For patients, this implant offers the opportunity to increase their independence and re-engage in everyday activities. It will also help in social settings as it may allow them to recognise faces and see the facial expressions of family and friends.
A telescopic lens implant is not a cure of end-stage AMD and will not restore vision, but it can help to improve vision in suitable patients.
The programme is led by Consultant Ophthalmologist, Mr David Keegan at the Mater Private. Mr Keegan is the first surgeon in the island of Ireland to offer this surgical option to patients as part of the CentraSight Care Programme.
In 2013 the first patient in the Mater Private successfully underwent this procedure and the CentraSight treatment programme. Here Mr Michael O’Brien tells his story.
- What is AMD?AMD (Age-related Macular Degeneration)This is a condition affecting the eyes as you get older. In Ireland AMD is the leading cause of sight loss in the over 50’s and there are over 7,000 new cases in Ireland every year.Age-related Macular Degeneration affects the macula - the part of the eye responsible for central vision. Central vision allows you to see the detail of what is in front of you - it is important in reading, writing, interpreting colours, making out facial features and shapes. With AMD the cells within the macula deteriorate, causing blurring or reduced central vision.End Stage AMDPatients with end-stage AMD have a central blind spot - often described as a black hole in the middle of their sight, making it difficult or impossible to see faces or read. Everyday activities are affected such as watching TV, preparing meals, dressing, shaving, applying makeup.There are no drugs or treatments to cure end-stage AMD, the most advanced form of the disease. It can result in severe loss of central vision sight. Side-vision, peripheral vision, is not affected by AMD and can be used to compensate somewhat for the central vision loss, but not to a great extent as the resolution and quality of vision is very low.
- How the Telescope Works
The telescopic lens implant is tiny, smaller than a pea and is implanted inside one eye, behind the iris (the coloured part of the eye).
As end-stage AMD affects central but not peripheral vision, a combination of the existing peripheral vision and the magnification of the telescopic lens is used to improve vision.
The telescope works by projecting the “central vision” onto healthy areas of the macula, which are normally used for peripheral or "side vision”. At the same time it also enlarges the size of the image and reduces the effect the blind spot making it possible to see the detail of central central vision.
With the telescope in essence the eye with the telescopic implant is used for detailed central vision such as seeing the green man on a pedestrian light. The other eye is used for peripheral vision such as checking to see if cars are coming from the side.
A critical element in the success of this procedure is the training provided to patients and their full participation with the training programme. CentraSight is the treatment program we work with right through the process from initial assessment to the procedure to follow up care. Patients are trained and supported in learning to use both eyes effectively, with the support of the telescope.
- How Do I Use It?
The telescope implant does not limit your natural eye movements and does not require you to move your entire head, as you have to do with external magnifying appliances. You can use natural eye movements to see things that are close and far away from you, such as reading printed materials or watching television.
As a trade-off to improving central vision, the peripheral vision will be restricted in the eye with the telescope implant. However, your peripheral vision will stay the same as before the surgery in your non-implanted.
Every patients works one-on-one with a low vision aid specialist to learn to use the implant. The training takes place over a number of weeks involving set sessions here in the hospital and then exercises to practise at home.
- Is It Difficult to Use?
The brain is highly adaptable even at older ages. You will work with CentraSight low vision specialists to develop the skills you need to use your new vision. One of the skills you need to learn is how to switch your viewing back and forth between the eye with the telescope implant and the eye without the implant. You will also need to wear eye glasses and may need to sometimes use a hand-held magnifier with the telescope-implanted eye to read or see fine details clearly. However, in general, less magnification will be needed after your surgery.
- Suitable Patients
The telescope implant has been shown to improve vision and quality of life in patients with End-Stage AMD. Not everyone who has End-Stage AMD is a candidate for the CentraSight treatment program.
In general suitable patients include those who are over 75 years, with stable/end-stage AMD. To be considered a potential surgical candidate for the telescopic implant there are a number of criteria to be met.
- Have irreversible, End-Stage AMD resulting from either dry or wet AMD.
- Are no longer a candidate for drug treatment of your AMD.
- Have not had cataract surgery in the eye in which the telescope will be implanted.
- Meet age, vision and cornea health requirements.
Visual tests, training and rehabilitation evaluation will also be carried out, including the use of a telescope simulator to see if the magnification will work for you.
The results of these will help your Ophthalmologist decide if you are likely to benefit from the CentraSight treatment program and the telescopic lens implant. The tests will also help determine which eye should be treated and what your vision may be like following treatment.
The success of the implant depends on you and your involvement in making the most of the implant, as much as the technology itself. This forms a substantial part of deciding if you are a suitable candidate. You will work directly with a CentraSight Information Specialist who will help review your suitability.
- The Procedure
Patients suitable for the Telescopic Implant undergo a 4-step program delivered by the Mater Private Retinal Eye Centre and CentraSight. Importantly this program continues after surgery to ensure you get the best from this device and that you adapt comfortably to it. There is a lot of training involved so that you can learn to use and make the most of the device.
1 - Diagnosis
The first step involves a complete eye examination and a review of your medical history, including any conditions that may make the procedure difficult for you or increase the likelihood of complications. Your Consultant Ophthalmologist will explain the potential benefits and safety risks, and will answer any questions you may have.
2 - Candidate Evaluation
During this step, our Low Vision Specialist will assess what your vision would be like with the telescopic implant. This will be done using external telescope simulators - hand held 'telescopes'. The assessment will show what your vision may be like after the telescope implantation surgery and if the magnification will be useful to you.
The training and rehabilitation program requirements after surgery will be discussed,along with how you will be expected to participate in this program. We will also look at how any changes in vision will effect your daily life and how to plan for this so that you can get the best from the implant.
3 – Surgery
The surgery is a day case procedure so you will not be in the hospital overnight.
The surgical procedure to implant the telescopic device is performed only on one eye. It involves removing the eye’s natural lens and replacing it with the tiny telescope implant.
4 - Learning to Use Your New Vision
After you have recovered from surgery, a specially trained Low Vision Specialist will work with you to help you learn how to use your new vision - both when you are sitting still (for example, reading or watching TV), and when you are moving around (for example, walking or cooking). You are the most important person in this step. You will be given exercises and tasks to help you to learn to use your new vision.
- Following the Procedure
You will begin a course of sessions with a Low Vision Specialist who will help you learn and adapt to using the telescopic implant. There will also be regular check-ups to monitor your progress.
You should expect to wear glasses as this is a vision aid not sight restoration.
- Recognising faces, Watching TV, Reading
- Painting, gardening, knitting, watching GAA/rugby
- Seeing golf ball in flight, playing tennis
- Never having to use a magnifying glass or glasses again
Michael O'Brien from Sligo was one of the first patients, under the care of Mr David Keegan Consultant Ophthalmologist, to successfully undergo telescopic lens implantation. Following surgery, Michael spent several sessions with Low Vision Aid Specialist, Geoffrey Meynet, learning to use the implant.
Michael is now reading the paper, sending text messages and watching the GAA again