An Interview with Dr. D'Amelio

Dr. Maurizio D'Amelio graduated from the University of Catania (Italy) in 1987 with a specialization in Anaesthesia and Intensive Care, and a specialization in Neurosurgery in 1994. He currently works with an anaesthesiology team at the Vittorio Emanuele of Catania, a citizen’s hospital, in the Department of Emergency Surgery, and with an advanced rescue team on a public emergency ambulance service. He has authored several scientific publications and he currently chairs the Technical/Scientific Committee for the Blue Sky Association, a charitable organization based in Rome working to promote vitreous awareness and scientific research.

The Blue Sky Association has been successful in coordinating several avenues of research related to vitreous floaters. Can you briefly describe the objectives of these projects?

Since 2005, the Association has helped organize and initiate 4 projects which are in various stages of progress. One of our studies was developed in collaboration with the Department of Biochemistry and Molecular Biology at the University of Catania. This study is focused on determining the involvement of a ubiquitous enzyme, transglutaminase (tTg2), in the formation of aggregates as they are found in floaters. The first evidence from this research was presented at the International Congress of Biochemistry on Amine Biogene in October, 2007.

Another project was developed in collaboration with the Institute of Medical and Environmental Research (IRMA) of Acireale-Catania. This study aims to assess metabolic variations in the cells of the vitreous due to a loss of intercellular communication. This work could verify the role of receptors and proteins, specifically, protein Cx 43, in connecting cells to each other. Attempts have also been made to isolate cells of hyalocites in vitro.

A statistical, epidemiological study was started in 2007 and it was announced and presented to the XXIV Annual Congress of the Ophthalmological Society Triveneta (North Italy) in June 2008. This study is designed to document the social role and the impact of floaters in the productive population.

The Association is also involved with an ongoing clinical study of the application of 20, 23, and 25 gauge instruments, to vitrectomy equipment already used in a mini-invasive surgery developed by a major American laboratory. The system is known as the AVE (Adaptable Vitrectomy Enhancer) and it has the advantage of eliminating retinal tractions during aspiration of the vitreous.

Do any of these projects show promise for the development of an effective treatment for vitreous degeneration?

It’s still premature to talk of a cure. Our attempts, in particular, are a very small contribution which target one particular aspect, but each new acquisition adds a piece to a great mosaic. I hope a cure will be possible after all the complex biochemical mechanisms and relatives interactions with the vitreous’ surrounding structures have been explored. I believe that many answers will come from advanced research in other fields of investigations including those in biomaterials.

In your opinion, why hasn’t the ophthalmologic profession been more aggressive in the pursuit of a less invasive, complication free, treatment for floaters?

On the contrary, in the latter part of this century, technology has developed devices for eye surgery which are more thin and therefore, less aggressive. Floater treatments have profited from those developments. For many years, surgery of the vitreous was considered too risky due to the potential complications. It was restricted to cases of trauma and removal of foreign bodies but with fears of disability. 1970 saw the development of the first endoscope, which enabled abandonment of the open-air-vitrectromy. In 2002, Fujii perfected the technique of TSV (transconjunctival sutureless vitrectomy) and in 2004, he proposed a variant of vitrectomy for floaters now known as the FOV (Floaters only vitrectomy). The FOV provides for a more selective removal of the vitreous, but the removal of the posterior portion, close to the retina, is dependent on the size of the vitreous detachment and floaters may remain and still be seen after intervention. The percentage of complications reported in a few vitrectomy studies has been variable but includes cataracts, retinal detachment, bleeding, and infections (rare).

How has the Blue Sky Association been successful in stimulating interest in this area?

Our success is the result of the interest and efforts of a few people who suffer from floaters. The Association holds annual meetings and the Executive Committee decides on projects based on effective use of resources and posts them on the Association’s website. We are a small organization and we work to increase the visibility of the community of patients, to organize local scientific meetings, and sensitize research teams to the condition. For example, in the past year we have been able to finalize an initiative to conduct ocular screening in city squares with a mobile diagnostic unit. Our next ambitious project planned for the incoming year is to initiate a hospital outpatient program which involves the cooperation of the clinical department director. It is harder to stimulate research projects because they require funding.

Have there been any discoveries made from past vitreous research which you consider to be particularly noteworthy or any researchers whom you consider to be leaders in this field?

Past research in the fields of biochemistry and molecular biology research have revealed much about the structure and surrounding tissues of the vitreous, but there are still many mechanisms and interactions which need to be clarified. In my opinion, studies on the cellular matrix are essential to understanding the processes involved in degenerative vitreous diseases because any alteration of that matrix activates a variety of pathways which induce changes in the constituents. In this area, I can cite two experts who have authored numerous, specific studies. They are Dr. Sebag of Los Angeles and Prof. Bishop of Manchester. We are also beginning to read the scientific works of other researchers from around the world and we hope to identify the laboratories involved in this research so that we can create a comprehensive list.

During the past few years the medical community has shown much interest in 'regenerative medicine' and stem cell based cures for variety of illnesses. Have you seen any interest in applying these technologies to the treatment of the vitreous?

Stem cells are undifferentiated cells able to divide up to differentiate into specific cell types. This feature can be exploited to repair damaged tissues. But despite the potential benefits tied to stem-cell based therapies, there are still many problems to be solved; such as, identifying a method to activate the functional differentiation and eliminating the immuno-reactivity processes. Current studies are under way to isolate retinal stem cells, cells of the iris’s trabeculate, and the corneal ephitelium. These studies are focused on the treatment of retinal damage, corneal damage, and glaucoma. Studies on corneal stem cells for a regenerative therapy are in the advanced stages. We are unaware of any studies on vitreous cells at the moment. We hope that in the future, this field will be extended to the vitreous.

What can the average patient suffering from degenerative vitreous syndrome do to encourage the medical community to take floaters more seriously?

The most notable example of patient activism is the famous petition of the student in Singapore. His efforts were significant because they increased awareness of the condition and the resultant suffering as well as JSEI’s research capabilities. We hope that the community of floater sufferers at large can organize themselves and work to advance the treatment of degenerative vitreous diseases in much the same way as other major institutions, associations, and foundations support and finance research for their respective causes.