms of improved subjective complaints and signs of dry eye as well as objective ocular surface criteria. Switching from preservative-containing tafluprost to preservative-free formulation is reasonable and can improve compliance due to its efficacy. Keywords: glaucoma, intolerance, treatment, dry eye, preservatives, preservative-free, compliance, efficacy, tafluprost, Taflotan. For citation: Belogurova A.V., Eskina E.N., Oganezova J.G. IOP-lowering effect and tolerability of prostaglandin analogues in primary open-angle glaucoma and ocular hypertension as risk factors for glaucoma progression. Russian Journal of Clinical Ophthalmology. 2019;19(1):21–26. About the authors: 1Alyona V. Belogurova — MD, PhD, ophthalmologist; 1Erika N. Eskina — MD, PhD, Professor, medical director; 2Janna G. Oganezova — MD, PhD, Assistant Professor of the Ophthalmological Department. 1LLC “Clinic “Sphere”. 10, Starokachalovskaya str., Moscow, 117628, Russian Federation. 2Pirogov Russian National Research Medical University. 1, Ostrovityanova str., Moscow, 117997, Russian Federation. Contact information:&nbsp;Alyona V. Belogurova, e-mail:&nbsp;[email protected].&nbsp;Financial Disclosure:&nbsp;no authors have a financial or property interest in any material or method mentioned. There is no&nbsp;conflict of interests. Received&nbsp;19.12.2018.<br

Carotenoids in the treatment of age-related macular degeneration: a drug delivery system does matter

M.L. Maksimov1–3, J.G. Oganezova3,4, I.D. Kanner5, A.A. Voznesenskaya6 1Kazan State Medical Academy — Branch of the Russian Medical Academy of Continuous Professional Education, Kazan, Russian Federation 2Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation 3Pirogov Russian National Research Medical University, Moscow, Russian Federation 4Research Center for Medical Genetics, Moscow, Russian Federation 5Lomonosov Moscow State University, Moscow, Russian Federation 6National Medical Research Center of Endocrinology, Moscow, Russian Federation Age-related macular degeneration (AMD) is one of the leading causes of low vision and blindness worldwide for people over age 60. By 2040, the number of people living with macular degeneration is expected to reach 288 million due to the exponential acceleration of population aging. A decline in visual functions caused by AMD has a significant economic impact in all countries. Besides aging, there are other multiple heterogenic risk factors associated with AMD: gender, environmental condition, lifestyle, genetic characteristics, chronic inflammatory processes in the human body, level of education, etc. It is important for the ophthalmologist to be aware of modifiable risk factors and thus to collect a comprehensive medical history, interact with patients using motivational interviewing and to involve promptly other healthcare specialists into the patient management strategy. Etiopathogenesis of AMD is still not entirely understood. However, it is known that the major pathways include age-related alterations of retinal pigment epithelium (RPE) cells, oxidative stress, dysregulated lipid metabolism, inflammation, hemodynamic changes, and neovascularization. Carotenoids lutein and zeaxanthin are natural compounds with a proven efficacy in reducing AMD progression, which have been demonstrated to act as medications for patients with early AMD stages. The micro-encapsulated formula offers such an advantage as gradual and controlled release of active substances. Keywords: age-related macular degeneration, risk factors, etiopathogenesis, carotenoids, lutein, zeaxanthin, microcapsules. For citation: Maksimov M.L., Oganezova J.G., Kanner I.D., Voznesenskaya A.A. Carotenoids in the treatment of age-related macular degeneration: a drug delivery system does matter. Russian Journal of Clinical Ophthalmology. 2023;23(1):60–65 (in Russ.). DOI: 10.32364/2311-7729-2023-23-1-60-65. </p

Lens disorders in degenerative myopia. Treatment options

M.G. Rabadanova1,2, J.G. Oganezova1, E.V. Kremkova1, M.M. Yakh'yaeva1 1Pirogov Russian National Research Medical University, Moscow, Russian Federation 2O.M. Filatov City Clinical Hospital No. 15, Moscow, Russian Federation Cataracts are the leading cause of vision loss in patients over 50 years. In addition to senile cataracts, its earlier development due to various risk factors (for example, degenerative myopia characterized by lens opacity even in low myopia) is also an issue. This article discusses the pathogenesis of cataracts with a focus on oxidative stress, which is also important for myopia progression. The published and authors' data on the association between myopia and cataracts are addressed. The importance of early diagnosis of cataract in patients with myopia at the stage of lens suture compaction and its early radial and meridional opacities (that is possible with maximum mydriasis) is emphasized. Potential complex therapy with anti-cataract drops characterized by antioxidant effect is discussed as a pathogenetic approach to delay cataract progression in patients who (for various reasons) are not suitable for surgery. Recommendations for modifying the lifestyle to prevent cataract development are provided. Keywords: degenerative myopia, myopic cataract, lens, oxidative stress, antioxidants, risk factors, drug treatment, pirenoxine. For citation: Rabadanova M.G., Oganezova J.G., Kremkova E.V., Yakh'yaeva M.M. Lens disorders in degenerative myopia. Treatment options. Russian Journal of Clinical Ophthalmology. 2023;23(4):207–212 (in Russ.). DOI: 10.32364/2311-7729-2023-23-4-6. </p

Epidemiology of hereditary eye disease in the populations of Russian Federation

V.V. Kadyshev1, E.K. Ginter1, S.I. Kutsev1, Zh.G. Oganezova1,2, R.A. Zinchenko1,3 1Research Center for Medical Genetics, Moscow, Russian Federation 2Pirogov Russian National Research Medical University, Moscow, Russian Federation 3N.A. Semashko National Research Institute of Public Health, Moscow, Russian Federation Aim: genetic epidemiological study of hereditary eye diseases in various populations of the Russian Federation and comparative analysis of these findings. Patients and Methods: the sample included 12 ethnic groups from 14 regions of European Russia. The entire population irrespective of gender or age was examined. To confirm a certain type of inheritance of diseases from heterogeneous groups, the material was subjected to the multicomponent analysis used in multiple family registration. The rate of segregation was evaluated using the Weinberg proband method. Molecular genetic tests (Sanger sequencing, MLPA, AFLP, RFLP, whole exome sequencing) were applied. To identify the cases of hereditary disease accumulation in individual populations and/or ethnic groups, the prevalence of certain diseases in this population was calculated using F-distribution to compare the samples of rare diseases. Results: more than 46,000 patients and their relatives with presumably hereditary conditions were examined and data were collected. 554 clinically diverse hereditary diseases in 9,979 individuals were identified. Isolated hereditary eye disease (60 clinical variants) was identified in 1,407 patients (14.56%). The mean prevalence of isolated hereditary eye disease was 1:2,272 (or 44.01 per 100,000). When assessing patterns of nosological spectrum and prevalence of isolated hereditary eye disease in each population/ethnic group using principal component analysis, 2 clusters were isolated. The first cluster includes 6 Russian populations and the second cluster includes 5 ethnic Volga Region groups, which are more similar to Russian populations than the North Caucasus people. In general, 57 hereditary syndromes (affecting anterior and posterior eye segments) in 1,051 patients were discovered. The mean prevalence of syndromic hereditary eye disease was 1:3,040 (or 32.89 per 100,000). Keywords: ophthalmogenetics, genetic epidemiological study, spectrum, ethnic grou p, type of inheritance, segregation, accumulation, isolated and syndromic hereditary eye diseases, prevalence, retinal degeneration. For citation: Kadyshev V.V., Ginter E.K., Kutsev S.I. et al. Epidemiology of hereditary eye disease in the populations of Russian Federation. Russian Journal of Clinical Ophthalmology. 2022;22(2):69–79 (in Russ.). DOI: 10.32364/2311-7729-2022-22-2-69-79. <br

Glaucoma laser treatments: modern approaches and practice guidelines

M.H. Rabadanova1,2, J.G. Oganezova1,3, E.A. Egorov1, D.V. Katz2, V.V. Novoderezhkin2 1Pirogov Russian National Research Medical University, Moscow, Russian Federation 2Municipal Clinical Hospital No. 15 named after O.M. Filatov, Moscow, Russian Federation 3Research Center for Medical Genetics, Moscow, Russian Federation Glaucoma represents a significant medical, economical, and social burden for the healthcare system both in Russia and worldwide. Despite a variety of pharmacological, surgical and laser treatment options, the number of patients with irreversible glaucomatous damage to visual function is continuously rising. Currently, more emphasis has been made on laser micropulse techniques for the treatment of glaucoma. It is underpinned by several important advantages of this modality: it has demonstrated high efficacy; can be performed in outpatient settings without general anesthesia; is well-tolerated by patients; can be repeated over time and combined with surgeries; and is considered as a cost-effective treatment. There are different laser treatment options: laser trabeculoplasty, iridogonioplasty, laser iridectomy, goniopuncture, and laser cyclodestructive procedures, as well as their modifications. The article discusses specific features of these techniques, indications and contraindications, and laser characteristics. The article emphasizes the role of gonioscopy as an effective ocular assessment technique helping to create an individualized laser treatment plan for glaucoma patients. Also, the article focuses on pre- and postoperative management of patients and presents an algorithm for the management of patients with different glaucoma forms referred to the laser treatment. Keywords: glaucoma, gonioscopy, micropulse laser treatment, pre-operative management, intraocular pressure, pigment dispersion syndrome, trabeculoplasty, iridogonioplasty, iridectomy, goniopuncture, cyclocoagulation, bromfenac. For citation: Rabadanova M.H., Oganezova J.G., Egorov E.A. et al. Glaucoma laser treatments: modern approaches and practice guidelines. Russian Journal of Clinical Ophthalmology. 2022;22(4):265–272 (in Russ.). DOI: 10.32364/2311-7729-2022-22-4-265-272. </p