IMPLANTABLE MINIATURE TELESCOPES

An introduction by James Bole BSc (Hons). GCGI. MIfL Director – Vision Rehabilitation Ltd Vice Chair – RWPN Trustee – Headway (Aylesbury Vale) Part of a group of Specialist Rehabilitation Officers working on the IMT project, through FocalPoint UK

Who is involved Hannah Dunbar – PhD. MCOptom, Associate Director of Clinical Services for VisionCare Ltd and Lead Optometrist for Moorfields Eye Hospital. Mr Ahmed El-Amir – FRCOphth. FRCS. AAOphth – a world renown American-born surgeon in the field of vitreo-retinal surgery and a leading specialist in Paediatric Retinopathy of Prematurity screening------and (allegedly) an accomplished amateur footballer. FocalPoint (UK) – a team of specialist Rehabilitation Officers lead by Andy Fisher, providing post-op low vision support to the IMT project CentraSight Ltd – an American Opthalmic company leading on the development of IMT across the world. VisionCare Ophthalmic Technologies – whose founders Yossi Gross & Dr Isaac Lipshitz invented the IMT

A multi-disciplinary approach..... Initial diagnosis – Eye specialist Candidate screening – Optometrist Implant – Eye surgeon Visual rehabilitation/training - ROVI

Background End-stage Macular Degeneration Vision less than 6/60 ROVI / LV practitioner has tried everything..... Where next ??

What is it Is similar to an Intra-ocular lens but is 13 mm by 4 mm Is a telescope designed by Dr. Isaac Lipshitz (in Israel), an expert in LV telescope design

What is it >X3 magnification 20 – 24 degrees visual field Fixed focal length Spectacles to adjust focus Inserted into one eye only for detailed tasks Other eye for navigation / mobility Requires intensive pre-operation training with patches to teach the brain to be able to switch on and switch off each eye

Pre-op testing External Telescopic Simulator (ETS) Simulates the experience of the IMT in the eye Visual acuity can be measured to determine the best eye for surgery Includes caps to simulate near and distance vision

Left Right X3 external telescope – X3 wide angle IMT at 8 degrees at 24 degrees

Typical ARMD......

A simulation of the IMT......

How does it work Scarred Macula Central Visual Field Projection (Natural Lens/IOL) CAT Implantable Telescope Central Visual Field Projection

Surgical bit Corneal incision >12mm Capuslar incision >7mm

The end result (surgically).....

Mrs Margaret Ward aged 90, interestingly not registered at the time but with less than 6/60 in both eyes, living quite independently with her 95 year-old husband in Aylesbury in Buckinghamshire

Rehabilitation

Re-learning to read..... X A D F I I T – B – M – P – H (72) X A D F I I T – B – M – P – H (48)

Re-learning to read..... N P U E G D S R (28) N – P – U – E – G – D – S – R A C M O V L M Q D A – C – M – O – V – L – M - Q – D (22)

Re-learning to read.....WORDS.... rid use may buy big (28) roofpuresnowtime deliver flattery whether The two women went to the shops. After the meal they went to town. (22)

And a few puzzles

Conclusions.... It is not suitable for everyone There are strict suitability assessments to go through It is expensive There are other similar alternatives (but which do not have the level of rehabilitation support It is NOT a cure, hence not available through the NHS (N.I.C.E.)

Now...how can YOU help ?? If you live and work particularly in the North of the country Are good at rehabilitation, particularly Low Vision Have time to commit to some training and taking on individual service users Happy to be paid for a set of rehabilitation / low vision training sessions FocalPoint UK would like to hear from you BUT – there is no guarantee of work on a regular base

And finally

From the Journal of Nutritional Biochemistry – Feb 2015 Red wine is good for you Helps to burn fat Helps to lower blood pressure Has the potential to reduce effects of Dementia Has anti-oxidants that help fight cancer(s) Helps reduce strokes / heart disease In the USA, documentary proof of 34% lower death rates amongst those who drink red wine

So A healthy rehab force is a happy rehab force so.....get down to the pub and stay healthy