Tiny telescope implant in eye offers huge impact for macular degeneration patients

09/12/2012 12:00 AM

09/12/2012 6:51 AM

UC Davis Eye Center surgeons on Tuesday unveiled a new, bionic tool for treating macular degeneration: a miniature telescope, smaller than a pea, that is implanted directly into the eye.

The mini-telescopic device is barely detectable, but a close look at a patient with the implant reveals a slightly luminescent spot where the pupil would be.

That shiny, albeit foggy-looking, lens holds a world of promise for patients with end-stage macular degeneration, a retinal disorder that limits vision to a cloudy warp of reality.

Advanced macular degeneration affects 2 million people in the United States, with 500,000 new cases diagnosed each year. The genetic disease is the leading cause of legal blindness nationwide in adults 60 and older.

For the aging wave of baby boomers, the miniature telescope represents a breakthrough treatment for a casualty of old age, akin to the hip and knee replacements that have now become commonplace.

As age-related macular degeneration progresses, patients frequently develop scarring in the macula, said Dr. Jennifer Li, one of the UC Davis surgeons on the forefront of using the new device. Along with that comes a decline in the ability to see fine detail and a loss of central vision, leaving clear only the peripheral vision.

Until now, Li said, end-stage patients with the so-called dry form of macular degeneration have had no lasting medical or surgical treatment available. Often they've had to rely on hand-held magnifiers and bulky telescopes attached to glasses, increasing the chance of an accident or fall.

The miniature telescope is the first medical device to be implanted inside the eye, said a spokeswoman for VisionCare, the California firm that manufactures the device.

It was approved by the U.S. Food and Drug Administration in 2010, and VisionCare is working with UC Davis in a partnership that allows UCD's eye center to be among the first in the nation to begin implanting the devices. The product is priced at $15,250, VisionCare's spokeswoman said, and Medicare has said it will cover the cost.

Virginia Bane, 89, of Pollock Pines is the first patient in Northern California to undergo the surgery. Dr. Mark Mannis, a UC Davis eye surgeon who partnered with Li to perform the surgery, said Bane was carefully selected to pioneer the treatment.

"Virginia approaches this with enthusiasm and analytical thinking," Mannis said. "It's courageous to be the first person to do this."

Bane, who received her implant in May, is also one of the first 50 people in the United States to undergo the surgery. In an interview, she said the procedure was painless but weeks of occupational therapy were needed to train the brain to use the device to full benefit.

"After surgery, you begin to see wonderful things happen because of the scope," Bane said. "You can see the faces of your friends. And it's wonderful to be able to read again."

An artist who began training in watercolors when she was in her seventies, Bane is particularly looking forward to picking up a paintbrush again.

Occupational therapist Terri Hayward said Bane has been able to move her living-room easy chair back away from the television, and has progressed toward reading smaller type.

The trick, Hayward said, is for Bane to reprogram her brain so the telescoped eye adopts an alpha role over the eye with only peripheral vision.

The device works somewhat like a camera. Li said it uses two miniature mirrors to form a telescope to magnify images two to three times their normal size. This larger image is then projected onto the healthy retina areas surrounding the degenerated macula.

The lens itself is six times as thick as those used for patients with cataracts. It is implanted behind the iris during outpatient surgery.

Bane said she comfortably went out to dinner the same day as her surgery, with only a patch over her right eye to betray her ordeal.

The procedure currently is available for those 75 and older. As the FDA continues to monitor results, the age limit may relax, allowing younger baby boomers to participate, the surgeons said.

Already, a queue of about a dozen candidates is waiting to be evaluated for the next round of implants at UC Davis. Several Society of the Blind members who work with Bane attended the gathering Tuesday.

Among them was Jeannie Little, 79, of Sacramento, who said she's interested in receiving the implant herself.

"Since 1998, I've had a little gray shadow in one of my eyes that's gotten worse," Little said. "I just bravely got my hip replaced at the end of April, and I can approach this with the same gusto."

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