State funding of the institutes of the National Academy of Medical Sciences of Ukraine allows providing medical services free of charge - Filatov Institute director.

In an exclusive interview with the Interfax-Ukraine agency, Natalia Pasechnikova, the director of the Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine, which celebrated its 85th anniversary on April 4, spoke about the scientific discoveries and unique methods of treatment developed by the specialists of the institute, about the possibilities of technology transfer in ophthalmology and the prospects for attracting foreign patients.

Text: Hanna Levchenko

The Filatov Institute Clinic is the only highly specialized ophthalmological center in Ukraine, which provides consultations, diagnostics and treatment (conservative and surgical) of all types of eye diseases using innovative technologies.

The clinical base of the Filatov Institute consists of nine highly specialized departments, in which 475 patients can be simultaneously hospitalized.

The Institute employs 200 researchers and doctors, including one corresponding member of the National Academy of Medical Sciences of Ukraine, 12 professors, 29 doctors and 55 candidates of sciences. The doctors of the clinic use 240 own methods of diagnostics, therapeutic and surgical treatment, of which 225 are protected by patents.

Five national centers operate on the basis of the institute - the only Ophthalmotraumatology Center in Ukraine, the Ukrainian Center of Inflammatory Eye Diseases, the Center for Pediatric Ophthalmology of Ukraine, the only Center of Eye Cancer in Ukraine and the only specialized Center of Eye Burns in the world. The institute has the only department of eye oncological pathology in Ukraine with 70 beds.

More than 16,000 patients are operated on in the clinic of the institute annually, the polyclinic of the institute annually conducts more than 170,000 consultations. About 2% of patients (about 3,500 people a year) are foreign patients from the CIS countries, the countries of near and far abroad.

In 2020, positive treatment results were recorded in 96.1% of cases.

- What are the main results of the Institute's work in 2020?

- As the director of the institute, I am happy that despite all the difficulties we managed to preserve the most valuable thing - our unique team of specialists who multiply the invaluable experience of previous generations of doctors and introduce the results of our scientific developments into ophthalmological practice.

What does this benefit the patients? Improvement comes faster, recovery time is shorter, and in some cases we get a result that we would not have been able to get if we had not had scientific developments and solutions. Suffice it to recall the operation carried out at the institute to remove a large intraocular hemangioma. Previously, intraocular tumors of this size could only be removed with the eye. For the first time in the world, our surgeons managed not only to preserve the eye, but even to obtain object vision (the patient did not see with this eye before the operation). And this happened only because we use our own development - the use of high-frequency welding of biological tissues in ophthalmic operations.

The Institute has always been the flagship of the national ophthalmological science and, I hope, it will always be so. This hope is supported by our young ophthalmologists. Today, the average age of those defending a candidate's dissertation is 32, but there are also those who have become a candidate of sciences before 30 years of age. The average age of a doctoral candidate is 42, although the youngest person with a PhD degree was 36. Imagine how much they can do, they have their whole life ahead of them.

And the scientific work that they are doing is a very high level and this is not only my opinion. Only in 2020, our surgeon Yakiv Hrytsenko was awarded the Prize of the President of Ukraine for young scientists, and a group of scientists from our institute became laureates of the state prize in the field of science and technology.

Last year was a test of strength for us, as for everyone, but despite the quarantine measures, we continue to work and provide routine medical care as a national health care facility to those who need it, naturally, doing everything possible to protect our patients and our staff.

- To what extent is the institute financed?

- Probably the shortest answer: less than necessary, based on the need to meet the requirements of the time.

- Are other sources of financing for the institute used, besides the budgetary ones?

- Certainly. We have partners who understand the importance of the institute for Ukrainian ophthalmological science and, ultimately, for patients. And they support our projects and endeavors.

Let me give you an example. The clinic of the institute is one of the first ophthalmological clinics in Ukraine, where clinical experience has been gained in the detection and treatment of retinopathy of prematurity. This disease occurs due to the fact that by the time the premature baby is born, the blood vessels that feed the retina of the eye do not have time to develop fully. And if assistance is not provided on time, 200-300 blind children will be added annually in Ukraine. Such children can be helped, but subject to timely detection of the disease and timely laser surgery. At present, the level of laser equipment is quite high, and if a doctor has professional skills in performing an intervention, the effectiveness of treatment exceeds 90%. But today there is an acute shortage of ophthalmologists in Ukraine, and there are only a few narrow-profile specialists in retinopathy of prematurity with such skills. And to take a premature baby to such a specialist, even in a reanimobile equipped with an incubator, even accompanied by a resuscitation doctor, is a high risk for the baby.

We have developed a mobile model of care for these patients. Since 2008, the specialists of the Filatov Institute have been saving babies' eyesight directly in the departments for nursing premature children in the clinical hospitals in Odesa, Mykolaiv and Kherson regions. Over the years, we have managed, avoiding risks, to preserve vision for about 500 babies.

And our work did not go unnoticed, since 2016, thanks to partnership with a charitable organization, the program for helping premature babies has continued its development as the joint charitable project "I want to see. Southern Region." Over the years of the project, mobile equipment, unique for Ukraine, was purchased for us, transport, consumables were paid for in the amount of approximately UAH 10 million. And this is not the only example.

In addition to working with partners who support us on a long-term basis, we conduct our own charity events and take part in existing ones. With the money raised, we opened the first office of the Center for Prevention of Childhood Blindness and Low Vision, and we hope to move on.

- How do you assess the prospects of the institute's joining a single medical space and financing the institute through the National Health Service of Ukraine?

- Today it is difficult to talk about it, there are a lot of problems. Although the reasons for many problems are clear to me. A lot of criticism is caused by tariffs, the fact that they do not take into account the cost of medical services. After all, as they believed: they counted the number of nosological forms, the number of cases in each nosology and the available money was divided among all. And it turned out that the tariffs cover the costs of medical institutions, to put it mildly, not completely. On the other hand, how was it to be done? Should the costs of some diseases be fully covered, while others should be passed on to the patients? Or should we calculate everything correctly, realizing that there is no this money in the country?

The current state funding of the institutes of the National Academy of Medical Sciences of Ukraine allows us to provide medical services free of charge, and part of the drugs is also paid by the state. And some of them are very expensive, such as the anticancer drug we use to treat retinoblastoma, an intraocular tumor in children. This makes our highly specialized, high-tech care available to more patients. And this is the main thing for us.

- What investment projects (development projects) are being implemented at the institute at present? Do these projects have partners?

- The state has always been and remains the main partner for us. For more than 20 years, the unfinished building of a new medical facility, the construction of which was frozen back in 1996, stood on the territory of the institute. And all this time we made efforts to finish building it.

The need for a new building has arisen a long time ago. The main building, which to this day houses five departments of the institute, was built under Volodymyr Petrovych Filatov, like many other objects in Odesa, from materials of shell deposits with wooden floors. For 82 (!) years, the building has never been overhauled. The main reason is that it is impossible to stop the flow of patients: while we were doing repairs, some of the patients would lose their sight.

We won a tender for a state investment project and started construction work. The new building has six floors. The first will house the admission department and a complex of clinical laboratories, which today are located in different buildings. From the second to the fourth floor there will be departments of the clinic, and the sixth floor will be completely given over to operating rooms, an anesthesiology department and recovery wards. Modern materials and technologies are used in construction, while the facility will be equipped accordingly.

We really hope that we will be able to create a completely new perception of the state medical institution by both patients and doctors. We are working hard to complete construction this year.

- How do you assess the prospects for the implementation of the mechanism of public-private partnership (PPP) at the institute? Are there any examples of such projects? What is missing to attract large-scale private investment?

- Today, the PPP mechanism does not provide for participation of state and municipal enterprises and organizations in such projects. This is what the law says - "except for state and municipal enterprises." What is missing? The legislative base, the prescribed mechanisms for returning the invested funds to the investor and making a profit, and, naturally in such a situation, investors.

Today there is another promising mechanism - technology transfer. We are often asked if we use it, implying that we have the technology, that there is interest in it, that we sold or allowed to use it and got money for it. But our technologies are technologies of treatment, operations. This can only be taught, and we do it. People come to us for courses, internships, they pay for them. But for some reason this is not considered a transfer.

Even if we have invented a device or drug to sell it, we first need to protect it, that is, to obtain a patent, and not Ukrainian, but international. Because they will change, say, the screw (or not) and register it at the international level as their development and will make money on it. And all our patents are local. To pass the examination and get it, we need several thousand hryvnias, while an international patent costs tens of thousands of dollars or euros.

In addition, we need an enterprise that is ready to implement a project at least at the level of an industrial design, and this requires drawings, engineering calculations. Who will undertake this without money and who will pay for it?

The idea to sell or transfer technology is great and correct, but there are no mechanisms, no conditions have been created. Probably, at some point all this will appear and work, but it takes time.

- How do you assess the system of training medical personnel, the system of continuous professional education and advanced training? What can be improved?

- For me, the fact that a doctor should study all his life is natural. Moreover, in our time, when science, technology, pharmacology is developing at an incredible speed, something new appears almost every day. A modern doctor should be aware of at least his specialization. More is very difficult, huge amounts of information.

But when you recommend a doctor to your friends, what are you talking about? About his practical experience, and above all about his positive experience: how he helped you, how many he cured, and not about how many courses he took, how many webinars he watched and listened to. This practical point was left aside.

At the present time, I think, there is a need to look at existing medical institutions from the point of view of availability of doctors with positive practical experience in the treatment of specific diseases. This is especially important today, when there are few good specialists left, thousands of excellent doctors have left to work abroad. In addition, it is necessary to create such a register so that every family doctor or polyclinic doctor can see where the necessary specialist is closest to whom he could refer the patient.

And what do we have today? The family doctor sends the patient to a specialist in the district clinic. He failed and sent the patient to a higher level (I mean a hospital, not a doctor), regardless of whether there is a specialist there with the ability to treat this disease or not. There they treated, treated - not cured ... Well, and so on. As a result, time was lost, the patient, God forbid, got complications, and he gets to the right specialist as "difficult." And the state paid for all these stages (the money "goes after the patient") and wasted the money.

Moreover, training should also be not only theoretical, but also practical. How can, for example, an ophthalmologist surgeon learn to do a new operation, just by listening to a webinar? No, he must first stand next to a specialist during the operation, then assist, then operate, but under his supervision. And only then he can be entrusted with an independent operation. This is how I taught my students, and believe me, this is the only way to teach.

- Does the institute have international projects? What are the main areas of international cooperation?

- Our institute is well known in the world ophthalmological community: we are a member of the International Council of Ophthalmology (the European headquarters), we are the founder and member of the Black Sea Ophthalmological Society.

Scientists from the Institute represent our country with dignity at world international congresses, conferences and symposia, reports on our research and achievements have been repeatedly applauded by colleagues. Many of our leading experts are active members of such reputable European and world ophthalmological organizations as the European Society of Ophthalmology, the American Academy of Ophthalmology, the Royal College of Ophthalmologists of Great Britain, the European Society of Retinal Specialists EURETINA, the European and American Society of Cataract and Refractive Surgery, the World Glaucoma Association (WGA), the European Ophthalmic Oncology Group (EOOG), the European Pediatric Ophthalmology Society (EPOS), etc.

We receive offers of cooperation, participation in global international research. We have signed agreements on cooperation with organizations and companies in Israel, Switzerland, Germany, Mexico, India, Hawaii. We are collaborating with Linköping University (Sweden) in the development of an artificial cornea and are participating in a global study conducted by the National Institutes of Health (the United States) in the field of research into hereditary ophthalmic diseases and the development of technologies for their diagnosis.

The demand for ophthalmological medical services is growing all over the world, and the lack of highly qualified specialists has created the preconditions for signing memoranda on the establishment of branches of the institute in other countries (currently in China and Bulgaria). Unfortunately, there are still difficulties in this issue due to the coronavirus pandemic, but I hope that after humanity copes with the pandemic, we will be able to resume these projects.

- What are the main directions of scientific work of the Institute, the most significant scientific achievements of recent times?

- Let's just look at the last decade. The technology of application of high-frequency electric welding of biological tissues in ophthalmology, created by us together with specialists of the Institute of Electric Welding of the Academy of Sciences of Ukraine, is one of the most effective and is widely used in the treatment of patients with retinal detachment, diabetic retinopathy - one of the most severe complications of diabetes mellitus, with intraocular neoplasms. In 2012, a group of our scientists for their research on the use of high-frequency electric welding of biological tissues in vitreoretinal surgery was awarded the II Euretina. Innovation Awards. prize at the XII Congress of the European Society of Retinal Specialists EURETINA.

I have already mentioned our work on the creation and testing of an artificial cornea from synthetic recombinant human collagen. This approach can help restore vision to millions of people who need corneal transplants. The report of our scientists on the use of original collagen implants for the treatment of corneal ulcers was recognized as the best at the 2014 EU Cornea Congress in London.

There is one more important area of scientific work. We have entered an era when antibiotics are losing their effectiveness, and there is an urgent question of finding alternative therapies. The method developed at the Institute for the treatment of inflammatory eye diseases is based on a completely new approach that combines the use of methylene blue, which has anti-inflammatory and antimicrobial properties, with laser radiation with a carefully selected wavelength. After four years of research, we have been treating patients with a new method for more than five years, and the results have exceeded all expectations.

In parallel, our immunological laboratory (by the way, the oldest in Ukraine), together with the Institute of Molecular Biology and Genetics of the National Academy of Sciences of Ukraine, is working on the use of components of the immune system for the treatment of inflammatory eye diseases. A method of using stem cells to increase the synthesis of anti-inflammatory proteins is at the stage of clinical trials, its successful completion will allow creating a new direction for the treatment of recurrent inflammatory eye diseases, which often lead to blindness. Research continues on nanoparticles of gold and silver, which have the ability to increase the regenerative capacity of the body. Unlike antibiotics, patients do not get used to drugs based on them, while they do not develop allergic reactions.

At present, our institute and the Institute of Thermoelectricity of the National Academy of Sciences of Ukraine continue to work together on the development of thermoelectric ophthalmic equipment. A device has already been developed for measuring temperature in various parts of the eye with the ability to register temperatures in real time. This is necessary to control the heating of the eye tissue during laser surgery.

And this is not a complete list. In our daily practice, we use more than 240 of our own methods of diagnostics, therapeutic and surgical treatment to preserve eyesight for patients and prevent disabilities. Thus, we annually save the state millions of hryvnias of public funds.

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