- Lisa Jevens
Telescope implant brings hope to age-related macular degeneration
Up until very recently, a diagnosis of age-related macular degeneration was a point of no return in vision loss. (AMD is when retinal cells of the macula—the back of the eye—break down, leaving patients with a "blind spot" in the center of their field of vision.)
AMD has robbed nearly 1.8 million Americans age 60 and older of their sight. More than 500,000 new cases are diagnosed each year, according to the National Eye Institute.
There is no cure for AMD, but there is a revolutionary new treatment program called CentraSight, in which a miniature telescope the size of a pea is implanted in the eye, behind the iris. The telescope can restore reading ability and facial recognition in some end-stage AMD patients. More than 400 Americans have gotten the implant since the program was approved by the FDA in 2010. It's also covered by Medicare.
If the technology sounds futuristic, that’s because it is. Dr. Samuel Masket of Advanced Vision Care in Los Angeles, explains how it works: "In the center of our retina we have cones, which discern fine detail. When they are lost, the cells outside that area are generally functional. The telescope creates magnification inside the eye. When you make the image large enough, it hits those good cells, and the patient gets the image."
The telescope is implanted in only one eye because with magnification you lose visual field, Masket explains. "It is like looking through the world through a straw," he says. "The other eye is used for walking around."
Doctors say results are high and risks are low due to a stringent patient qualification process. Only a select group of eye surgeons have received training to implant the telescope. Currently 80 are approved to do so nationwide.
To qualify for the implant, patients must be 75 years old or older, have end stage AMD in both eyes, and must not have had cataract surgery in both eyes in order to be considered, says Masket, who has done 12 procedures. All were successful with no complications, he says.
Dr. Jonathan Rubenstein, Vice-Chairman of Ophthalmology at Rush University Medical Center in Chicago, describes the CentraSight process as threefold: diagnosis and evaluation, surgery and rehab.
Part of the evaluation process is a trip to a local low vision center, such as The Chicago Lighthouse. There, they do a test trial with an external telescope to see if the implant would help them. "After surgery, we have to teach patients how to use this new vision," he says. "It's analogous to getting an artificial limb. We’re training the brain how to use the image that is coming from this telescope, and how to process and integrate it with the other eye’s image."
Masket says the adjustment process takes time. "Unlike routine cataract surgery, which has an instant response, this is a learned response," he says. "We rarely see a big improvement within the first few weeks. The patient’s brain must adapt, and it varies from person to person. Their brain learns to sort between those two images."
Anthony Adducci of Schererville, Ind., is one of Rubenstein’s patients, and success stories. In 2008, the retired pipefitter was told there was nothing he could do about his AMD. He had stopped driving and had to rely on his wife to read things for him. After the procedure in May 2013, which Adducci says was completely painless, he says his vision is getting better every day.
"I was two feet away reading the eye charts, now I’m 10 feet away," he says. "I can read large print. And best of all, I could see my grandson performing in a marching band competition at Lucas Oil Stadium in Indianapolis. I could see all the way down to the field."
Adducci is still doing plenty of rehab, learning to make the most of his new vision. "The more you put into it, the easier it gets. It’s like going back to school again," he says.
If you have been diagnosed with AMD, do not be afraid to ask your eye doctor if you might be a candidate for the telescope implant, because many eye professionals may be unfamiliar with it, Rubenstein says. He adds that it is particularly important to inquire before you have cataract surgery, which could disqualify you later on.
"With time, as more patients have the implant, the awareness will go up," he says.
Originally published in the Los Angeles Times Prime Time senior living section on June 5, 2014.