Free journal Take it home! SECOND quarter 2015
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Magazine del Instituto Oftalmolรณgico
F E R N ร N D E Z -V E G A
A great leap forward. Instituto Universitario Fernรกndez-Vega The light of Agatha Ruiz de la Prada
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Alterations in the Vitreous. The importance of an early detection
Protect your skin from the summer sun is good but... and the eyes? p. 32
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A great step in research and teaching
Prof. Luis Fernández-Vega.
The launch of the Instituto Universitario Fernández-Vega (FernándezVega University Institute), approved by the Government of Asturias after the Universidad de Oviedo suggested it, represents a qualitative and quantitative leap in ophthalmological research and in teaching within this medical field. It is also recognition to the work that has been done in this field by the Fundación de Investigación Oftalmológica (Eye Research Foundation) in the laboratories and classrooms within our Institute for the last six years, and brings to light the excellent work performed, which goes far beyond the exhaustive daily clinical activity, something very uncommon in private medicine. From now on, the conjunction of resources and effort, with the quality label of the Campus of Excellence of the University, will enable us to face new challenges, access more and better funding and, ultimately, advance in the fascinating fight against the illness to which we are committed and to which we allocate significant resources.
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Editorial
We present this important achievement in this new issue of Vega in which, along with all the regular sections, we publish an exhaustive interview on strabismus in the younger generations. Furthermore, we look deeper into the advantages of intraocular lenses in a great variety of pathologies, as well as into some of the latest initiatives of the Fundación Fernández-Vega on behalf of the disadvantaged. It should finally be noted that the growing demand for our services in Madrid calls for a larger space in the capital for our peripheral clinic; therefore, during the first days of autumn we will move to new facilities located in Príncipe de Vergara. We will inform our patients and friends in due time.
About us The Instituto Oftalmológico Fernández-Vega (IOFV) is an Eye Hospital The surname Fernández-Vega has been linked to the practice of this speciality for over 125 years. At present, the Institute devotes all its efforts to the prevention, diagnosis and medical and surgical treatment of those diseases that jeopardise vision. Currently, the facilities of the Institute in Oviedo occupy a surface area of approximately 12,000 square metres, in which close 200 people work. Every year over 100,000 patients are seen and 8,000 surgeries are performed.
In order to stay ahead in innovation and to return to society part of what its patients have given to the Institute, the IOFV has launched the Fundación de Investigación Oftalmológica (FIO) (Eye Research Foundation). The Foundation carries out biomedical translational research in ophthalmology and vision sciences in conjunction with the generous contribution of other entities and foundations committed to the fight against this disease.
All this activity generates a great teaching capacity for health professionals devoted to vision (ophthalmologists, opticians-optometrists, nurses and Medicine students), it materialises through different pre and post-graduate programmes in collaboration with the Universidad de Oviedo. Furthermore, the Institute cares for disadvantaged people through the Fundación Fernández-Vega, present in Spain as well as in international missions, such as the ones carried out in the past few months in Peru, Liberia and Cambodia.
100.000 patients 8.000 surgeries
About us
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Table of contents
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Instituto Universitario Fernández-Vega • The Instituto Universitario Fernández-Vega has been constituted
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Making headlines • SECOIR 2015 • Neuropathic eye pain is rare but very incapacitating • The IOFV hosted the XI Conference of the Spanish National Association of Health Informers • Success of the Updating Course in Glaucoma • “Hot topic” at ARVO • Prof. Fernández-Vega received the Gold Medal and the title of Member of Honour from the Medical College of Physicians of Oviedo • New Headquarters of the Sociedad Española de Oftalmología • The FIO publishes its research and educational report 2014 • The Institute and the FIO will be the benefactors of the research carried out by FINBA • Telefónica and the Fundación de Investigación Oftalmológica enter into a collaboration agreement • Sharing experience at the Foro Comunicación y Escuela • The clinical practice in Madrid is being transferred
p. 24
Fundación Fernández-Vega • Second ophthalmology campaign in Ayacucho (Peru) • New visit to Down Asturias • Eyesight check-ups at Arbolar Association • Visit to the Siervas de Jesús de la Caridad • What the eyes cannot see… • Agreement between the Fernández-Vega and the Order of Malta Foundations
p. 32
Medical article/report • Alterations in the Vitreous. The importance of an early detection
p. 34
Ophthalmological divulgation • Caring for eyes during summer
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Medical article/report • The correction of astigmatism with toric lenses
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They look kindly upon us • “To be free is in one’s nature, the same as being nice or being intelligent”
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Lets see • Dra. Eva Villota answers the questions of our patients regarding their eye care
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Music • The Opera of Oviedo, 68 years of history
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Crossing of glances • Russell Crowe
Table of contents
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At the proposal of Universidad de Oviedo and once authorised by the Government of Asturias
The Instituto Universitario Fernández-Vega has been constituted Its domain will be, as a matter of priority, research and education. Affiliated to Universidad de Oviedo it means an important recognition for the work and potential of the Fundación de Investigación (FIO – Research Foundation), as many of its activities will be channelled through the new entity. Furthermore, it is the first in Ophthalmology and Vision Sciences at Universidad de Oviedo and the only one with a mixed public-private nature. One of the laboratories of the Fundación de Investigación Oftalmológica.
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Instituto Universitario Fernández-Vega
Patio of the Historical Building of the Universidad de Oviedo.
It implies an advance of a new collaboration model that will significantly drive initiatives that up until now were carried out independently
Facade of the Instituto Oftalmológico Fernández-Vega.
The Fundación de Investigación Oftalmológica (FIO – Eye Research Foundation), driven by the Instituto Oftalmológico Fernández-Vega, where it has its laboratories and headquarters, will see how many of its research and education activities now take place in collaboration with Universidad de Oviedo, under the denomination of Instituto Universitario Fernández-Vega. The joint activities of both entities will take place here, as approved by the Governing Council of the Principality of Asturias at the proposal of Universidad de Oviedo. The new Institute “means an important recognition for the work and long career of our Foundation, which was born in 2009 with a clear aim: to gain more knowledge about the basis of the diseases It will train that cause blindness and vision alterations researchers in order to achieve new and postprevention, diagnosis graduate and medical and surgical students measures”, explained Luis Fernández-Vega, whose drive and involvement have proven to be crucial to the final outcome. The Instituto Universitario Fernández-Vega is the first institute of these characteristics in Ophthalmology and Vision Sciences at Universidad de Oviedo and the only one with a mixed publicprivate nature, with all that implies for the advance of a new collaboration model that will significantly drive initiatives that up until now were carried out independently.
The area of activity of the new university centre is essentially devoted to the fields of research and education. In research, the new institute “will facilitate the interaction between researchers from Universidad de Oviedo and researchers from FIO, providing the greatest critical mass with the optimisation of the resources of both institutions to develop furtherreaching and multidisciplinary projects through the collaboration between basic and clinical researchers, access to more funding and carry out tasks that, for each entity on its own, were difficult to address,” explains the professor. On the other hand, in the field of education, and continuing with the work that is already being carried out by the FIO, the Instituto Universitario Fernández-Vega will train researchers and postgraduate students (doctorate and masters programmes). “Thus, for example, physicians who are already ophthalmologists can train in what we call the high specialties (masters in cornea, retina or glaucoma); opticians-optometrists, in Clinical Optometry; nurses who enjoy the operating theatre and Vision Sciences, in Ophthalmological Nursing; and like this many other graduates in Life Sciences, so that official programmes can be launched and the internationalisation of these addressed,” concludes the professor. Finally, one must highlight that with the launch of the new entity any initiative implemented is guaranteed the quality mark of the Universidad de Oviedo and its International Campus of Excellence.
Instituto Universitario Fernández-Vega
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SECOIR 2015 A team of eleven physicians from the Instituto Oftalmológico Fernández-Vega participated in the Spanish Society of Cataract and Refractive Surgery Conference (SECOIR in Spanish), which under the presidency of Dr José F. Alfonso, scientific coordinator of the IOFV, completed its third round last May. On this occasion, the conference took place in Las Palmas de Gran Canaria, at the Alfredo Kraus auditorium. The gathering, with a thorough, extensive and meticulous programme, witnessed over one hundred lectures, presentations and collaborations from the IOFV. Amongst these, we can highlight the paper: “Resultados del implante bilateral de la lente intraocular difractiva de foco único elongado” (Results of the bilateral implantation
Some of the representatives of the Institute at SECOIR.
Prof Fernández-Vega, in the middle of the photo, with the distinction of honorary president. To his left, Dr Ferreruela and to his right, Dr Alfonso.
of the diffractive intraocular lens with a single elongated focus) (Dr Luis Fernández-Vega Cueto, Dr José Ignacio Blázquez, Dr Begoña Baamonde, Prof Fdez.-Vega and Dr José F. Alfonso), awarded as best presentation of the session on lensectomy and intraocular lenses. Furthermore, the free paper “Segmentos de anillo intraestomales tipo Ferrara en la corrección terapéutica y refractiva del queratocono paracentral con ejes topográfico y comático perpendiculares” (Ferrara-type ring segments in the therapeutic and refractive correction of paracentral keratoconus with perpendicular topographic and coma axes), presented by Dr Fernández-Vega Cueto was also recognised... Likewise, Prof. Luis Fernández-Vega received an award as Honorary President of this Society.
Dr Fernández-Vega Cueto-Felgueroso was also recognised for his presentation.
Making headlines
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Neuropathic eye pain is rare but very incapacitating GESOC 2015 This is one of the conclusions reached by the experts who gathered in Oviedo in the XIII Meeting of the Sociedad Española de Superficie Ocular y Córnea (GESOC – Spanish Society of Ocular Surface and Cornea); they stand for the multidisciplinary treatment of this important ocular surface problem, subject of discussion during the meeting. “Sometimes, it is necessary to take measures that are already being used in other specialties such as Internal Medicine, Pain Units or with psychotropic drugs”, explains Dr Jesús Merayo, Universidad de Oviedo and Instituto Oftalmológico Fernández-Vega, and coordinator of the GESOC meeting. The fact is that neuropathic eye pain, which is the same as saying pain not associated to a noxious stimulus but to the malfunctioning of the sensory pathways, is very incapacitating for those who suffer it. According to over 200 national and international experts, it is a very rare type of pain, but it alters significantly the quality of life and even the quality of vision of those who suffer it. “Can you imagine the pain caused by, for example, toothache or a skin burn? Do you have a feeling of what happens to the muscles in the arms when the nerves are cut due to trauma?” asked Dr Merayo. “Move this to an area in the ocular surface, the cornea, which has 200 sensitive receptors more than the skin or 50 more than dental pulp”.
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Making headlines
This is why it was one of the main changes of the meeting, “for the first time in a scientific meeting, the different aspects of neuropathic eye pain were analysed in a multidisciplinary way; to this end we had the help of important national and international experts who enabled us to understand how it is address in other specialties”, he assures.
Advances in the treatment Doctor Merayo summarises it in three points: • Targeted therapies for targets on the ocular surface. • Regenerative treatments (new artificial tears and eye drops) based on blood platelets from the patient. • Treatments constituted from growth factors that act as a film or trap so that these factors do not escape from the cornea and remain longer in the ocular surface. During the meeting, amongst other presentations, they introduced the research carried out in the last few years in collaboration with the Instituto de Neurociencias de Alicante and they talked about new drugs to address ocular dryness. Another of the presentations advanced the research that is being carried out with new artificial tears and eye drops originating from the platelets from the patient’s blood, therefore making an eye-drop that can be manufactured. “We have been using it at the Institute for the last four years, and nearly 4 000 patients have benefited from it. The idea is that it can be used in the same way and with the same preparation method across Spain”, he concluded.
The IOFV hosted the XI Conference of the Spanish National Association of Health Informers Approximately 150 journalists specialised in health communication gathered for three days in Oviedo. The main discussion of the conference was the processing of the information during the Ebola crisis. Picture of Fco. Núùez Arcos
The participants, in front of the Institute.
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Making headlines
The IOFV, aware of the importance of communication in the field of health, relinquished its facilities to the conference. Furthermore, the medical director, Professor Luis Fernández-Vega, gave the opening speech where, after what was close to a master class on ophthalmology for informers, he assured that the first Luis Fernández-Vega “wouldn’t believe this”. “Over 100 years ago – he remembered – my greatgrandfather opened a small clinical practice; today we are welcoming a conference
of healthcare journalism with 150 communicators at the Ophthalmological Institute that carries his surname.” In this opening session, the Health Minister of the Asturian Government, Faustino Blanco, set out the general lines of work of his department and subsequently answered the many questions of the participants. The latter, as well as the sessions of the conference itself, had the opportunity of getting to know a state-ofthe-art entity in the field of oncology treatment such as the IMOMA, Instituto de Medicina
Oncológica y Molecular de Asturias (Oncology and Molecular Medicine Institute of Asturias).
Success of the Updating Course in Glaucoma The Instituto Oftalmológico Fernández-Vega hosted last 24 and 25 of April the Updating Course in Glaucoma. Headed by Drs Pedro Pablo Rodríguez Calvo e Ignacio Rodríguez Uña, it gathered nearly 200 ophthalmologists, some of them from other countries, around a programme that reviewed the latest news in the treatment of a pathology considered to be the second cause of blindness in the world. The ophthalmological community presented many advances. One must highlight the discoveries related to the morphology and functioning of the optical nerve, as well as the research carried out by the Fundación de Investigación Oftalmológica, linked to the IOFV, on the genetic basis of glaucoma and the new strategies of
Drs Rodríguez Calvo and Rodríguez Uña, with Prof Fernández-Vega and Dr Fernández-Vega Cueto-Felgueroso.
neuroprotection that open the door to a potential customised treatment for this disease. All specialists agreed on the importance of an early diagnosis. There are very useful techniques such as campimetry, optical coherence tomography (OCT), retinal nerve fiber layer Imaging and the HRT to this effect. The most recent advances are imaging techniques that enable a better visualisation of the optical nerve and a more thorough study of the neuroretinal rim and the colorimetric techniques that allow us to obtain information on the haemoglobin in the papilla of the optical nerve. The block devoted to the treatment of glaucoma was one of the most active ones. As far as medical treatment is concerned, the speakers highlighted the great advance of new drugs without preservatives, as well as the new door recently opened to future therapies based on neuroprotection. On another note, the sessions on surgical treatment presented excellent videos on different techniques (a number of variations of trabeculectomy, non-penetrating deep sclerectomy, implantation of different draining devices, new surgical techniques with minimum invasion and canaloplasty), which led to interesting discussions by the experts. The finishing touch was provided by the course on clinical cases, in which especially complex cases to diagnose or treat were solved thanks to the joint collaboration of the panellists. The attendees joined the dynamic discussions between the moderators and the panellists by asking questions through the instant messaging system, very active throughout the course.
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Making headlines
“Hot topic” at ARVO This distinction is awarded to just six out ofthe 100 lectures sent
Researchers Almudena Íñigo and Omar González.
One of the papers presented by the Fundación de Investigación Oftalmológica (Eye Research Foundation - FIO) at the ARVO conference in Denver (Colorado, USA) has been nominated “Hot topic” due to its “original and innovative” research. This distinction is awarded to just six out of the 100 lectures sent; it implies that the paper presented by the FIO will be published in numerous media.
The paper, titled “Effects of aging on neurochemical properties of mouse corneal cold sensory neurons, changes in morphology in their afferents projections and implications in basal tear secretion”, was presented by the tea, of ocular surface of the FIO and carried out by researchers Almudena Íñigo, Ignacio Alcalde, Omar González, Juana Gallar, Jesús Merayo and Carlos Belmonte. ARVO’s Annual Meeting is the most important professional meeting in the field of Ophthalmology.
Prof. Fernández-Vega received the Gold Medal and the title of Member of Honour from the Medical College of Physicians of Oviedo Last 26th of June, Professor Luis Fernández-Vega received the title of Member of Honour with Golden Diploma from the Medical College of Physicians of Asturias, a recognition with which its board wanted to particularly value his relevant professional and personal achievements “as a worthy representative of a family deeplyrooted in the Asturian medicine”.
Professor Fernández-Vega also pointed out Asturia’s good position in the medical field, with state-of-the-art medical entities such as the Hospital Universitario Central de Asturias, the Centro Médico, IMOMA, IUOPA, FINBA and the Institute. The institute, with approximately 200 professionals on staff attending over 100,000 consultations every year and enabling approximately 8,000 surgeries, has a marked trend towards high specialisation and strongly bets on research and the type of patient care that enables them to keep striving for excellence.
The medical director of the Instituto FernándezVega was very grateful for this distinction. He assured that it “holds him even more responsible in the exercise of his profession and in the humble cooperation he can offer the College”. He was also feeling especially proud given the fact that his grandfather, Luis Fernández-Vega Valvidares, presided years ago the institution that is now giving him this recognition. Prof. Fernández-Vega receives the gold medal from the hands of the President of the College of physicians, Dr. Braña.
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New Headquarters of the Sociedad Española de Oftalmología Prof Luis Fernández-Vega was in charge of the inauguration of the first headquarters on property of the Sociedad Española de Oftalmología (Spanish Society of Ophthalmology). As president of this society, and now on his fourth year, the professor stressed that he didn’t want to finish his mandate “without seeing one of the key ideas of his program come true”: “to have, for the first time ever, a permanent physical space for the associates to dialogue” enabling “more efficient work in conformity with the current circumstances”. To this respect, Prof Luis Fernández-Vega argued that, “even though we live in a hundred-year-old society, it is also a society that complies with current needs and that looks into potential future needs".
A permanent physical space for the associates to dialogue
Prof Fernández-Vega, during his speech.
Thus, the president of the SEO was proud to have a space that he described as the “finishing touch” and “legacy” for the future board, a result not of individual effort, but of the work of his predecessors, “gathered up and increased by us and which will continue, from September onwards, with those responsible for the new board of directors”.
The new Headquarters finishing touch and legacy Prof Fernández-Vega, with Prof Barraquer and Prof García Sánchez.
Making headlines
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The FIO publishes its research and educational report 2014 The Fundaci贸n de Investigaci贸n Oftalmol贸gica (Eye Research Foundation) has published its annual report for 2014, covering the different research and educational projects carried out throughout the last financial year. Over one hundred pages show the results of both its activity and the activities carried out in collaboration with other centres. These have been published in the most relevant scientific journals within its field of knowledge, as well as having been disclosed in the most prestigious national and international forums. Furthermore, the close relationship of the FIO with the clinical activity of the Institute enables activities such as the research of biomarkers for the early diagnosis and treatment of diseases such as glaucoma or keratoconus, and research in neuroprotection to gain a better understanding of the mechanisms of retinal damage and its progression in diseases responsible for most cases of blindness.
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Making headlines
A report that demonstrates the consolidation year by year of a project that was born only six years ago, and which still achieves its main objectives: go in-depth in the physiopathological basis of diseases to improve prevention, diagnosis and treatment of those pathologies that cause blindness and visual alterations, as well as generating a high capacity for training new researchers.
If you wish to access the whole report, you can find it here: http://fio.fernandez-vega.com/ publications/fundacion-deinvestigacion-oftalmologicamemoria-2014
The Institute and the FIO will be the benefactors of the research carried out by FINBA The Instituto Oftalmolรณgico Fernรกndez-Vega and the Fundaciรณn de Investigaciรณn Oftalmolรณgica (FIO - Eye Research Foundation) have entered into an agreement with Fundaciรณn para la Investigaciรณn Biosanitaria de Asturias (FINBA โ Foundation for Biomedical Research in Asturias) under which each of the three entities commits itself to collaborating in the presentation and execution of projects, as well as in all those areas related to the design, training and promotion in the field of biomedical research and innovation or any area of common interest at autonomic, national and international levels.
The Minister for Health and president of the board of FINBA, Faustino Blanco, and Prof Luis FernรกndezVega, president of the Fundaciรณn de Investigaciรณn Oftalmolรณgica and medical director of the Institute, explained during the signing of the agreement that the three entities will cooperate closely in activities that contribute to foster high-quality biomedical research, drive biomedical researchrelated projects and ensure the ethics of research and innovation.
Telefónica and the Fundación de Investigación Oftalmológica enter into a collaboration agreement
Both institutions have entered into a collaboration agreement to give support to research in advanced therapies and tissue engineering to create artificial corneas, this will be carried out at the Instituto Oftalmológico Fernández-Vega.
In the picture, from left to right: researcher from the FIO Omar González; Francisco de Bergia, head of Public Affairs of the Presidency of Telefónica; Prof Fernández-Vega; Dr Jesús Merayo; Gonzalo Macías, manager of the Institute; and researcher Almudena Íñigo, during a visit to the Foundation.
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Making headlines
Francisco de Bergia and Prof Fernández-Vega seal-the-deal with a handshake.
“What we are looking for is to develop the biologic structure that provides support to house and transport cultured cells that will regenerate the damaged part of the cornea, the final objective is for patients with corneal blindness to recover their sight,” explains Dr Jesús Merayo, Research Director at the Fundación de Investigación Oftalmológica.
The cornea is the transparent part of the eye that is shaped as a watch glass, the tissue that enables images to be focused when they arrive to the retina. If this tissue looses its transparency, corneal blindness occurs.
The loss of transparency can occur due to accidents, burns, infections, surgery or degeneration of the tissue. Approximately 5 000 corneas For the cornea to remain are donated every year in transparent a very active water Spain. Around 37% of these pumping service is needed, are dismissed, either and this function due to donor-related corresponds to The research problems (21%), or its innermost on advanced during the proceslayer, the corneal sing (79%), achieving therapies of the endothelium. FIO is focused only approximately “Thanks to this help, we will work 3200 transplants. on producing to substitute artificial just the patient’s The research on corneas in advanced therapies damaged layer, the lab of the FIO is focused aiming to save on producing artificial the few donor tissues for other pathologies corneas in the lab, in the same and to customise the scaffolding way as it is already done for skin or conduit to avoid rejection,” and cartilage. . highlighted the medical director
of the Instituto Oftalmológico Fernández-Vega, professor Luis Fernández-Vega. Telefónica’s commitment to healthcare has been a constant for over ten years, since it created a R&D department specific to this field. Ever since, it hasn’t stopped allocating resources and professionals so that its eHealth unit positions Telefónica as the Digital Telco leader in the social and health sector, with innovative solutions and the development of new services with great potential. But the company has always known that to follow that path and in order to launch its projects, the best partners must surround it. This agreement with the FIO opens a new path, as with it Telefónica engages for the first time in ophthalmological research together with the best professionals.
Making headlines
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Sharing experience at the Foro Comunicación y Escuela “If you are well trained, you have good ideas, working ability and a spirit of sacrifice, much can be achieved both in Spain and in the World”. With this words Professor Luis Fernández-Vega encouraged the students from the Instituto Elisa y Luis Villamil, in Vegadeo, to bet on developing their capabilities as much as possible in any setting, without resorting to moving to the big cities to be able to succeed.
Prof Fernández-Vega, with several students of the centre and Leticia Álvarez, from the journal El Comercio, in representation of the organisation of the Forum
As was his case. This is proven by his life and professional experience, which he shared with the students in the framework of the VII Foro Comunicación y Escuela, an initiative that seeks to bring the students closer to personalities in the Asturian society so that they can learn fist-hand about their trajectories and follow suit.
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Making headlines
Professor in Medicine, head of Ophthalmology at HUCA and director of the Instituto Oftalmológico FernándezVega, the professor answered all the questions raised by the young participants for over an hour. The attendees showed especial interest on understanding how one becomes an international model and on satisfying their curiosity on subjects such as the possibility of a cure for blindness or why many ophthalmologists still use glasses.
The clinical practice in Madrid is being transferred We had outgrown it. What started seven years ago at Plaza del Marqués de Salamanca 9, in Madrid, to facilitate check-ups and first explorations to potential patients of the Institute in Oviedo, has grown so much that, to be able to keep up the quality and trustworthiness standards, we need bigger facilities in which we can also take into account comfort.
Thus, foreseeably, during the first days of autumn, the current clinical practice located at Marqués de Salamanca will transfer to Príncipe de Vergara 131, where the patients will continue to receive the traditional care that characterises the Instituto Oftalmológico FernándezVega in nearly 1,000 m2 . Full information on the matter shall be provided.
Second ophthalmology campaign in Ayacucho (Peru) Tomás Parra Ophthalmologist of the Instituto Fernández-Vega
With the experience of the first campaign, which we undertook two years ago, the ophthalmology team from the Fundación Fernández-Vega constituted by Henar Morchón, holding a degree in Optics and Optometry, and ophthalmologist Dr Tomás Parra, set out last April on the long journey to Peru, thus answering to the request made by the Dominicas del Rosario de Ayacucho, headed by mother Covadonga (Campomanes, Asturias, 1922), to the director of the Foundation, Victoria Cueto-Felgueroso Botas. 24
Fundación Fernández-Vega
The expedition required months of preparations to gather medical and surgical supplies, prescription glasses and sunglasses, and the necessary drugs, eye drops, artificial tears and drugs for the diseases of the retina amongst others, to ensure the success of the campaign. After many hours in a plane, we received a warm and charming welcome to Ayacucho from the Dominicas, mother Covadonga being once again, at 93 years of age, at the head of the welcome party, as well as from the board of directors of Fundación ACOVAPERÚ, established by mother Covadonga for social purposes. We had a light breakfast and we went directly to the Hospital Regional de Ayacucho to start our work. We saw approximately 50/60 patients very day; most of them lacking almost everything they need. Most of them don’t have glasses, they are checked for far vision and for near vision and they get a voucher that they then swap for a pair of glasses. Patients often suffer from dry eye, chronic conjunctivitis and pterygium. They
Dr Tomás Parra examining a patient.
all receive a voucher with the prescribed drugs that they will subsequently exchange, of course, free of charge. This aspect of the campaign is very important as glasses and drugs are very expensive in Peru and are not within reach of these people. Ayacucho has many hours of sun per year, and the altitude of the city is nearly 2 800 meters with a very dry climate. This peculiar This peculiar atmosphere of the Andes produces, atmosphere due to exposure to UV of the Andes radiation from the sun, produces, due to many eye allergies and exposure to UV diseases: cataracts, radiation from pterygium, dry eyes, the sun, many chronic conjunctivitis,
eye allergies and diseases
and macular degeneration. Thus, we distribute many sunglasses with UV filter, artificial tears and lutein antioxidants for the eye, which is the preventive aspect of the campaign.
The people of Ayacucho gave a warm welcome to the team of the Foundation.
On the second day, we received patients from Huanca Sancos, an Andean community three hours away by car from Ayacucho. They presented more severe eye diseases, as this
Fundación Fernández-Vega
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Days of lot of work, which is worth when the achievements made and the satisfaction of people who have almost nothing.. community is more isolated and finds it more difficult to gain access to specialised medial care. At the end of the day, we met with the elected representatives to explain to them the visual problems we had detected and its potential solutions.
Optometrist Henar Morch贸n tends to a girl.
The following days we continued with intense work throughout the day, seeing nearly 60 patients every day until the 29th, which was devoted to surgery at the Hospital Regional in Ayacucho. Three patients with advanced cataracts had been scheduled, as well as one with a pterygium that invaded up to the pupillary axis. The technique used for cataract surgery had to be extracapsular, nowadays fallen into disuse in developed countries, due to the lack of devices to perform more advanced techniques, but At a given time during surgery.
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Fundaci贸n Fern谩ndez-Vega
the result was more than satisfactory as the patient recovered his vision. Days of hard work, but it is all worth it when one sees all that has been achieved and the face of satisfaction of people who don’t have much. On the evening of the 29th, we visited the ophthalmology centre built by the Dominicas in Ayacucho; it is nearly finished and it is devoted to the rehabilitation of visually disabled individuals, in the future it will be an ophthalmology centre, showing the deep concern of mother Covadonga with vision problems. They have built a bakery in the same plot, already in operation, with its own trademark and state-of-theart facilities, fully equipped and devoted to training the local youth. As farewell from the people of Ayacucho we take the memory of days of intense work, the sincere appreciation of those people in so much need, the great work carried out by the Dominicas
Over 50 patients had their eyes checked every day.
and the beauty of the Andes and the city, with its beautiful Plaza de Armas and the numerous church towers and bell towers that seem to be saying ‘see you soon!’
New visit to Down Asturias Last 12th of June took place the second visit of the year to Asociación Down Asturias. This time, a team from the Foundation constituted by doctors, optometrists and maintenance personnel accompanied the director of the Foundation, Victoria Cueto-Felgueroso Botas. Throughout the evening, the team checked the eyesight of 18 patients in what has already become a regular cooperation for the Fundación Fernández-Vega. “We are truly amazed by the work carried out at Down Asturias; we look forward to collaborating with them by doing everything in our power”, assured the director of the Foundation to Inés Fernández, president of the Asociación Síndrome de Down.
Victoria Cueto-Felgueroso Botas, director of the Foundation (centre), and Inés Fernández, president of the Asociación Síndrome de Down (right), together with a patient and her mother.
Eyesight check-ups at Arbolar Association A team of four people visited last Friday the neighbourhood of El Natahoyo, in Gijón, to check the eyesight of 15 patients. Dr Ignacio Rodríguez, optometrists Alberto Barros and Manuel Prada, and Abraham Álvarez, from maintenance, worked together with the associates and family members of Arbolar throughout the evening. The association of Arbolar is an entity constituted by 52 members, users, fathers, mothers and guardians of the Centro Residencial de Apoyo a la Integración de Cabueñes
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Fundación Fernández-Vega
(Residential Centre Assisting Integration in Cabueñes), as well as other individuals with intellectual disadvantage and their families; the aim of the association is to perform different activities for social integration, to support families and, as in this case, to improve health and quality of life.
Dr Rodríguez Uña examines the eyes of a patient.
Arbolar and the Foundation have collaborated throughout the years with a high acceptance and participation success rate; on this occasion 29 individuals are enrolled and will be attended in two sessions.
Visit to the Siervas de Jesús de la Caridad At the end of May, Dr Rodríguez Uña and optometrist María Rueda visited the convent of the Siervas de Jesús de la Caridad, in the centre of Oviedo, to perform eye checks to all its residents. This visit was carried out within the framework of an initiative that is expected to continue throughout the years: to collaborate with an order that provides an importance service to disadvantaged individuals and collectives in the capital of the Principality. This assistance is part of the action program of the Fundación Fernández-Vega, whose activities include providing ophthalmology services to collectives with some kind of difficulty.
A nun from Oviedo’s convent, about to have her eyesight checked by Dr Rodríguez Uña.
What the eyes cannot see… Behind each local project of the Fundación FernándezVega is an impeccable work of logistics. The maintenance team of the Institute, Abraham Álvarez, Serafín Antón and Marco Díaz are responsible for this. They are in charge of all the setting-up and they help physicians and optometrists to explore those patients with reduced mobility and/or with intellectual disabilities. They are also responsible for loading and driving the van of the Foundation, carrying a slit-lamp, an auto refractometer, a tonometer, a binocular ophthalmoscope, From left to right, Serafín Antón, Marco Díaz and Abraham Álvarez, with the Foundation’s van. octotypes, a box of lenses, etc. All one needs to find the right prescription for the patients, to measure their ocular pressure and to be able to examine properly the anterior segment and the eye fundus. Many kilometres and much work are behind each effort of the Fundación Fernández-Vega.
Agreement between the Fernández-Vega and the Order of Malta Foundations The Fundación Fernández-Vega and the Fundación Hospitalaria de la Orden de Malta in Spain (FHOME in Spanish) have signed a framework agreement whereby they will share relevant experiences for the purpose of their respective foundations. Specifically, they will able to enter into national and international partnership agreements in healthcare programmes or in eye surgery procedures. As a first project for this framework agreement, a team of ophthalmologists and optometrist from the Instituto Oftalmológico Fernández-Vega will go to the facilities of the Centro Sanatorio Marítimo in Gijón to perform eye checkups to its residents. If any eye condition requiring surgery is diagnosed during this visit, the Fundación Fernández-Vega
Jaime Churruca and Azlor de Aragón, president of the FHOME, and Dr Álvaro Fernández-Vega, deputy medical director of the IOFV, during the signing of the agreement.
will, after assessing each case, perform such surgery free of charge.
The Fundación Fernández-Vega, via the Instituto Oftalmológico Fernández-Vega, bring together the social and patronage work The Fundación Hospitalaria de of the Fernández-Vega family, la Orden de Malta aiming to humanise in Spain promotes healthcare even reviews and social activities in across the Spanish surgery free the framework of the borders; its of charge charitable and welfare objective is to activities of the Malta facilitate access Order in Spain. For to services and the development and execution ophthalmological provisions to of these activities, the FHOME disadvantaged collectives, as relies on XXX’s continuous well as promoting prevention, collaboration (in their charity and training and awareness on eye welfare activities). conditions.
Fundación Fernández-Vega
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Alterations in the Vitreous The importance of an early detection The vitreous humour can play dirty tricks. While it is normal to see small flying flies, it is not a good sign that these flying elements turn into cobwebs, soot or spots that differ from the usual ones. These alterations may indicate that there is something wrong and lead to issues as severe as retinal detachment. Therefore, it is paramount to understand its symptoms and make an early identification to avoid severe consequences, warns the deputy medical director of the Institute, Dr Álvaro Fernández-Vega, who explains in the following lines the keys to make an early detection of potential alterations that may lead to much more severe problems.
“It is paramount that people are aware of the symptoms of vitreous detachment, as this can alert us to a possible retinal tear, first step for a retinal detachment”, warns Dr Álvaro FernándezVega. But, what is the vitreous? What function does it have, and what are the symptoms that should alert us that something is not right?
Dr. Álvaro Fernández-Vega.
uncomfortable due to their density, mainly myopic patients. Men and women have them in the same proportion.
When does it start to be a problem?
The problem starts when transparency is Vitreous humour is a transparent gel Vitreous humour lost. Sometimes, the vitreous humour constituted by collagen, hyaluronic can stop being transparent, prevenacid and 99% water that fills the is a transparent ting the images to reach the retina. For cavity within the eye. Light and gel constituted example, when a haemorrhage occurs images have to go through it to by collagen, inside the eye staining it with blood, or reach the retina, where the vision hyaluronic acid when there is an inflammation of the process takes place. Its volume is eye that opacifies the vitreous with the approximately 4 millilitres, it provides and 99% water that fills the products of the inflammation. In these structural support to the eye and situations, there is a very sophisticated offers a transparent path for light cavity within surgery, called vitrectomy (Figure 1), and images to reach the retina. In the eye which enables us to remove the opayoung people it is adhered to the cified vitreous humour. This surgery connects the retina, which in turn covers all the surface of the eye eye globe to a pump that infuses serum into the fundus. eye at a constant pressure, so that the eye does not collapse, while we remove the vitreous gel with a But this gel contains condensations and opaque device that cuts and sucks it. To be able to see the points that the patient perceives as flying flies inside of the eye with a microscope we light it up or worms, and which are best observed against using optical fiber. lighter backgrounds. These alterations are not anomalies; it is normal for all of us to see them in those conditions, and some people might find them
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Medical article/report
But how to know when to perform surgery and when not to? This surgery is justified in cases of severe opacification of the vitreous humour, but not just to remove flying flies as the risks outnumber the benefits, assures Dr Álvaro Fernández-Vega, who also indicates that there is yet no effective medical treatment to remove these trivial condensations of the vitreous humour. It is also worth noting that vitreous humour does not regenerate once it has been removed by vitrectomy, but the serum introduced in the eye is finally substituted by aqueous humour produced by the eye. It might also be necessary to remove the vitreous gel, for example, in diabetic patients with severe diabetic retinopathy, whose abnormal blood vessels grow in the posterior surface of the vitreous producing haemorrhages and retinal detachment.
Evolution throughout the years With age, the vitreous humour becomes more liquid, and this liquid gets accumulated in pools within the gel. With this loss of gel volume appear contractile forces: as the vitreous gel contracts, it separates from the back wall of the eyeball (the retina) in its posterior side, but never at the front, as the link to the retina in that anterior area is
very strong. “This is the normal process of ageing of the vitreous, so it will happen to all of us at some point”, states Dr Fernández-Vega. However, there might be no problem during this separation, which is often the case, or the vitreous might pull from the retina, causing problems, whether to its adherence to the posterior part, the area of maximum central vision of the retina, what we call the macula (Figures 2, 3 y 4) or at the front, the most anterior retina.
has occurred. Although the probability of the retina breaking at that point is low, and most people won’t suffer retinal tearing, being such a severe pathology as a retinal detachment, it is mandatory to undergo an immediate ophthalmology examination when the first sings appear.
FIGURE 1 Línea de infusión
The risk of retinal detachment If the separation and traction happen in the most anterior part of the eyeball, a retinal tear can occur, which in case of not being immediately treated, welding it with laser, will cause retinal detachment. This is why, Dr Álvaro Fernández-Vega believes it is paramount for people to be aware of the symptoms of vitreous detachment, as this can alert us to a possible retinal tear, first step for a retinal detachment. And while seeing floating bodies is normal, the sudden change of these elements is not. “People report ‘I was seeing my usual flying flies and then, I suddenly started seeing cobwebs, soot, spots, different to what I usually see”, explains the deputy medical director of the Institute, who adds that this is usually accompanied by seeing lights or lightning.
Iluminación Vitrectomo con corte y aspiración
FIGURE 2 Section of a normal retina. The adherence of the vitreous humour to the centre of the posterior retina (fovea) can be seen. Adherencia del humor vítreo Retina
FIGURE 3 Section of a retina with abnormal adherence of the vitreous humour, causing traction of the posterior retina and its alteration.
FIGURE 4 Section of a posterior retina with the formation of a macular hole due to traction.
This sudden change in the floating bodies is what can alert us that a vitreous detachment
Medical article/report
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Caring For Eyes During Summer Summer is finally here and, weekly markets during summer. “One must choose appropriately one’s sunglasses and be with it, the much coveted aware of its importance beyond aesthetics; sun. By now, most part of sunglasses will protect us from UV rays, very society is aware of the need damaging to the different eye structures: the cornea, the crystalline and the retina”, explains to take precautions to Dr. Carlos Lisa. “These protect the structures may suffer skin from keratitis, inflammation an excessive of the cornea, early cataracts and exposure macular degeneration to the sun; associated to an however, excessive exposure to sunlight”. there is not the same Is best not to use Then, which are the notion of having of the sunglasses at all than characteristics to protect one’s ideal sunglasses? The eyes from the UV using poor quality most important thing is that they have filters rays and, to this sunglasses to protect as much end, as well as not as possible from UV radiation, with an average darkness, protecting looking directly both from the light that comes in from the front and to the sun, there is no from the light that comes in through the sides and, better ally, even on cloudy above all, avoid plastic lenses - these not only give days, than a good pair of no protection from UV radiation, but they can also be harmful for ocular health. sunglasses. The World Health Organisation recommends taking measures to protect one’s eyes and skin from an ultraviolet radiation index 3 and above, a figure that in Spain is surpassed most of the time. Thus, eye-health professionals recommend the use of sunglasses throughout the year, even though the intensity of the light, and therefore the risk, is higher in summer than in winter. The problem arises when we have to choose between the wide supply present not only in optician’s shops, but also in window shops and
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Ophthalmological divulgation
So much so, that Dr Lisa states that it is best not to use sunglasses at all than using poor quality sunglasses. “The reason is simple: generally, plastic lenses filter visible light, but do not filter any type of UV radiation, therefore, when we wear them our pupils dilate, allowing more UV radiation into the eye than if our pupils were constricted. Thus, it is more likely that we suffer injuries that, even though we might not realise it at the time, may appear in the future when they are already irreversible.
From childhood Sunglasses are not only for adults. In fact, a high percentage of the sun radiation that harms the eyes is absorbed before the age of 18 and, as is the case with skin, it is accumulative. Hence the importance of getting children used to using protective measures. “It is especially important for children to use sunglasses as their ocular structures are more transparent, more sensible than those of adults, UV rays are therefore more harmful to them”, highlights Dr Lisa. It is also important to take special precautions if one is
going to expose oneself to extreme situations, where the reflection of light can be higher. This is the case, for example, of water sports or snow activities. In these cases, it is best to use the highest filter. “Level 4 offers the highest protection and would therefore be indicated for these situations, in which it would also be convenient to use mirror filters, as they offer the highest protection against UV rays”, says Dr Lisa. For those who do not engage in this type of activities the required protection level is not as high, however, this doesn’t mean that special attention shouldn’t be paid to certain time-slots and daily activities.
For example: according to data from the WHO, 60% of the daily UV radiation is received between 10 am and 2 pm. And for beach lovers, another fact: white sand reflects up to 15% of solar radiation.
The correction of astigmatism with toric lenses
Drs Carlos Lisa and Luis Fernรกndez-Vega Cueto-Felgueroso.
Astigmatism is a refractive error that causes blurred and distorted vision; it affects up to 26% of the Spanish population1. In the pace of patients who undergo cataract surgery, the incidence of astigmatism above 1.5 dioptres rises to 30%2.
This error is usually due to an irregular curvature of the cornea and its main consequence is blurred and distorted vision that decreases visual acuity in near and far objects.
What is the situation of astigmatism amongst the Spanish population? And amongst those with cataracts? Dr. Fernández-Vega CuetoFelgueroso: It is estimated that 20 to 30% of the population worldwide has astigmatism. A study carried out in Spain with individuals over 60 years of age showed that only 10% of patients did not present astigmatism and 20% had severe astigmatism, i.e. above 2 dioptres. It is a very common refraction error, but it can also be corrected. Dr. Lisa: The incidence of severe astigmatism – 1.5 dioptres or above – in Spain is close to 25% of the population, becoming one of the most common eye conditions together with myopia and presbyopia. As the condition does not progress with age, its incidence does not differ in patients with cataracts. Is it possible to correct astigmatism during cataract surgery? Dr. Lisa: Certainly, astigmatism can be efficiently corrected during cataract surgery. Dr. Fernández-Vega CuetoFelgueroso : Not only is it possible, but it is one of our objectives when we are performing one of these surgeries. How is it done? What technologies and materials come into play? Dr. Lisa: Astigmatism comes determined by the morphology of the cornea, which can have a bigger curvature in one meridian than in the other, causing a
distorted focus of the images on the retina and affecting both near and far vision.
Likewise, biometers for the calculation of intraocular lenses are increasingly accurate.
Performing corneal incisions that can change the curvature or using toric intraocular lenses, which include the correction of astigmatism, can correct this.
Dr. Lisa: The latest technologies have helped us to be more efficient and accurate in the diagnosis and treatment of these graduation errors. We can virtually correct all degrees of astigmatism with a high rate of success.
Dr. Fernández-Vega CuetoFelgueroso: Toric intraocular lenses can correct astigmatism up to 12 dioptres, for low astigmatism we use the same incisions we used to introduce the lens of the cataract to correct them. If there is any residual astigmatism after cataract surgery, one must remember that we can use femtosecond laser or intracorneal rings to correct it Is it common for patients to ask about this type of correction for refractive errors? Dr. Lisa: It is a common question, as patients are increasingly aware of their eye problems and are interested in the origin of the astigmatism and how it can be corrected. Dr. Fernández-Vega CuetoFelgueroso: Yes, patients are increasingly looking for a premium surgery in which they can become emmetropic, i.e. they do not need to use glasses for any distance most of the time. What have the latest technologies provided to this type of interventions?
Is it a complicated surgery for the patient? Dr. Fernández-Vega CuetoFelgueroso: Absolutely not. Surgeons need more time to prepare, choose the lens, make calculations… but for the patient is like any other cataract surgery and it can be over in about 10 minutes. Dr. Lisa: : I agree, the correction of astigmatism does not imply a higher surgical risk for the patient. Does the patient fully recover his vision? Dr. Fernández-Vega CuetoFelgueroso: Yes, the patient will be able to see as well as he did before when he was using glasses, but without the need to wear them. Dr. Lisa: Today, we can normally correct all the astigmatism power and therefore, the patient, if no other problem exits, will recover his vision completely.
Dr. Fernández-Vega CuetoFelgueroso: As well as the aforementioned toric lenses, there are digital markers that help us intraoperatively to place the lens in the correct position.
(1) Roberto Muñoz, Marcos. ‘Corrección de astigmatismo con Lente intraocular tórica en pacientes con catarata’, 2011. p. 52. (2) Vanmarsenille D, Conem, C. Vandoorslaer, N. Vision Needs Monitor 2012.
Medical article/report
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Ágatha Ruiz de la Prada
“To be free is in one’s nature, the same as being nice or being intelligent” Just by familiarising ourselves a little bit with Ágatha Ruiz de la Prada, the word freedom is present all over the place: in her work, in her wishes, in her image and in her attitude. This designer and businesswoman from Madrid has reached the ends of the Earth with a brand as decisive and unmistakable as her personality, in which we try to penetrate through this interview
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They look kindly upon us
Who or what inspires Ágatha Ruiz de la Prada? Contemporary art has been my main source of inspiration throughout my life. Picasso has always been my idol. What is the situation of fashion in Spain? Fashion in Spain is at a very interesting moment. We are the leading country in “fast fashion” and I hope that this has an even bigger effect on independent designers. You have created a brand recognised worldwide, you have held fashion shows all over the world (even in Uzbekistan), you have created a collection of reinforced doors! You have exhibited at museums, you are copied and, furthermore, you influence the design lines of great classic designers. What part of your work tends to make you happier? Do you set challenges for yourself? What I try to avoid is monotony, I love constantly changing what I’m doing. I also love leaving my personal mark on new objects and products, creating my little Ágatha microcosm. What is required to have so much freedom? Is there any place in which you are inhibited, a setting in which you do not dare to do or to say what you want? To be free is in one’s nature, the same as being nice or being intelligent. I guess that the first years of life have in this, as in everything else, much influence. Sometimes I remain silent, but if I’m asked, of course I speak my mind. And there is nowhere in the world where I wouldn’t dare wear my clothes. You say that your greatest virtues are your patience and your confidence. Can you give
us a crucial example in which these have helped you? To succeed in fashion and to succeed in Spain has been a battle at all times. But I have finally succeeded. Of course, I have had help, lots of it, at all times. In a great interview in 1984, Paco Umbral describes you as a “feminine Oscar Wilde”. What book would you have liked to have written? “In Search of Lost Time”, by Proust. You are one of the icons of the movida madrileña. What music do you like? How do you choose the soundtrack for your fashion shows? I like to remember and pay tribute to this irreverent period. My ear has stayed by in the 80’s. What would you like to enjoy but there is no way it is going to happen? I don’t understand the electronic music of new generations; I have a hard time distinguishing the melody within that tearing noise. Cósimo, the Baron in the Trees by Italo Calvino, lived in the trees, made his own clothes, was an aristocrat, devoured books, knew people from everywhere… Is there were the name of your daughter comes from? It is more because of Cósima Wagner, the great muse of the musicians, I always wanted for my children to be musicians… As you know, the Instituto Oftalmológico FernándezVega is an entity with a long family tradition. In fact, the fifth generation has just joined in. Your daughter, Cósima, has also started working with you. According to you, what is the secret to garner the best
from a family tandem in the professional life? What you have achieved at the IOFV is remarkable. I dream with achieving that too. It is one of my great challenges at this point. I know it’s going to be super difficult, but with family patience comes naturally, the secret is going to lie in patience. You are a patient of the Institute; you have undergone surgery in Oviedo. How was your experience? Great, in a week I was perfectly recovered. I never dreamt it would be that easy. What would an eye of the Instituto Oftalmológico Fernández-Vega designed by Ágatha Ruiz de la Prada look like? Probably fuchsia, and with multicoloured eyes coming out from everywhere. Will we see you soon in Asturias? When I bring the rest of my family to have their eyes corrected.
They look kindly upon us
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Dra. Eva Villota
Dra. Eva Villota answers the questions of our patients regarding their eye care
I am 45 years old, I’m myopic and I see many flying flies. I’m worried because they bother me and because I’m afraid they are going to make me lose vision. Flying bodies or flying flies are tiny specks that many people see moving around their visual field, especially when they stare at a plain background such as a wall or the sky. In fact, they are microscopic slivers of gel-like substance formed in the vitreous humour, the transparent liquid that fills the interior of the eye. What one sees are the shadows of these floaters reflected on the retina.
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Generally, they are not very important, and are very frequent in individuals with high myopia, because in these patients the vitreous degenerates earlier in life and in a more remarkable way. They are not associated to any pathology and they do not cause loss of vision, unless the patient perceives a sudden change in these flying flies and they become associated to thunder or fixed spots in the visual field. There is no specific treatment to remove them. One should avoid following and focusing them and should use sunglasses when there is a lot of light so that the flies are less remarkable.
I am 65 years old and I weight 100 kilos, I was diagnosed diabetes 20 years ago. I undergo regular check-ups because physicians say that the diabetes has affected my eye. I’ve recently had a haemorrhage and I’ve been treated with laser, ever since I don’t see properly. They say that I need to receive more laser treatment, but I don’t want to because I’ve lost vision since I had the treatment. What should I do? Are there any other treatments?
I’m 69 years old and I have been diagnosed with dry macular degeneration in both eyes. I have always worked exposed to the sun and I have never used sunglasses. Is it possible that this has affected me? What can I do to cure the disease? Macular degeneration is an early ageing of the macula, the centre of vision. Its main origin is age; however, it has been associated to other factors such as smoking and sun exposure. There are also genetic factors that determine the onset and seriousness of the disease. Therefore, its origin is multifactorial. “Dry” age-related macular degeneration (AMD) has a slow continuous progress, in a way that the patient adapts the appropriate low vision aids at each point, thus decreasing his disability. There is no specific treatment, but taking vitamin complexes, omega-3 fatty acids and antioxidants slows its progression and seriousness.
When diabetes goes unchecked for a long time, it affects the blood vessels in our body. Those in the eye, which are the thinnest ones, are the first to be harmed. It is very important to keep sugar levels below 150 mg/ml, avoid smoking, as well as maintaining an appropriate weight, controlled blood pressure and the appropriate levels of blood lipids. This is how we ensure that the disease is not going to harm our blood vessels, or will just inflict a mild damage. If the ophthalmologist has already detected damage to the retina that needs laser, we are probably AMD does Dra. Eva Villota facing a very advanced not affect stage of the disease. lateral vision answers the questions of our patients We are talking about (peripheral). regarding their eye care proliferative diabetic This means retinopathy, by which that there new abnormal blood is never vessels or neovessels complete grow. These neovessels loss of are very fragile and can vision. This bleed or cause retinal condition detachment, leading only causes to complete blindness. the loss It has been known of central for over 20 years vision. that laser prevents Generally complete blindness speaking, in diabetic patients, macular but it is true that degeneration very few patients can cause achieve any visual you to lose improvement. More your ability than one session of to read, laser is usually used to control the neovessels drive and recognise faces at a certain distance. and its effect is not immediate, so the risk of However, most people with this condition are haemorrhages persists for several months after able to go about their daily life without too much the treatment. Intraocular injections of drugs are difficulty. usually associated to control de “flooding” of the retina or macular oedema. These injections achieve visual improvement in a high percentage of patients – between 60 and 70%.
Lets see
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The Opera of Oviedo, 68 years of history Jaime Martínez González-Río Musical culture is one of the hallmarks of Oviedo. The Opera is probably the most characteristic as there have been musical performances since the XVII century at the “Casa de Comedias”, located at Plaza El Fontán. At the end of the XIX century the need for a new theatre was felt, it was approved by municipal initiative in 1876 and the writer and councillor Leopoldo Alas, “Clarín”, played a key role in its development and, even, in its denomination. The Teatro Campoamor was inaugurated in September 1892 with Meyerbeer’s Les Huguenots. It was characterised from the very beginning for presenting the most prestigious titles and having the best singers, for example, contemporary pieces such as I Pagliacci and Cavalleria Rusticana in 1896, La Dolores by Tomás Bretón directed by its author in 1900, or La Bohème by Puccini in 1902, six years after its premiere. Major milestones were Wagner’s Lohengrin sang by Francisco Viñas, in 1908, Tristan und Isolde in 1921 with Walter Kirchhoff and Elsa Bland in the leading roles, Aida and La Bohème by Hipólito Lázaro in 1926, with the performance of tenors such as Lauri-Volpi, Miguel Fleta and a long etcetera that demonstrated the high quality of the performances and the liking of the population. The theatre was destroyed in 1934, after the civil war, and once it was reconstructed in 1948 at the City Council’s initiative, short Seasons were scheduled coinciding with the festival in September, with five
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Music
titles and just one performance. Our Season is the second oldest in Spain, after that of the Liceu in Barcelona. The initial Season was inaugurated with Manon, interpreted by great stars of the time such as Victoria de Los Ángeles, Giacinto Prandelli, Manuel Ausensi and Giuseppe Flamini, representing, according to the critics, a great artistic success that was then followed by Aida, Lucia di Lammermoor, La Bohème, Tosca and Rigoletto, sang, amongst others, by Mario del Monaco and Elisabetta Barbato. The city resumed a tradition that has remained until today. The City Council kept organising it for thirty years and Oviedo heard the voices of legendary names such as Franco Corelli, Montserrat Caballé, Piero Cappuccilli, Alfredo Kraus, Luciano Pavarotti, Leo Nucci, Mirella Freni, Gianna d’Angelo, Juan Pons, José Carreras, Matteo Manuguerra…. The Asociación Asturiana de Amigos de la Ópera was created in 1978 as a result of the
The president of the Ópera de Oviedo, Jaime Martínez, with Plácido Domingo.
Teatro Campoamor, headquarters of the opera season in Oviedo.
withdrawal of the City Council; the association, internationally as well, the pleasure of watching our with great dedication and effort, and in spite of production, created by Emilio Sagi, Iphigenie in great economic hardship, was able to maintain Tauride, sang by Plácido Domingo at the Kennedy the high quality of the Season. The 14th of Center in Washington in 2008. December 2004, it becomes the Fundación Ópera de Oviedo, professionalising its economic and In opera, characters with ophthalmological artistic management. This was the beginning of problems are common; I remember the “burning a project that represents opera as a close cultural of the eyes” to Samson on the third act of Samson phenomenon open to society, with the objective et Dalila, written by Camille Saint-Saens and the of, on the one hand, creating and diversifying to one-eyed Princess of Eboli, in Verdi’s Don Carlo, a new public, growing to four performances per but it is counterbalanced with the beautiful story of title, free live performances in a giant screen in Iolanta, the last opera written by Piotr Tchaikovsky Oviedo and towns in the province, conferences and in 1892, telling the story of a blind princess that performances for children, introducing new titles, after learning of her condition, and thanks to love participating at Opera Europa and to a physician - I’m guessing a y Opera XXI to promote operagood ophthalmologist - is able to Premio Lírico 2013 related activities, etc. All of this is recover her vision… to the best opera done maintaining the high level of singers - José Bros, Stuart Skelton, singer to Sondra Finally, our next Season 2015Dolora Zajick, Carlos Alvarez, etc., 2016 starts in September with La Radvanovsky for together with new productions Walkiria; Nabucco, The Marriage Norma in Oviedo and co-productions, and with of Figaro, El Duque de Alba and and Barcelona. the guaranty of having our Coro La Bohème will follow it on a de la Ópera and the orchestras monthly basis. OSPA and OFIL as regular collaborators. This has (www.operaoviedo.com). I encourage the reader won it national recognition, such as the Premio to join us. Thank you. Lírico 2013 to the best opera singer to Sondra Radvanovsky for Norma in Oviedo and Barcelona, or the co-production with the London Royal Opera House of Peter Grimes as best new production or,
Music
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Russell Crowe We all have a brother in law like Russell Crowe. And if it’s not a brother in law it will be a cousin, a neighbour or a childhood friend. It is the type of person we call to carry furniture if we are moving, to fix a socket or even to burden him – unexpectedly - with a dark personal problem. Generally, we do not put much trust in his sensibility. He doesn’t seem like a very sophisticated person to the naked eye. On the contrary, he has that monolithic look of old statues, chiselled from a single block of granite stone. Maybe that’s why he inspires confidence: he is a solid and firm individual, without those uncomfortable emotional alterations that afflict contemporary men. Seen from the outside, he doesn’t seem to aspire to be anything else than what he is, unlike you and I, who constantly believe we are called for greater achievements at a personal and professional level as well as in our love life (never reaching such high goals, by the way, which ends up generating doubts regarding our scope for improvement, and even an insurmountable personal frustration).
Russell Crowe rose to fame with his performance of one of this individuals whose rough shopwindow denies any possibility of back room. Police officer Bud White is what we would call a “noble brute”, the guy whose only mission is to beat up his adversary until the latter becomes a selfconfessed criminal.
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Crossing of glances
While in the cast of LA Confidential, a masterpiece of modern Film Noir, many of the characters overvalue their own intelligence, Bud will make use of unsuspected detective qualities to solve a complex case of large-scale corruption and, at the same time, keep the girl – in this case a stunning Kim Basinger. Who would have thought? From them on, Crowe has built his career with characters that seem to be in one piece, but who are determined to contradict Oscar Wilde when he wrote: “You never get a second chance to make a first impression”. A sweaty gladiator, a daydreaming
mathematician, a patriarch of the Bible or an old sea dog from the British armada: in every case, his expression is a lock that, once open, enables us to rectify first impressions. Do not be rush to judge here. And remember: in the same way the characters that Russell Crowe plays deserve a second opportunity, maybe so does your brother in law, or your neighbour.