Physician Update - Putting the Telescope Where?
Putting the Telescope Where?
Date: June 28, 2013
I’s a bit like the “give me your tired” inscription on the Statue of Liberty, only with an ophthalmic twist. Johns Hopkins now offers an implantable miniature telescope (IMT) to appropriate older patients with end-stage age-related macular degeneration, but, says ophthalmologist Oliver Schein, many have not heard about it.
“I know a lot of perfect candidates are out there,” he says—patients whose lives would greatly improve with the IMT but who feel sure that nothing can help their vision.” As more connect with it, he says, that will change.
Schein, who directs the Wilmer Eye Institute’s Comprehensive Eye Service, is Johns Hopkins’ expert on the tiny magnifier, federally approved in 2010. He led Wilmer’s participation in clinical trials that fed into studies at 20 sites nationwide. And now he’s medical monitor for its several-year follow-up surveillance study.
“An implanted telescope obviously can’t reverse macular degeneration,” he says, “but it helps patients resume many favorite activities. It returns a measure of independence.”
At 4.4 millimeters in length, the IMT is a telescope that replaces the lens in one eye. It channels incoming light to a remaining healthy but narrow retinal margin outside the damaged macula. Patients still have blacked-out central vision, but gain clarity—through magnification—for the immediately off-center.
Magnification for patients with the condition isn’t new. Glasses with a fixed external telescope, for example, are a staple of low-vision care. “But the IMT can be a much more effective way to deliver magnification,” Schein says.
“Having the telescope inside the eye increases the width of the visible field three or four times that of the external, fixed version.” he says. Tracking is also significantly better. “Since the IMT is within the eye, patients can track objects, despite their head or eye movements.”
Schein doesn’t discount the anti-stigma benefit of the implant. Patients value their normal appearance and the ability to make eye contact.
While being cleared for the implant, besides an FDA age 75 requirement, there’s an in-depth evaluation to rule out precluding health conditions, as well as testing to assure benefit from the IMT. Patients are also coached on what to expect after surgery. Surgical recovery is fast. However, training the brain to coordinate sight from the implanted eye, which loses peripheral vision, and the nontelescopic eye that sees only peripherally takes months of training from experts in low-vision rehab.
So far, patient response is enthusiastic, Schein says. And there’s a real plus: Medicare covers the IMT.
410-955-0580 for information.