Physician Continuing Education

From time to time, our blog will have important articles to share with the larger community of physicians in order to provide better care and diffusion of knowledge. Our posts categorized as “Continuing Education” will host all of this knowledge. Patients may find this information useful. However, as it is written with other physicians in mind, you may not understand a specific topic or acronym.

Physicians, free to ask questions or bring other discussions to the surface by using the comment section below each post.

Implantable Miniature Telescope

Screen Shot 2015-08-09 at 10.05.50 AMSouthern Vitreoretinal is participating in the implantable miniature telescope for advanced macular degeneration.   SVA doctors will confirm the diagnosis of End-Stage AMD, and possibly refer to a cataract surgeon for the telescope implantation procedure if the patient is a good candidate who meets all the eligibility requirements.

INDICATION FOR USE (USA):

The intraocular telescope is indicated for monocular implantation to improve vision in patients greater than or equal to 65 years of age with stable severe to profound vision impairment (best-corrected distance visual acuity 20/160 to 20/800) caused by bilateral central scotomas associated with end-stage age-related macular degeneration.

Patients must:

  • have retinal findings of geographic atrophy or disciform scar with foveal involvement, as determined by fluorescein angiography
  • have evidence of visually significant cataract (Grade 2)
  • agree to undergo pre-surgery training and assessment (typically 2 to 4 sessions) with low vision specialists (optometrist or occupational therapist) in the use of an external telescope sufficient for patient assessment and for the patient to make an informed decision
  • achieve at least a 5-letter improvement on the ETDRS chart with an external telescope
  • have adequate peripheral vision in the eye not scheduled for surgery
  • agree to participate in postoperative visual training with a low vision specialist.

CONTRAINDICATIONS:

Implantation of the intraocular telescope is contraindicated in patients:

  • with Stargardt’s macular dystrophy
  • with central anterior chamber depth (ACD) < 3.0 mm; measurement
    of the ACD should be taken from the posterior surface of the cornea (endothelium) to the anterior surface of the crystalline lens
  • with the presence of corneal guttata
  • who do not meet the minimum age and endothelial cell density

requirements (age 65 to < 70 min. cell density 2300 cells/mm2; age 70 to < 75 min. cell density 2000 cells/mm2; age 75 or greater min. cell density 1800 cells/mm2)

  • with cognitive impairment that would interfere with the ability to understand and complete the Acceptance of Risk and Informed Decision Agreement or prevent proper visual training/rehabilitation with the device
  • who have evidence of active CNV on fluorescein angiography or treatment for CNV within the past six months
  • with any ophthalmic pathology that compromises the patient’s peripheral vision in the fellow eye
  • with previous intraocular or cornea surgery of any kind in the operative eye, including any type of surgery for either refractive or therapeutic purposes
  • who have prior or expected ophthalmic related surgery within 30 days preceding intraocular telescope implantation
  • with a history of steroid-responsive rise in intraocular pressure, uncontrolled glaucoma, or preoperative IOP > 22 mm Hg, while on maximum medication
  • with known sensitivity to post-operative medications
  • who have a history of eye rubbing or an ocular condition that predisposes them to eye rubbing in whom the planned operative eye has:
    • Myopia > 6.0 D, Hyperopia > 4.0 D
    • Axial length < 21 mm
    • A narrow angle, i.e., < Schaffer grade 2
    • Cornea stromal or endothelial dystrophies, including guttata Inflammatory ocular disease
    • Zonular weakness/instability of crystalline lens, or pseudoexfoliation Diabetic retinopathy, untreated retinal tears, retinal vascular disease,
      history of retinal detachment, retinitis pigmentosa Intraocular tumor
    • Optic nerve disease