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EW FEATURE 39 Dr. Colby. "The eye has to be a nor- mal eye with the exception of AMD. The corneal endothelium needs to meet a certain minimal level of number of cells in order to proceed with the surgery, and that's FDA mandated. The anterior chamber has to be large enough to accommodate the telescope, which does protrude above the pupillary plane. The pa- tient can't have any issues that com- promise the integrity of the lens capsule, for example pseudoexfolia- tion or a history of trauma, because the device needs to sit within the capsular bag to be stable." To make use of the telescope and make the potential risks of sur- gery worth it, patients have to im- prove with an external telescope simulator device that tests their abil- ity to improve and adapt to the de- vice. It also assesses the potential field of view with the implanted eye at that magnification. "If they don't improve with the simulator, they aren't candidates," said Chet Kumar, D.P.T., vice presi- dent, Business and Market Development, VisionCare. "If they pass that, patients will see the low- vision occupational therapist who will figure out what their functional goals are and if the technology's ca- pabilities are in line with that. [The OT] will also relate back to the oph- thalmologist if the candidate patient has good rehab potential." It helps if patients are upbeat, hard workers with reasonable expec- tations. Patients should be active with their low vision as well, not people who are having their daugh- ter or son do all their activities or reading for them. "People who come in with a glass half full attitude will probably do better," said Henry Hudson, M.D., Tucson, Ariz. "Women do a little better than men. People who are artists do better than people who are not artistic. I think the best can- didates are people who have realistic expectations. They have hopes, but realistic expectations, and they are motivated to do the work. It's very much a program. It's not a proce- dure. If they accept that it's a program and there's a rehab compo- nent, they tend to do much better." How long it takes a person to adjust to the telescope is individu- ally based. There's no real way of as- sessing that upfront, but the simulator gives patients and physi- cians some idea. "The goal is for patients to know what they're getting," said Dr. Hudson. "Most of our simulators un- derestimate the success. If patients are happy with how they do in test- ing, they should be happier with the actual result." Most patients are extremely happy and grateful for the device and their functional improvements. According to Dr. Hudson, the aver- age patient goes from being legally blind to reading a Kindle with glasses. "All in all, patients I talk to say they're glad they did it, even though it's not a cure. It's an option that in- tegrates into their visual system and can improve quality of life," said Dr. Kumar. "It's for the people who want to be able to read a book in the nurs- ery to their grandchild. It's for peo- ple who want to go out to the bank and do their own finances." "When people come in and bring pictures or a piece of art or tell you a story, it's just amazing," said Dr. Hudson. "When you pick the right candidate, it's one of the most rewarding things ever, as rewarding as a patient with a retinal detach- ment getting 20/20 vision back. This is an opportunity to make a differ- ence. It's a real opportunity for mul- tiple specialties—optometry, comprehensive ophthalmology, vit- reo-retinal surgery, and occupational therapy—to take a team approach to go after this one particular disease, central visual blindness from AMD, and make an impact." EW Editors' note: Drs. Colby and Hudson have no financial interests related to this article. Dr. Kumar is vice president of VisionCare. Dr. Primo has financial interests with VisionCare. Contact information Colby: kacolby@meei.harvard.edu Hudson: henhud@msn.com Kumar: chet@visioncareinc.net Primo: sprimo@emory.edu February 2011 December 2011 What's ahead in 2012 Poll Size: 507 EyeWorld Monthly Pulse EyeWorld Monthly Pulse is a reader survey on trends and patterns for the practicing ophthalmologist. Each month we send a 4-6 question online survey covering different topics so our readers can see how they compare to our survey. If you would like to join the current 1,000+ physicians who take a minute a month to share their views, please send us an email and we will add your name. Email ksalerni@eyeworld.org and put EW Pulse in the subject line; that's all it takes. Copyright EyeWorld 2011 CentraSight implantable telescope technology helps improves vision in end-stage AMD Source: James Gilman, C.R.A.

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