TELESCOPE in the Eye!
US FDA recently approved a miniature Telescope lens implant for patients with end stage Macular degeneration
Lets revisit the anatomy of the ye in relation to this breakthrough innovation.
Think of the macula as the most sensitive part of the retina. I like to explain the retina as the “Film” of the camera. Over time, with age and with other associated factors like genetic preponderance, smoking , systemic diseases including high blood pressure etc, this macular area which is the center of our visual field degenerates and hence affected patients miss the central part of any picture they are seeing. This condition called “Age related Macular Degeneration” or AMD is the leading cause of blindness in the United States of America.
Cumbersome low vision aids including high magnifying hand held devices including CCTV technologies have been used in such conditions to relatively magnify the image and help these patients see around the defective area.
One of my close friends and colleagues, Dr. Isaac Lipshitz from Israel, has invented a Galilean-design based implantable telescope which incorporates wide-angle micro-optical lenses which helps magnify images within the eye to 2.2 or 2.7 times their normal. The magnification allows central images to be projected onto healthy perimacular (around the defective macular zone) areas of the retina instead of the macula alone, where breakdown of photoreceptors and loss of vision has occurred. This helps reduce the ‘blind spot’ and allows the patient to distinguish and discern images that may have been unrecognizable or difficult to see.
Findings from the clinical trials show that the telescope does improve vision for the majority of patients. One problem though with all telescopes is that, when vision is narrowly focused, the peripheral view gets lost. Hence the concept with this surgery is to implant the telescope lens in only one eye. The other eye is used for peripheral vision.
Rehabilitation after surgery (which can take 6 months to a year) therefore is a very important part of this surgery where patients have to be selected and willing to undergo that training. Then after surgery, they learn to look at a picture for example up close with the implanted telescope but if they’re scanning the room to see exactly where the picture is, they use the other eye, which also has end-stage macular degeneration.
In order to implant this device, we need to remove the natural lens, or the cataract, and then use a portion of the natural lens to position and support the telescope. In summary, this telescope lens implant is a comparatively “Bulky” lens implant in relation to what we traditionally use in cataract surgery.
This promising technology though is not for everyone. Selection of candidates requires that they be 75 years of age or older, have not had cataract surgery and have end stage Dry AMD (no longer a candidate for drug therapy)
This implant costs approximately US $15,000, which does not include the cost of surgery and rehabilitation. However, it is covered by Medicare for eligible patients.
I would encourage any patient who is noticing deterioration in vision to get it checked by their eye doctors to determine status of cataracts and also any coexistent Macular degeneration. These are exciting times as we apply technological innovations to help functional recovery, sometimes beyond natural capacity.