IMIR-SALES (NovaID)-ENG 14S

INNOVATION AND RESEARCH IN EYE CARE

ENG

de la maculainstitutInnovating Eye Care

VISION-RELATED DISEASES: A HIDDEN EPIDEMIC

2 _ VISION-RELATED DISEASES: A HIDDEN EPIDEMIC VISION-RELATED DISEASES: A HIDDEN EPIDEMIC _ 3

A worldwide health problem§ According to estimates by the WHO, there are approximately 39 million blind people in the world,

a figure which represents 0.7 % of the global population.

§ 285 million people worldwide suffer from some kind of visual impairment.

§ 80 % are cases that could be prevented or cured.

§ The Report on Blindness in Spain, published by the RetinaPlus Foundation and Ernst & Young,

estimates that 70,775 people suffer from blindness in Spain.

§ Age-related macular degeneration (AMD) is the primary cause of sight loss in the western

world in people aged over 50.

§ More than 25 million people suffer from this disease in the world today.

§ It’s estimated that this figure will grow by about 500,000 people every year.

The use of highly innovative techniques and treatmentsplace the Institut at the forefront of leading international centres for the treatment of visual disorders


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SPECIALTY AREAS

MEDICAL RETINA

Age-related macular degeneration (AMD) is the primary cause of sight loss in patients aged over 50

PATHOLOGIES WITH TREATMENT MAJOR DISEASES UNDER RESEARCH

Exudative or wet AMDExudative AMD, also known as wet or neovascular AMD, is the less common form of age-related macular degeneration (about 15 %) but tends to progress more rapidly. It requires immediate treatment to stop central vision from being irreversibly destroyed within a short period of time (weeks or months).

The main treatment to attempt to control wet AMD uses the application of angiogenesis inhibitors via intraocular injections directly into the vitreous cavity. This treatment manages to stop the illness in three out of four cases and improve it in one out of three.

Degenerative myopiaMyopia is a state of abnormal eye growth associated with degenerative changes in its structure. Patients with myopia have a high risk of developing retinal pathologies, such as macular disorders or a detached retina, so they must be regularly checked to detect any possible injury. In those cases where retinal complications are diagnosed resulting from myopia, each patient will receive individualised treatment that may require intravitreal injections, laser photocoagulation or vitreoretinal surgery.

Diabetic retinopathy and diabetic macular oedemaDiabetic retinopathy is one of the ocular complications of diabetes, an illness that affects the body’s ability to control its blood sugar levels and to which the retina is particularly vulnerable.Macular oedema is the inflammation and accumulation of fluid in the macula, the part of the eye responsible for central and pinpoint vision (the one we use to read or recognise faces) and occurs when the retina’s blood vessels leak. Vein occlusionRetinal vein occlusion is the second most common cause of vascular disorders of the retina after diabetic retinopathy and a frequent cause of blindness. It’s defined as the dilation of the retinal veins, associated with retinal haemorrhages, intraretinal oedema, retinal ischaemia and macular oedema. Today several drugs are available that have dramatically changed the visual prognosis for such patients.

Dry or atrophic AMDThis is the primary cause of sight loss in the western world in patients aged over 50. Dry AMD makes up 85 % of all cases of age-related macular degeneration.

Retinitis pigmentosaRetinitis pigmentosa refers to a group of inherited diseases of the retina characterised by a gradual loss of photoreceptor cells (apoptosis), predominantly rods, and of retinal pigment epithelium due to specific protein and enzyme mutations. Retinitis pigmentosa affects 1 out of every 2,000 people and is the main cause of total blindness.

Stargardt diseaseStargardt disease is the early degeneration of the retina due to genetic causes. It’s normally diagnosed in people aged under 20. Sight loss is progressive and varies depending on the patient. There may be very serious loss of sight.

The Institut de la Màcula collaborates closely with the Barcelona Macula Foundation: Research for Vision, a foundation dedicated exclusively to research in the field of retinal illnesses that cause blindness, within which Stargardt disease is a priority. The aim of this collaboration is to find solutions and treatments for those illnesses that are still incurable and cause blindness.

The Institut de la Màcula employs the Treatment FUSION© process to optimise and personalise the proactive and intensive treatment of wet AMD

de la maculainstitutInnovating Eye CareSPECIALTY AREAS

RETINA SURGERY

Macular holeA macular hole is a defect or break in the tissue located in the centre of the macula (fovea) that causes diminished central vision or a blurred area in the centre of the visual field (scotoma). Macular holes are related to age and normally occur in people aged over 80. Although they can close up on their own, the vast majority of cases require surgery. Epiretinal membrane An epiretinal membrane occurs when tissue contraction on the retinal surface leads to wrinkling or “puckering”, with the consequent loss and distortion of vision. In many cases this has to be removed by microsurgery to avoid irreversible vision loss.

Vitreomacular traction syndromePartial separation of the posterior vitreous from the underlying retina with residual anchors or connections

that exert traction on the retinal surface causing visual impairment. Removing these tractions by vitrectomy prevents sight loss and restores vision in many cases. Retinal detachmentRetinal detachment affects approximately 1 person out of every 15,000. Treatment is almost always surgical and consists of reattaching the retina. The speed and degree of visual recovery will depend on each particular case. Proliferative diabetic retinopathyImmediate, ongoing treatment is required to avoid the more serious, irreversible consequences of this illness which can involve blindness. In this case, advances in microsurgery help us solve extreme and severe situations. Laser and various microsurgical techniques are highly effective in solving this problem in many desperate severe cases.

The Institut is equipped with cutting-edge technology

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CORNEA, REFRACTIVE SURGERY AND CATARACTS

Refractive surgeryThe aim of refractive surgery is to permanently reduce or eliminate dependence on optical correction (glasses or lenses). Laser techniques, carried out on the cornea are the most widely used for lesser degrees of myopia, hypermetropia and astigmatism. Phakic intraocular lens techniques are normally used in more severe cases of correction or when laser techniques cannot be used for some reason.

The excimer laser we use at the Institut de la Màcula allows us to carry out personalised treatments to increase precision in correction and improve visual quality, as well as more efficiently respecting the thickness of the cornea.

Presbyopia surgeryPresbyopia, sometimes known as “eye strain”, is the gradual loss of accommodation involving difficulties in focusing on near objects. This affects everyone as from 40-50 years of age and is normally corrected with reading glasses or multifocal glasses or contact lenses.

Of all the techniques being used to correct presbyopia, at the Institut de la Màcula we recommend replacing the transparent crystalline lens with a multifocal lens implant (bifocal/trifocal) or a monofocal lens with monovision, or advanced monovision, as these are the safest, most stable, effective and definitive methods available today.

The only definitive treatment currently available is to extract the crystalline lens which, due to the age-related loss of accommodation, is the cause of the appearance of presbyopia. Trifocal lenses are also an innovative solution for the treatment of presbyopia.

Cataract surgeryA cataract is one of the most common ocular alterations and is defined as any opacity in the crystalline lens. Cataracts can be caused by many different factors.

Cataract surgery is the most frequent operation carried out in ophthalmology. The surgical technique of choice for removing cataracts is phacoemulsification, a microsurgery that requires no stitches.

KeratoconusKeratoconus is the most frequent axial corneal ectasia of non-inflammatory origin. The central or lower paracentral area of the cornea becomes thinner and progressively more cone-shaped, resulting in myopia, irregular astigmatism and cone apex protrusion.

It’s very important to diagnose such patients in the initial stages because, with the application of treatments to stop its progression, the prognosis of keratoconus has greatly improved and the need for corneal transplants has diminished.

Corneal opacityAny loss of substance, either through trauma, inflammation (keratitis), infection, dystrophy or corneal degeneration can result in corneal opacity which significantly reduces eyesight. Advanced keratoconus can deform the cornea, leading to images being severely distorted. In these cases, treatment consists of replacing the damaged cornea (corneal transplant).

Dry eyeDry eye syndrome represents a varied group of disorders characterised by symptoms of ocular discomfort and associated with a reduction in the production of tears or abnormally fast evaporation of the tear film.

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The Institut carries out personalised treatments to ensure the best quality vision

At the Institut de la Màcula we choose the intraocular lens with the greatest refractive precision for each patient to achieve the best quality vision and emmetropia after surgery


GLAUCOMA

Glaucoma is an eye disorder that’s generally characterised by a pathological increase

in intraocular pressure due to a lack of drainage of the aqueous humour, although

this is not the only reason, and its common ultimate condition is an optical neuropathy

characterised by the progressive loss of optic nerve fibres and changes in their appearance.

This illness affects a large number of people and its incidence ranges from 1.5 % to 2 %

among those over 40. It’s one of the main causes of irreversible blindness in the world.

One typical consequence of glaucoma is the loss of visual field, detected using a

campimeter. Loss of vision due to glaucoma first affects the peripheral part of the visual

field. If the illness is not treated, the visual field will gradually and increasingly shrink, the

central part will darken, finally degenerating into total blindness in the affected eye.

Closed angle glaucomaThis is an ophthalmological emergency. There’s a reduction in the iris-cornea angle,

comprising the angle between the root of the iris and the cornea. Its course is normally

acute with a sudden increase in intraocular pressure, sharp pain, reduced visual acuity,

seeing halos around lights, red eye, pupil dilation (midriasis), nausea and vomiting.

Open angle glaucoma The iris-cornea angle is normal. Progression is slow and there are no apparent symptoms

but vision gradually deteriorates; that’s why this kind of glaucoma is often called “the

silent thief of sight”. Depending on its cause, open angle glaucoma is classified into:

§ Primary. If there’s no other illness causing it. Chronic open angle glaucoma comes under

this category, the most frequent form of this illness.

§ Secondary. When it’s caused by another illness.

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We’re equipped with the most innovative tests and tools for screening, diagnosing, treating and monitoring the progress of glaucoma cases

At the Institut de la Màcula we evaluate each case with the utmost precision and experience to choose the most appropriate treatment for each patient


OCULAR PLASTIC SURGERY

BlepharoplastyEyelid cosmetic surgery has a very rejuvenating effect without causing any drastic changes in your image and without visible scarring.

Due to the complex anatomy of the eyelid and its relationship with proper eye health, it’s essential for an ophthalmologist specialised in oculoplastic surgery to carry out the operation. Familiarity with the eyeball and its related structures is fundamental to be able to carry out such surgery correctly and, above all, safely.

Eyelid malpositionThe eyelids can suffer from a range of pathologies. The most common are badly positioned eyelids such as drooping (palpebral ptosis), ectropion and entropion. Benign or cancerous lesions may also appear, requiring complex surgery.

Ocular, palpebral and orbital tumoursA wide range of tumours can occur in the periocular area and there are many different benign lesions and cysts but also cancerous tumours. It’s crucial for such lesions to be treated by a specialist as they require highly specific surgical techniques. Watery eyesWatery eye is a relatively common problem, representing one of the symptoms that most often lead patients to consult an ophthalmologist. The lachrymal system can be altered at any stage, from the start of the canaliculi to the nasolachrymal duct. We currently have all kinds of treatment for lachrymal obstruction whatever its location, using modern endoscopic techniques that avoid external scars and guarantee a faster recovery. BlepharospasmBlepharospasm is the involuntary closing of the eyelid or excessive involuntary blinking. The first symptom of blepharospasm may be an occasional increase in blinking in one or both eyes or simply difficulty in keeping the eyes open. This is usually treated with botulinum toxin while surgery is reserved for patients who do not respond to pharmacological treatment.

Thyroid ophthalmopathyThyroid ophthalmopathy is an autoimmune disorder in which the patient’s own immune system attacks the thyroid gland and, in most cases, produces hyperthyroidism. The same antibodies that react against the thyroid also react

against the orbital fat and extraocular muscles, leading to thyroid ophthalmopathy. This needs to be treated from a multidisciplinary approach in which a specialised endocrinologist and ophthalmologist must treat the illness together, in addition to other specialists. Facial paralysisFacial paralysis is a temporary or permanent dysfunction of the facial nerve. When the facial muscles lose their normal tone, the orbicularis oculi muscle of the upper eyelid loses its ability to contract and therefore close the eye properly. This can lead to significant ocular surface illnesses like dry eye syndrome. Today we have modern techniques performed via minimally invasive surgery to ensure adequate eye protection. Other ocular consequences of facial paralysis are misdirection of the lower eyelid (ectropion), watery eye and blepharospasm. Orbital lymphangiomaLymphangiomas are benign lesions that are normally present from birth, although they may not have been noticed until years later. The treatment of this malformation requires very difficult surgery with very high risk as these lymphatic malformations can be found even in the healthy tissue of the orbit. At the Institut de la Màcula we are pioneers in Europe in the percutaneous sclerosing treatment of orbital lymphangioma. This treatment does not require any stitches and leaves no scars.

Palpebral and orbital reconstructionA sufficiently severe trauma of the eye can lead to serious damage to the internal structures of the eyeball that may result in permanent loss of sight. The most serious situation is when the eye is perforated or blown-out as this disruption in the ocular walls entails a high risk of sight loss and loss of eyeball viability if not treated urgently by surgery. Occasionally, the disruption of eye structures in this case is so severe that the eyeball is lost completely. In these cases our treatment focuses on the patient’s cosmetic rehabilitation by implanting prosthetic eyeballs that can perfectly imitate a healthy eye.

The most complex palpebral trauma, involving loss of tissue, may be difficult to treat as there can be severe scarring in addition to the trauma of the injury per se. In the vast majority of cases an acceptable recovery can be achieved, both in functional as well as in cosmetic terms, via the use of advanced eyelid reconstruction techniques.

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Our experience in microsurgery allows the Institut to carry out minimally invasive surgery without visible scars and with shorter recovery periods


FACIAL COSMETIC MEDICINE

At the Institut de la Màcula we use non-surgical

techniques to treat facial ageing.

Botulinum toxin This has many applications in medicine today,

including facial rejuvenation without surgery.

Botulinum toxin (commercial name Botox) is a

preparation resulting from a toxin produced by the

Clostridium botulinum bacterium. It acts by blocking

neuromuscular transmission, thereby relaxing the

action of the muscles. It has many applications

in medicine today, including facial rejuvenation

without surgery.

As it relaxes the facial muscles, certain wrinkles

disappear or smooth out. Botulinum toxin works

particularly well on three areas: between the

eyebrows, the forehead and on crow’s feet.

After being injected, botulinum toxin takes about

three to five days to achieve its full effect. This injection

is painless and does not require any post-operative

treatment. One week after the injection the result is

evaluated and, if deemed necessary, the treatment

can be touched up. The effect of botulinum toxin is

always temporary and lasts between three and six

months.

Fillers: hyaluronic acidOver the years, the facial tissue usually loses volume

with the consequent appearance of folds and lines.

Today treatments are available to replace this lost

volume by injecting natural fillers such as hyaluronic

acid.

These treatments are carried out during the

consultation and recovery is almost immediate.

Hyaluronic acid can be used on most areas of the

face, such as between the eyebrows, on nasolabial

folds, the jaw, lips and cheeks.

There is another area where the application of

hyaluronic acid is particularly useful: on bags

under the eyes. Those patients with prominent

creases under the eyes are good candidates for

this treatment. The application of hyaluronic acid

effectively fills these lines, providing a totally natural

appearance.

These treatments are not permanent and usually

last between six and eighteen months, depending

on the product used. Should the treatment not

be satisfactory for the patient, the hyaluronic acid

can be dissolved in just a few hours by applying

hyaluronidase.

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Improve your appearance through preventive treatments that are used under local or topical anaesthesia, minimising the potential risks to your health


CONTACT LENSES LOW VISION

Based on a thorough and complete patient examination, the medical team of

the Institut de la Màcula defines a number of optical and non-optical aids to

help enhance the patient’s visual ability, allowing him/her to adapt to the new

situation.

§ Optical aids: magnifiers, microscopes, telemicroscopes, telescopes.

§ Non-optical aids: large print, writing guides, everyday objects (talking watches,

threaders, special filters, various types of lighting).

§ Electronic aids: television magnifiers, closed circuit TV (CCTV).

Contact lenses provide a better visual field and a better correction of visual acuity in some cases that are difficult to correct with glasses.

Teamwork between the optometrist and the ophthalmologist means that we can prevent or provide prompt treatment for any complication that might result from the use of contact lenses.

The contact lens department of the Institut de la Màcula offers different types of adaptation:

§ Extended wear contact lenses as an alternative to the usual correction for myopia, hypermetropia and astigmatism.

§ Lenses to correct presbyopia.

§ Pre-operative simulations for cataract and refractive surgery.

§ Therapeutic use or support for pharmacological treatment.

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The contact lens department offers advice and individualised adaptation of contact lenses by means of a prior ophthalmological study, specific diagnostic tests and a thorough assessment for each patient

The latest advances in ophthalmic surgery have improved the success rate in recovering the sight of many patients

de la maculainstitutInnovating Eye CareMAIN PATHOLOGIES AND THEIR TREATMENT

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SURGICAL AND MEDICAL RETINA

Exudative or wet AMD

Pathological myopia

Dry or atrophic AMDDiabetic retinopathyStargardt disease

Macular oedema Venous thrombosis

Vein occlusion

Central serous chorioretinopathy

Macular hole

Epiretinal membrane or macular pucker

Retinal detachment

Diabetic retinopathy

Ocular injections of angiogenesis inhibitors. Fusion© treatment. Photodynamic therapy: direct or on feeder vessels. Laser photocoagulation.

Intravitreal injections. Photodynamic therapy. Laser photocoagulation or vitreoretinal surgery.

New therapies under pre-clinical and clinical research projects.

Intravitreal injections of aVEGF or steroids. MicroPulse laser.

Intravitreal injections of aVEGF or steroids. Laser photocoagulation in BRVO. MicroPulse laser.

Laser. Photodynamic therapy. MicroPulse laser. Intravitreal injections. Systemic treatment.

Small-incision vitreoretinal microsurgery. Posterior vitrectomy.

Small-incision vitreoretinal microsurgery. Posterior vitrectomy.

Small-incision vitreoretinal microsurgery. Posterior vitrectomy. Scleral surgery. Laser photocoagulation.

Small-incision vitreoretinal microsurgery. Posterior vitrectomy. Scleral surgery. Laser photocoagulation. Intravitreal injections of aVEGF or steroids.

PATHOLOGY TREATMENT PATHOLOGY TREATMENT

CORNEA, REFRACTIVE SURGERY AND CATARACTS

Cataracts

Corneal refractive surgery

Presbyopia surgery

Corneal opacity

Phacoemulsification with IOL implant.

LASIK, PRK. Posterior chamber phakic IOL implant: ICL.

Monovision (LASIK, PRK, crystalline lens extraction). Crystalline lens extraction surgery with multifocal IOL implant (bifocal/trifocal).

PTK. Penetrating keratoplasty. Anterior lamellar keratoplasty. Posterior lamellar keratoplasty.

OCULAR PLASTIC SURGERY

Blepharoplasty

Lachrymal surgery

Orbital lymphangioma

Palpebral and orbital reconstruction

Blepharoplasty. Eyebrow lifting. Botox. Hyaluronic acid. Chemical peeling. Mesotherapy.

Endoscopic lachrymal surgery.

Percutaneous sclerosing therapy.

Advanced palpebral reconstruction techniques. Prosthetic orbital implant. Minimally invasive transconjunctival orbitotomy.

GLAUCOMA

Open angle glaucoma Closed angle glaucomaSecondary glaucoma

Pharmacological treatment. Laser and surgical treatment (trabeculectomy, non-penetrating sclerectomy, valve implant).

de la maculainstitutInnovating Eye CareTEAM

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The Institut de la Màcula staff, specialised in different areas of

ophthalmology, is a first class team with international training in their

areas of expertise, delivering patient care in many different languages.

It consists of retinologists, cornea specialists, refractive and cataract

surgeons and an oculoplastic surgery team, all extremely thorough and

diligent in their work to maintain our commitment to people who rely on

our centre.

The new facilities have therefore enhanced the ability of our professional

staff to carry out research projects, especially in diseases of the macula and

the retina.

Dr. Jordi Monés, MD, PhD, Ophthalmologist, macula

and vitreoretinal Specialist. Director of the Institut

de la Màcula and Barcelona Macula Foundation.

Coordinator of the Ophthalmology Department at

the Centro Médico Teknon.

As founder and Medical Director of the Barcelona

Macula Foundation: Research for Vision, he’s

dedicated to fighting blindness supporting and

carrying out research in retinal diseases that

currently have no treatment.

Dr Monés is an Elected Member of the AMD

and Retinal Dystrophies Expert Committee of the

European Vision Clinical Research Network (EVICR.

net) and is a scientific advisor of several research

groups. Dr Mones is currently conducting Phase I, II

and III clinical trials.

Dr. Monés is member of the Board of Directors of

the FC Barcelona, Responsible of the Medical Area

and Performance and Responsible of the Section of

Athletics.

The Institut results from the combined passion and vocation of a team, led by Dr. Jordi Monés

de la maculainstitutInnovating Eye CareGENERAL INFORMATION

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Located in a privileged area of Barcelona, near the foothills of Tibidabo, the centre is surrounded by the calm and nature offered by a less tourist-centred part of the city.

The Institut’s facilities have enhanced the ability of our team of professionals to carry out research projects into diseases of the macula and the retina.

The Institut forms part of the Centro Médico Teknon, accredited by the Joint Commission (one of the major international bodies for healthcare quality), a distinction that places the Institut at the highest level of, excellence and medical safety.

The Institut de la Màcula is located in an enviable setting that allows patients to recover in very peaceful surroundings

The Institut de la Màcula is an international benchmark in the treatment of medical and surgical pathologies of the macula, retina and vitreous and forms part of the Centro Médico Teknon. The Institut’s new building, inaugurated recently, has further enhanced patient comfort and continues to offer the best in service.

Use of cutting-edge techniques and treatments places the lnstitut at the forefront of international centres renowned for curing sight disorders.

The Institut also plays a very active role in research projects and takes part in all phases of clinical trials (I, II and III).

The Institut’s success is based on its tailor-made service, extremely thorough medical care, innovation and the continuous introduction of improvements resulting from its specialists’ involvement in research projects. The Institut de la Màcula is ruled by a rigorous culture of quality management, oriented towards providing the best possible care and achieving patient satisfaction with the utmost safety.

The Institut is entirely oriented towards offering medical care that ensures patients’ optimal recovery

Facilities designed to meet patients’ needs and state of the art equipment

de la maculainstitutInnovating Eye CareSUPPORT FOR INTERNATIONAL PATIENTS

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Patients enjoy the best medical care and staff in any of the centre’s specialties: retina, cornea, glaucoma and cosmetic surgery

As part of the Teknon Medical Campus, the Institut

de la Màcula offers a comprehensive health service.

Our team will guide you in all the specialties covered

by the centre, which has 400 specialist doctors at the

forefront of all surgical and medical specialties, as well as

its own surgical area and diagnostic, hospitalisation and

emergency services, among other facilities.

The Institut is at your service to ensure your stay in

Barcelona is as pleasant as possible, both for yourself

and for your family or companions.

During your stay in Barcelona, we will:

§ Be your connection point with our medical team,

making sure you have all the information you need

related to your medical care.

§ Coordinate the translation service.

§ Help find accommodation for you and your

companions or put you in touch with the Teknon

Club International Patient Service.

If you wish, you can contact us via email:

[email protected].

The Institut de la Màcula offers a comprehensive health service that is ruled by a rigorous culture of quality management, oriented towards providing the best care and patient satisfaction with the utmost safety

de la maculainstitutInnovating Eye CareBARCELONA MACULA FOUNDATION

A pioneering Foundation researching into new treatments to combat

blindness, especially for diseases that, today, still have no cure.

The search for new treatments to combat pathologies such as atrophic

AMD, retinitis pigmentosa and Stargardt disease forms the focus of the

Foundation’s research.

Other institutions of renowned medical prestige also collaborate in

addition to the Institut de la Màcula, such as the Fundació Centre de

Regulació Genòmica (CRG), the Institut de Ciències Fotòniques (ICFO),

the Institut Català de Nanociència i Nanotecnologia (ICN2), the University

of California (Irvine), the Hospital Universitari Vall d’Hebron, the Agència

de Qualitat i Avaluació Sanitàries de Catalunya - Generalitat de Catalunya

and the Universidad Miguel Hernández - CIBER-BBN.

Support research at www.barcelonamaculafound.organd help prevent millions of people from losing their sight in the future

26 _ BARCELONA MACULA FOUNDATION BARCELONA MACULA FOUNDATION _ 27

By the year 2020, 90 million people will be totally blind

The Foundation is taking part in a major social and scientific undertaking and helping to eradicate blindness in the near future


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InstItut de la MàculaCentro Médico TeknonÀrea Vilana _ Building Office 90 Vilana, 12 _ 08022 Barcelona (Spain)

T. +34 93 595 01 [email protected] @ins_macula

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IMIR-SALES (NovaID)-ENG 14S