Eyedolatry: Age Related Macular Degeneration

New Implantable Telescope Brings Better Vision to those with Advanced Macular Degeneration

Age Related Macular Degeneration with advanced
central vision disruption
image credit to eyedolatry.blogspot.com

Imagine a world where your central vision was nothing but a blur or distortion. Any time you try look at something straight on, you can only see the periphery of the object you are trying to see. Try recognizing faces or reading your cell phone or a book with nothing but peripheral vision. This is what the world looks like for the millions of people worldwide that have advanced macular degeneration. There is no cure for this devastating visual condition, but a new implantable telescopic device can help restore some of that central vision zone for the first time ever.

The CentraSight implantable telescope is made by VisionCare Ophthalmics, and is a vision enhancing device that can improve central vision range when placed inside the eye. Traditionally, patients with central vision loss had to rely on handheld or spectacle mounted telescopes to try to enhance their central vision. These devices were bulky and distracting, not to mention their limited visual potential (about 10 degrees of field is all they can provide!). The CentraSight implantable telescope is just over 4 mm in size and sits discretely in the eye, making it less obvious to those around you that you are using a low vision device, and also freeing up your hands that would have otherwise had to hold the magnifying lens up to the eye whenever you wanted to use it. Because the telescopic optics are inside your eye, there is the added benefit of a much larger observable field of view, between 20 and 24 degrees of gained central vision area is attainable with the implant/

Enlarged view of the CentraSight implantable telescope. This is actually under 5 mm in size via

Implant inside the eye. It is placed in the same place that a post-cataract surgery implant
would traditionally be inserted via

Who Qualifies?
In October the FDA updated the candidacy needs for patients interested in the CentraSight implant to offer younger patients the opportunity to pursue the implant. The new requirements are:

1) Bilateral Central Vision Loss due to Age Related Macular Degeneration

If one eye is damaged with macular degeneration but the other still has great preserved central vision, then the patient is not a candidate. The implant needs to be placed on the better seeing eye in order to provide of any improvement in perceived vision. If the implant is put in the bad eye, then the brain will just suppress the bad eye's image and use the good eye only like it was doing before surgery. You would have just had a very expensive surgery without any visual benefit. In order for the telescope to work, your brain has to want to process its image, and that is why it must be placed on the eye with better vision to achieve the best effect.

2) Best Corrected Vision between 20/160 and 20/800

This telescopic implant will only be beneficial if the patient has advanced vision loss, so vision must be poor in order for the telescopic implant to make sense. The reason that poor vision is so important to achieve success with this surgery is that by putting in the telescope, you are sacrificing all peripheral vision out of the eye with the implant. To give up all of that visual field, you have to have a true need for central vision to make the sacrifice worth it.

3) No prior history of cataract surgery

When you have cataracts removed, the surgeon places a clear, plastic implant inside your eye to help correct post-operative vision. The telescopic implant is placed inside the eye in very much the same way. The telescope sits inside of the posterior capsule, just like a standard IOL. Once you have a post-cataract implant in place, there are many risks in removing it, so at this time the telescope implant must only be placed in people that have not had cataract surgery and can be fit with the telescopic implant from the very first.

4) At Least 65 years old

This age limit was just decreased by the FDA (previously the limit was age 75). Since the study results published show that the implant is both safe and effective, the age has been lowered to allow more people suffering from devastating vision loss to benefit.

Some Basics on What to Expect

Before the surgery takes place, your surgeon is going to refer you to a low vision specialist to help you prepare for the type of vision this telescopic implant can provide. The world is going to look quite different after surgery because with the telescope in place, one eye will be responsible for central vision and the other will do all of the peripheral vision tasks. The telescope creates a type of monovision if you think of it in that light. Once the telescope is in your eye, you can't see anything but that central 20 to 24 degrees of field because the telescope is converting all of your available retinal photoreceptors into central vision processing centers. The patient will need practice and coaching to get used to having their eyes see so differently, and before and after implantation there is going to be a learning curve to get comfortable with the new vision provided.

Very little can be done with modern medicine to return lost vision to someone with macular degeneration, but the reason that the CentraSight telescope has been so popular in the news lately is because studies show such promising vision improvement. In the course of one year after telescopic implantation in the better seeing eye, 90.1% of 206 participants had gained 2 lines of letters on a visual acuity test, and 66.6% achieved 3 lines of visual improvement. This improvement in vision can mean the difference in recognizing faces, or living more independently. You aren't going to be driving or reading small font books, but it can make navigating every day tasks much easier and safer.

Dr. Isaac Porter explains the telescopic implant in the video above.

Are you interested in learning if you or a loved one could benefit from the CentraSight implantable telescope? Please head to this website to find a provider in your area, or ask your local eye doctor for a referral to specialist that offers this treatment!

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Retinal Photography: Macula

Age Related Macular Degeneration 18:47

We all know that 20/20 is perfect vision, but there is a very small, central area of the eye that makes those fine details of 20/20 possible. This central vision area is called the macula. In this ocular structure, you have the highest density of photoreceptor cells in the entire eye. As a result, in retinal photographs this high density area looks like a dark spot in an otherwise light pink or purple retina. Most of my patients ask me if that dark area is a problem, but as long as the color is uniform, your macula should be nice and dark. Color variations in that area are indicative of possibly permanent, devastating visual conditions. Here are some that I have seen in my practice to date:

Normal, healthy retina with a dark central macula. This is your comparison photo for mine below!
photo via

Diabetic Retinopathy with exudates and macular edema

In the above picture, diabetic changes have caused leakage of blood vessels near the retina, and a condition called macular edema. The macular tissue is swollen around the yellow appearing exudative material. This will cause blurry vision and distortion. The hope is that as blood sugar levels normalize, the swelling will resolve and the macular tissue will return to normal.

Geographic Atrophy from Macular Degeneration

Age related macular degeneration is a disease of the eye where central vision can be permanently destroyed, as is the case in the above picture. This patient has permanent vision loss, and the macular tissue is nothing but a devitalized scar.

Macular Scarring withWet Macular Degeneration

Unfortunately, this is the other eye of the patient with macular degeneration above. This eye had wet macular degeneration; the more aggressive type of the disease where bleeding causes extensive swelling and scarring. This eye had several injection treatments, but this is the best ophthalmologists could do to stabilize damage. Smoking and sun exposure are huge risk factors for macular degeneration (as well as genetics), and this is a condition that your doctor is evaluating for at every single eye examination.

Toxoplasmosis

Toxoplasmosis is a more rare parasitic infection of the eye. The infection is typically spread through cat feces, but similar infections can be contracted from exposure to dog and bird excrement. This patient had permanent scarring from a childhood infection, but the parasitic infection is no longer active. There is no treatment after scarring has developed to restore vision.

Plaquenil Retinopathy

Plaquenil is used for treatment of malaria, but more commonly in the United States for inflammatory conditions like Rheumatoid Arthritis. In higher doses or with long-term use, plaquenil can cause macular scarring and vision changes. When changes to the macula are seen, plaquenil should be discontinued. In the majority of patients taking this medication, plaquenil use can be safe and without visual effects. If you are taking this medication, a yearly eye examination is required to monitor for this potentially permanent visual change! The patient in this photograph had been using Plaquenil for years, but gone a without an eye examination for 2-3 years and in that time this macular change occurred!

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