A miniature telescope implant helps Eleanor Risman see clearly what she hasn’t for more than a decade – bright colors, her favorite television shows and the rank and suit of the cards in her beloved video poker.
She recently awoke before 7 a.m. just so she could see television anchor Randi Naughton on the early morning news. She had listened to Naughton on Martin Kilcoyne’s radio show.
“I always wondered what she looked like,” said Risman, 85, of Collinsville. “The reds were real vivid, and her complexion — pink. It was clear, like out of a clear blue sky. And her hair was nice.”
Age-related macular degeneration had been slowly robbing Risman of her sight for the past 15 years. But she is now adjusting to a new way of seeing the world, a view that had long been a blur. Just over a year ago, Risman was one of the first three patients in the region to have an intraocular telescope implant.
Dr. Mujtaba Qazi of the Pepose Vision Institute in St. Louis County is the only eye surgeon between Kansas City and Chicago implanting the telescopes, approved by the FDA three years ago. Qazi performs the surgery with a retina specialist, Dr. Nancy Holekamp, at Barnes-Jewish St. Peters Hospital.
About 1.7 million Americans have end-stage age-related macular degeneration, the leading cause of blindness in older Americans. The disease slowly destroys the macula – the central and most sensitive part of the light-sensing retina at the back of the eye. Vision gradually becomes blurry with a blind spot in the middle, making it difficult or impossible to see faces, read and perform everyday activities.
The telescope, smaller than a pea, replaces the eye’s natural lens. The device magnifies images that would normally be seen in one’s central vision and projects it onto part of the retina that is still healthy and can capture light. The eye with the implant is used for central vision, while the other eye is used for peripheral vision.
“That’s pretty remarkable. There’s no other surgery for these patients,” Qazi said. “We’re talking about someone who can only see the big ‘E’ on the eye chart, and now they can see a few lines down.”
The procedure comes with risk, however. Cutting through the cornea – the transparent window covering the outside of the eye – increases the risk of persistent swelling of the cornea. This can progress to vision-impairment or the need for a corneal transplant.
According to the clinical study involving 217 patients, five patients needed a corneal transplant. Because of the risk, the FDA approved the device only in patients ages 75 and older.
In addition, the clinical study showed nearly half the patients reported their vision-related quality of life either stayed the same or got worse.
This may be because adjusting to the new way of seeing can be difficult. While about 75 percent of patients saw their distance vision improve – some 60 percent by three lines or more on the eye chart – it takes about six months of therapy to adjust to the enlarged images. Objects appear closer than they are, making it difficult to judge distance and depth, explained Monica Perlmutter, the lead low-vision therapist with Washington University Occupational Therapy.
“There is quite an adjustment period for the patients, and they need to be motivated to participate fully in the rehabilitation process,” Perlmutter said. The goal is to switch between using the telescope eye for tasks where details are needed – looking at people’s faces, reading and writing – and the other eye for more mobile activities.
The cost of the surgery and rehabilitation is covered by Medicare. While the telescope costs about $15,000, hospital and provider fees vary. In addition to a surgeon and occupational therapist, a retina specialist must screen candidates for the implant – making sure the telescope can fit in the eye, and the patient can adapt during practice with an external telescope.
About 60 teams of providers are performing the implant and rehabilitation across the country, and about 400 patients have had the surgery, according to officials with CentraSight, the treatment program created by the telescope developer, VisionCare Ophthalmic Technologies Inc.
Qazi said since the clinical study, providers are better at determining the best candidates for the surgery, which ensures better outcomes. Doctors also now implant the telescope in the eye with the best vision, which improves how patients use the magnified images. He predicts that as more people have the surgery and show good long-term results, the age threshold will be lowered.
Risman said she feels that if she got the implant at a younger age, she would have adapted to it more easily. Even so, she said, the improvement has been “wonderful.”
Living on her own, the telescope helps her do things to maintain her independence, like using the microwave, paying her bills and reading food labels. She had forgotten what it was like to enjoy little things, like watching television.
“Frankly, I don’t think I watched it. I sat and listened to it. It was vague,” she said. “I can see now.”