Therapy for End Stage Age-Related Macular Degeneration

End stage age-related macular degeneration may result in several presentations. Those with the extreme form may have had extensive hemorrhaging both under the retina and into the central cavity of the eye, or may have chronic leakage from abnormal blood vessel, which can not be closed off by any of the current treatments.  In those cases, there is very little that can be offered in the way of improving vision or aiding the patient in maximizing the use of their remaining vision.

There are, however, patients with age-related macular degeneration who have significant loss of central vision, but have been stabilized through treatment or, are dry and progressing very slowly.  These patients, in the past, have benefited from low vision devices. Such devices included very strong reading glasses, magnifying glasses, loupes, telescopes, and closed circuit television.  Many of these devices were cumbersome and/or impossible to carry around and were not effective under certain lighting conditions.

To this end, a device has recently been FDA approved which will overcome many of the shortcomings of previous low vision devices.  This new addition, to the assist those with stabilized poor central vision, is the Implantable Miniature Telescope (IMT). However, not all patients with stable low vision will qualify for the use of this device.

What is the IMT?

The IMT is a very small telescope which is implanted inside the eye, similar to having an intraocular lens implant for those who have had cataract surgery.  The difference is that the IMT is a much larger implant than the intraocular lens used in routine cataract surgery, nor is it as flexible, so it can not be implanted, folded, through a small incision.  This consequently would require the use of sutures to close the eye and a somewhat longer post-operative recovery period.

Does the Use of the IMT Require Any Special Adjustment?

Unlike normal cataract surgery where vision is restored to “normal”, there is a difference in image size and visual field.  Before the surgery, every patient is placed through a “simulation trial” to determine if they can adjust to the “new vision”.  If they pass this trial and they still desire to have the IMT, the surgery is performed similar to cataract surgery, and usually, under local anesthesia.  But even after the surgery there is a period of visual rehabilitation training in order to achieve the full benefits of the IMT.

Are There Special Criteria to be Fulfilled?

Before a patient can be considered for the IMT, there are currently certain conditions which must be met.  These include:

  1.   ARMD which is irreversible, end stage, and stable
  2.   No longer on any drug therapy for ARMD
  3.   Have not had prior cataract surgery
  4.   Have a clear cornea with normal endothelial count
  5.   75 years of age or older
  6.   Best corrected vision between 20/80 and 20/800
  7.   Prior vision correction: less than -6.0 and less than +4.0

Where is the Surgery Being Performed?

Currently there will only be a select few practices within the United States which have been approved to do IMT surgery.

These facilities are multi-disciplinary and have been setup in such a manner that they have ophthalmologists who have experience in determining the eligibility criteria and performing the surgery, optometrists who are trained in low vision evaluation, and visual occupational rehabilitation therapists who are experienced in assisting patients in adapting to the use of the IMT.

For further information, inquire at: