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Retina Macular Degeneration Telescope Implant—Changing Visual Expectations and Evolving the Standard of Care for End-stage Age-related Macular Degeneration Patients Charles C Wykoff, MD, PhD, FACS 1,2 Clinical Assistant Professor of Ophthalmology, Retina Consultants of Houston, Blanton Eye Center, Weill Cornell Medical College, Houston Methodist Hospital, Houston, Texas, US Abstract End-stage age-related macular degeneration (AMD) affects approximately 1.8 million Americans and limits older adults’ ability to perform activities of daily living. No current pharmaceutical options exist for visual improvement in these patients. The telescope implant is the only Food and Drug Administration approved intraocular device for visual rehabilitation in end-stage AMD patients, with either bilateral geographic atrophy or disciform scarring, who are phakic (in at least one eye) with best spectacle-corrected visual acuity of 20/160–20/800 or worse in both eyes. Keywords Telescope implant, end-stage AMD, five-year outcomes Disclosure: Charles C Wykoff, MD, PhD, FACS, does not have any disclosures or conflicts of interest to report relevant to VisionCare Ophthalmic Technologies, Inc. The opinions expressed in this paper are his own and supported by existing evidence. No funding was received in the publication of this article. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, adaptation, and reproduction provided the original author(s) and source are given appropriate credit. Received: July 29, 2015 Published: October 16, 2015 Citation: US Ophthalmic Review, 2015;8(2):116–17 Correspondence: Charles C Wykoff, MD, PhD, FACS, Retina Consultants of Houston, Blanton Eye Center, Houston, Texas, US. E: End-stage AMD—Clinical Challenge with New Option for Visual Rehabilitation Age-related macular degeneration (AMD) is a leading cause of vision loss with approximately 200,000 new diagnoses of its neovascular form each year in the US alone. 1 Fortunately, many of these patients benefit from anti- vascular endothelial growth factor (anti-VEGF) pharmaceutical treatments, and such management has changed the epidemiology of blindness in many countries. 2–5 However, many patients have advanced dry AMD manifest as geographic atrophy or end-stage neovascular AMD associated with macular fibrosis and disciform scarring. The characteristic central scotoma of end-stage AMD, affecting approximately 1.8 million Americans, 6 can significantly limit older adults’ ability to perform activities of daily living and engage in social interaction, negatively affecting their quality of life, and increasing rates of depression and dependency on caregivers. 7,8 In these frustrating clinical situations, where no current pharmaceutical option exists for visual improvement, one may consider refractive visual rehabilitation with implantation of an intraocular telescope. The Implantable Miniature Telescope (IMT or “telescope implant,” VisionCare Ophthalmic Technologies, Saratoga, CA) is the only Food and Drug Administration (FDA) approved intraocular telescopic implant for visual rehabilitation in end-stage AMD from geographic atrophy or disciform scarring. The telescope implant is indicated for such bilateral, phakic (in at least one eye) patients with best spectacle-corrected visual acuity (BSCVA) of 20/160–20/800 or worse in both eyes. 9–11 116 The telescope implant is a fixed-focus, unilaterally implanted device that produces a telephoto effect and enlarges objects in the patient’s central visual field by about threefold. Approximately 20–24° of external field of view is projected onto approximately 55° of retina, and therefore, the peripheral field of the implanted eye is reduced. 11 Given the permanent monovision-like situation created with one eye serving central function and the other peripheral function, patient education both before and after surgery is critical to success. To facilitate this, there are more than 120 dedicated CentraSight teams in the US and Europe, which utilize structured steps for patient screening and postimplantation rehabilitation for optimal device utilization and maximization of visual function. 12 Originally approved in 2010, in the fourth quarter of 2014, the FDA expanded the telescope implant label to include patients who are 65 years and older, significantly increasing its potential reach within our aging population. 9–11 The device is implanted into the capsular bag by a qualified anterior segment surgeon at the time of cataract surgery through an enlarged wound. The device has a 4.4 mm anterior–posterior length and protrudes through the pupil by approximately 0.1–0.5 mm, allowing clearance of approximately 2.5 mm between the device and the corneal endothelium. Five-year Outcomes Following Telescope Implantation—Sustained Visual Improvement Two years following implantation in the IMT-002 prospective clinical study that led to the initial approval of FDA, mean BSCVA improved more Touch ME d ica l ME d ia