Innovative Surgery Aids Late-Stage AMD Patients

Helen Locklear, 75, is grateful to be able to see the flowers in her yard again.

“I have a beautifully landscaped yard. I can really look at the colors of my roses and lilies. That makes me very excited,” she said.

Arlington cornea surgeon Aaleya Koreishi, M.D., implanted a tiny telescope into Locklear’s right eye at Arlington Memorial Hospital in March to combat her end-stage age-related macular degeneration.

Locklear said she still is getting used to the telescope’s distortion of depth perception.

“My coffee cup seems to be about the same size as my hand,” she said.

Koreishi, who is the only Dallas-Fort Worth surgeon performing the procedure, has implanted the telescopes in four patients. Locklear had the most successful outcome.

Koreishi said all four patients have regained some sight.

“Success is all relative based on what sight they hope to regain. We have to manage expectations. They won’t be able to drive again. But watching movies, seeing faces—we take that for granted. Giving that back to patients has such value,” she said.

Smaller than a pea, the telescope implant uses micro-optical technology to magnify images which would normally be seen in non-peripheral vision. The images are projected onto the healthy portion of the retina not affected by the disease, making it possible for a patient to see straight-ahead objects. The outpatient procedure, which takes about an hour, is covered by Medicare.

A pre-surgery evaluation simulates what a person may expect to see once the telescope is implanted to determine if the potential improvement will meet the patient’s expectations. After surgery, the patient works with vision specialists to learn how to adapt to their new vision. Patients will perform eye exercises with their new implant for 6 to 12 weeks after the surgery.

End-stage AMD is the leading cause of blindness in older Americans, affecting more than 15 million Americans.  AMD primarily affects the macula, the back central portion of the eye. The macula contains millions of light-sensitive cells that allow individuals to see fine detail. The retina instantly converts light, or an image, into electrical impulses, which are sent to the brain.

About 2 million Americans have advanced forms of AMD with associated vision loss. About 500,000  have end-stage AMD and may be candidates for the telescope implant. Despite the availability of new drug treatments that slow the progression of AMD, the number of people with end-stage AMD is expected to double by the year 2050.

To be considered a potential candidate for the telescope implant, patients must meet age, vision and cornea health requirements. Candidates must have irreversible end-stage AMD that cannot be treated by medication and not had cataract surgery in the potentially implanted eye.

Patients with end-stage AMD have a central blind spot or missing area in their vision while maintaining peripheral vision. Locklear said cars in oncoming traffic would disappear and then come back in sight.

This vision loss is uncorrectable by glasses, drugs or cataract surgery. Patients with end-stage AMD find it difficult or impossible to see faces, read, and perform everyday activities such as watching TV, preparing meals, and self-care.

The telescope implant has been demonstrated in clinical trials to improve quality of life by improving patients’ vision and increase independence.  Patients in the Food and Drug Administration clinical trials were are able to see 3-4 lines better on the eye test chart.

Results from the two U.S. clinical trials, conducted at 28 ophthalmic centers, have been published in peer-reviewed scientific journals including Ophthalmology, American Journal of Ophthalmology, and Archives of Ophthalmology.

Steve Jacob is editor of D Healthcare Daily and author of the book Health Care in 2020: Where Uncertain Reform, Bad Habits, Too Few Doctors and Skyrocketing Costs Are Taking Us. He can be reached at steve.jacob@dmagazine.com.

Posted in Medical Devices.