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Muqit MMK, Le Mer Y, Olmos de Koo L, Holz FG, Sahel JA, Palanker D. Prosthetic Visual Acuity with the PRIMA Subretinal Microchip in Patients with Atrophic Age-Related Macular Degeneration at 4 Years Follow-up. OPHTHALMOLOGY SCIENCE 2024; 4:100510. [PMID: 38881600 PMCID: PMC11179408 DOI: 10.1016/j.xops.2024.100510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/30/2024] [Accepted: 03/04/2024] [Indexed: 06/18/2024]
Abstract
Objective To assess the efficacy and safety of the PRIMA neurostimulation system with a subretinal microchip for improving visual acuity (VA) in patients with geographic atrophy (GA) due to age-related macular degeneration (AMD) at 48-months postimplantation. Design Feasibility clinical trial of the PRIMA subretinal prosthesis in patients with atrophic AMD, measuring best-corrected ETDRS VA (Clinicaltrials.govNCT03333954). Subjects Five patients with GA, no foveal light perception, and VA of logarithm of the minimum angle of resolution (logMAR) 1.3 to 1.7 (20/400-20/1000) in their worse-seeing "study" eye. Methods In patients subretinally implanted with a photovoltaic neurostimulation array containing 378 pixels of 100 μm in size, the VA was measured with and without the PRIMA system using ETDRS charts at 1 m. The system's external components, augmented reality glasses, and pocket computer provide image processing capabilities, including zoom. Main Outcome Measures Visual acuity using ETDRS charts with and without the system, as well as light sensitivity in the central visual field, measured by Octopus perimetry. Anatomical outcomes demonstrated by fundus photography and OCT up to 48 months postimplantation. Results All 5 subjects met the primary end point of light perception elicited by the implant in the scotoma area. In 1 patient, the implant was incorrectly inserted into the choroid. One subject died 18 months postimplantation due to study-unrelated reasons. ETDRS VA results for the remaining 3 subjects are reported here. Without zoom, VA closely matched the pixel size of the implant: 1.17 ± 0.13 pixels, corresponding to a mean logMAR of 1.39, or Snellen of 20/500, ranging from 20/438 to 20/565. Using zoom at 48 months, subjects improved their VA by 32 ETDRS letters versus baseline (standard error 5.1) 95% confidence intervals (13.4, 49.9; P < 0.0001). Natural peripheral visual function in the treated eye did not decline after surgery or during the 48-month follow-up period (P = 0.08). Conclusions Subretinal implantation of PRIMA in subjects with GA experiencing profound vision loss due to AMD is feasible and well tolerated, with no reduction of natural peripheral vision up to 48 months. Prosthetic central vision provided by photovoltaic neurostimulation enabled patients to reliably recognize letters and sequences of letters, and with zoom, it improved VA of up to 8 ETDRS lines. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Mahiul Muhammed Khan Muqit
- Vitreoretinal Service, Moorfields Eye Hospital, London, United Kingdom
- Institute of Ophthalmology, University College London, United Kingdom
| | - Yannick Le Mer
- Department of Ophthalmology, Fondation Ophtalmologique A. de Rothschild, Paris, France
- Clinical Investigation Center, Quinze-Vingts National Eye Hospital, Paris, France
| | - Lisa Olmos de Koo
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Frank G. Holz
- Department of Ophthalmology, University of Bonn, Germany
| | - Jose A. Sahel
- Department of Ophthalmology, Fondation Ophtalmologique A. de Rothschild, Paris, France
- Clinical Investigation Center, Quinze-Vingts National Eye Hospital, Paris, France
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Daniel Palanker
- Department of Ophthalmology, Stanford University, Stanford, California
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Śpiewak D, Drzyzga Ł, Dorecka M, Wyględowska-Promieńska D. Summary of the Therapeutic Options for Patients with Dry and Neovascular AMD. J Clin Med 2024; 13:4227. [PMID: 39064267 PMCID: PMC11278184 DOI: 10.3390/jcm13144227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 07/15/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
Age-related macular degeneration (AMD) is the leading cause of irreversible blindness worldwide and a severe medical and social problem. The steadily increasing number of patients is related to the aging of the population. So far, many factors affecting the development of AMD have been identified, which can be divided into non-modifiable, including genetic factors, age, and sex, and modifiable or environmental factors, such as smoking, poor diet, and hypertension. Early stages of age-related macular degeneration are characterized by fundus drusen and abnormalities in the retinal pigment epithelium. In late stages, geographic atrophy and choroidal neovascularization (CNV) are observed. The treatment of AMD, especially its advanced forms, is very challenging. Intensive research has made it possible to treat advanced stages of the dry form of AMD with pegcetacoplan and avacincaptad pegol, new drugs approved for use in the US. Pegcetacoplan targets the C3 and avacincaptad pegol targets the C5, the pivotal proteins of the complement cascade. The drugs are administered by intravitreal injection. The gold standard for neovascular AMD (nAMD) consists of intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) drugs such as bevacizumab, ranibizumab, aflibercept, brolucizumab, and faricimab. Treatment can be administered according to the fixed, pro-re-nata, and treat-and-extend regimens. The latter seems to have the best effect on improving visual acuity (VA) and the maximum therapeutic benefit. The search continues for the best ways to deliver intravitreal drugs. Current methods include sustained-release implants and hydrogel platforms for drug release, while the most promising future pathways for treating dry and nAMD are stem cell and gene therapy.
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Affiliation(s)
- Dorota Śpiewak
- Department of Ophthalmology, Prof. K. Gibiński University Clinical Center, Medical University of Silesia, 40-514 Katowice, Poland
- Clinical Ophthalmology Center Okolux, 40-754 Katowice, Poland
| | - Łukasz Drzyzga
- Department of Ophthalmology, Prof. K. Gibiński University Clinical Center, Medical University of Silesia, 40-514 Katowice, Poland
- Clinical Ophthalmology Center Okolux, 40-754 Katowice, Poland
| | - Mariola Dorecka
- Department of Ophthalmology, Prof. K. Gibiński University Clinical Center, Medical University of Silesia, 40-514 Katowice, Poland
- Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-287 Katowice, Poland
| | - Dorota Wyględowska-Promieńska
- Department of Ophthalmology, Prof. K. Gibiński University Clinical Center, Medical University of Silesia, 40-514 Katowice, Poland
- Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-287 Katowice, Poland
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Savastano A, Ferrara S, Sasso P, Savastano MC, Crincoli E, Caporossi T, De Vico U, Vidal Aroca F, Francione G, Sammarco L, Gambini G, Fedeli C, Di Nardo E, Rizzo S. Smaller-Incision new-generation implantable miniature telescope: Three-months follow-up study. Eur J Ophthalmol 2024; 34:1111-1118. [PMID: 37920982 DOI: 10.1177/11206721231212545] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
PURPOSE To evaluate three months follow-up of SING IMT implant in patients affected by late-stage AMD. DESIGN Prospective cohort study. SUBJECTS In a total of 80 eyes of 40 patients who underwent the enrollment tests, 11 patients' eyes affected by late-stage AMD matched the inclusion criteria and underwent SING IMT implant from February to June 2022. METHODS Before surgery, each patient underwent the enrollment examination to verify inclusion and exclusion criteria. MAIN OUTCOME MEASURES BCVA for distance and for near, IOP, ACD and ECD were evaluated at 1 and 3 months follow up. Also quality of life in doing the activities of daily life was evaluated. RESULTS BCVA for distance and for near improved from baseline to 3 months follow up (23.91 ± 9.418 ETDRS letters and 59.09 ± 11.58 ETDRS letters respectively (p < 0.001). An endothelial cell loss was shown (p < 0.001), with a rate of cell density reduction around 8.3% (baseline vs 3 months). CONCLUSIONS SING IMT could be a valid surgical device to improve patients' sight and quality of life which have been deteriorated by late-stage macular degeneration. Further studies with more patients and longer follow up are needed to confirm our results.
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Affiliation(s)
- Alfonso Savastano
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Silvia Ferrara
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Paola Sasso
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Cristina Savastano
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emanuele Crincoli
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Tomaso Caporossi
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Umberto De Vico
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Giuseppe Francione
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Leonardo Sammarco
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gloria Gambini
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Chiara Fedeli
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Emiliana Di Nardo
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Stanislao Rizzo
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, Pisa, Italy
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Gutierrez-Benitez L, Biarge G, Salcedo E, Asaad M. Scharioth macula lens: Three-year follow-up. J Fr Ophtalmol 2024; 47:104006. [PMID: 37925324 DOI: 10.1016/j.jfo.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 09/21/2023] [Accepted: 10/04/2023] [Indexed: 11/06/2023]
Affiliation(s)
- L Gutierrez-Benitez
- Ophthalmology department, Consorci Sanitari de Terrassa, Hospital de Terrassa, Carr. Torrebonica, s/n, 08227 Terrassa, Barcelona, Spain.
| | - G Biarge
- Ophthalmology department, Consorci Sanitari de Terrassa, Hospital de Terrassa, Carr. Torrebonica, s/n, 08227 Terrassa, Barcelona, Spain
| | - E Salcedo
- Ophthalmology department, Consorci Sanitari de Terrassa, Hospital de Terrassa, Carr. Torrebonica, s/n, 08227 Terrassa, Barcelona, Spain
| | - M Asaad
- Ophthalmology department, Consorci Sanitari de Terrassa, Hospital de Terrassa, Carr. Torrebonica, s/n, 08227 Terrassa, Barcelona, Spain
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Mastropasqua R, Gironi M, D’Aloisio R, Pastore V, Boscia G, Vecchiarino L, Perna F, Clemente K, Palladinetti I, Calandra M, Piepoli M, Porreca A, Di Nicola M, Boscia F. Intraoperative Iridectomy in Femto-Laser Assisted Smaller-Incision New Generation Implantable Miniature Telescope. J Clin Med 2023; 13:76. [PMID: 38202083 PMCID: PMC10779865 DOI: 10.3390/jcm13010076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND In this study, we aimed to report the short-term (6 months) effects on visual functionality and safety of femto-laser assisted smaller-incision new-generation implantable miniature telescope (SING-IMT™) implanting, particularly related to postsurgical intraocular pressure increase, in patients suffering from end-stage age-related macular degeneration (AMD) and cataract. This device, designed for monocular use, aims to minimise the impact of the central scotoma by projecting the images onto a larger area of the photoreceptors surrounding the macula. METHODS In this prospective multicentric observational case series study, 6 eyes of 6 patients who underwent SING-IMT™ implantations were enrolled. At baseline and 6 months follow-up, best corrected distance visual acuity (BCDV) and best corrected near visual acuity (BCNVA), intraocular pressure (IOP), anterior chamber depth, endothelial cells count were assessed. In addition, IOP was also measured at 7, 15, 30, 45 days, and at 3 months follow-up. Finally, the incidence of complications was evaluated. RESULTS At final follow-up, in the study eyes, mean BCDVA improved by +10.0 letters (6.25; 13.8) letters and mean BCNVA improved by -0.30 logMAR (-0.55; -0.20). At postoperative month 6, we reported a mean IOP decrease of 4.50 mmHg (-5.75; -0.25). Interestingly, 83.3% of patients had an increased IOP value in at least one of the first two postoperative follow-ups (7 days and 15 days). In patients in whom intraoperative mechanical iridotomy was not performed, it was necessary to perform a postoperative YAG laser iridotomy to improve IOP management. Compared to the baseline, ECD loss at 6 months follow-up was 12.6%. CONCLUSIONS The SING IMT™ device was found to be effective in the distance and near vision improvement, without serious postoperative complications. We recommend intraoperative mechanical iridectomy in order to easily manage post-operative IOP and to avoid sudden IOP rise with its possible consequences. These good results can be a hope to partially improve the quality of life of patients suffering from severe end stage macular atrophy.
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Affiliation(s)
- Rodolfo Mastropasqua
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy; (R.M.); (M.G.); (L.V.); (F.P.); (K.C.); (I.P.); (M.C.)
| | - Matteo Gironi
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy; (R.M.); (M.G.); (L.V.); (F.P.); (K.C.); (I.P.); (M.C.)
| | - Rossella D’Aloisio
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy; (R.M.); (M.G.); (L.V.); (F.P.); (K.C.); (I.P.); (M.C.)
| | - Valentina Pastore
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, 70121 Bari, Italy; (V.P.); (G.B.); (M.P.); (F.B.)
| | - Giacomo Boscia
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, 70121 Bari, Italy; (V.P.); (G.B.); (M.P.); (F.B.)
| | - Luca Vecchiarino
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy; (R.M.); (M.G.); (L.V.); (F.P.); (K.C.); (I.P.); (M.C.)
| | - Fabiana Perna
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy; (R.M.); (M.G.); (L.V.); (F.P.); (K.C.); (I.P.); (M.C.)
- International Agency of Prevention of Blindness, 00185 Rome, Italy
| | - Katia Clemente
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy; (R.M.); (M.G.); (L.V.); (F.P.); (K.C.); (I.P.); (M.C.)
| | - Ilaria Palladinetti
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy; (R.M.); (M.G.); (L.V.); (F.P.); (K.C.); (I.P.); (M.C.)
| | - Michela Calandra
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy; (R.M.); (M.G.); (L.V.); (F.P.); (K.C.); (I.P.); (M.C.)
| | - Marina Piepoli
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, 70121 Bari, Italy; (V.P.); (G.B.); (M.P.); (F.B.)
| | - Annamaria Porreca
- Laboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, University “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy; (A.P.); (M.D.N.)
| | - Marta Di Nicola
- Laboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, University “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy; (A.P.); (M.D.N.)
| | - Francesco Boscia
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, 70121 Bari, Italy; (V.P.); (G.B.); (M.P.); (F.B.)
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Muqit M, Mer YL, de Koo LO, Holz FG, Sahel JA, Palanker D. Prosthetic Visual Acuity with the PRIMA System in Patients with Atrophic Age-related Macular Degeneration at 4 years follow-up. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.12.23298227. [PMID: 38014146 PMCID: PMC10680875 DOI: 10.1101/2023.11.12.23298227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Objective To assess the efficacy and safety of the PRIMA subretinal neurostimulation system 48-months post-implantation for improving visual acuity (VA) in patients with geographic atrophy (GA) due to age-related macular degeneration (AMD) at 48-months post-implantation. Design First-in-human clinical trial of the PRIMA subretinal prosthesis in patients with atrophic AMD, measuring best-corrected ETDRS VA (Clinicaltrials.gov NCT03333954). Subjects Five patients with GA, no foveal light perception and VA of logMAR 1.3 to 1.7 in their worse-seeing "study" eye. Methods In patients implanted with a subretinal photovoltaic neurostimulation array containing 378 pixels of 100 μm in size, the VA was measured with and without the PRIMA system using ETDRS charts at 1 meter. The system's external components: augmented reality glasses and pocket computer, provide image processing capabilities, including zoom. Main Outcome Measures VA using ETDRS charts with and without the system. Light sensitivity in the central visual field, as measured by Octopus perimetry. Anatomical outcomes demonstrated by fundus photography and optical coherence tomography up to 48-months post-implantation. Results All five subjects met the primary endpoint of light perception elicited by the implant in the scotoma area. In one patient the implant was incorrectly inserted into the choroid. One subject died 18-months post-implantation due to study-unrelated reason. ETDRS VA results for the remaining three subjects are reported herein. Without zoom, VA closely matched the pixel size of the implant: 1.17 ± 0.13 pixels, corresponding to mean logMAR 1.39, or Snellen 20/500, ranging from 20/438 to 20/565. Using zoom at 48 months, subjects improved their VA by 32 ETDRS letters versus baseline (SE 5.1) 95% CI[13.4,49.9], p<0.0001. Natural peripheral visual function in the treated eye did not decline after surgery compared to the fellow eye (p=0.08) during the 48 months follow-up period. Conclusions Subretinal implantation of PRIMA in subjects with GA suffering from profound vision loss due to AMD is feasible and well tolerated, with no reduction of natural peripheral vision up to 48-months. Using prosthetic central vision through photovoltaic neurostimulation, patients reliably recognized letters and sequences of letters,and with zoom it provided a clinically meaningful improvement in VA of up to eight ETDRS lines.
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Affiliation(s)
- Mmk Muqit
- Vitreoretinal Service, Moorfields Eye Hospital, London, UK
- Institute of Ophthalmology, University College London, UK
| | - Y Le Mer
- Department of Ophthalmology, Fondation Ophtalmologique A. de Rothschild, Paris, France
- Clinical Investigation Center, Quinze-Vingts National Eye Hospital, Paris, France
| | - L Olmos de Koo
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - F G Holz
- Department of Ophthalmology, University of Bonn, Germany
| | - J A Sahel
- Department of Ophthalmology, Fondation Ophtalmologique A. de Rothschild, Paris, France
- Clinical Investigation Center, Quinze-Vingts National Eye Hospital, Paris, France
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - D Palanker
- Department of Ophthalmology, Stanford University, Stanford, CA, USA
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Macnamara A, Chen CS, Davies A, Sloan C, Loetscher T. Low vision devices for age-related macular degeneration: a systematic review. Disabil Rehabil Assist Technol 2023; 18:998-1010. [PMID: 34416116 DOI: 10.1080/17483107.2021.1966523] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Age-related macular degeneration (AMD) is a degenerative condition impacting central vision. Evaluating the effectiveness of low vision devices provides empirical evidence on how devices can rehabilitate and overcome deficits caused by AMD. This evidence could help to facilitate discussion on necessary future improvements to vision enhancement technology. METHODS A systematic review of the literature was conducted on low vision device use in AMD populations. Relevant peer-reviewed research articles from six databases were screened. RESULTS The findings of thirty-five studies revealed a significant positive impact of low vision devices leading to improvements in visual acuity, reading performance, facial recognition, and more. While the studies were found to have moderate risks of bias, a GRADE assessment of the evidence suggested the certainty of the evidence was low-moderate. DISCUSSION Simple hand-held low vision devices (e.g., magnifiers) appear to currently have greater preferential support than newer visual enhancement technology (e.g., head mounted devices). Financial, comfort or usability reasons may influence preferences more than performance-based findings. However, there is a lack of studies examining newer technologies in AMD populations, which future research should address. Moreover, given the presence of bias across the studies and limited controlled experiments, confidence in the results may be low. CONCLUSIONS Most studies indicated that low vision devices have positive impacts on reading and visual performance. But, even though they are reported to be a valuable asset to AMD populations, more rigorous research is required to draw conclusive evidence. IMPLICATIONS FOR REHABILITATIONLow vision devices can improve patient outcomes (e.g., vision, reading ability) for age-related macular degeneration populations.A multidisciplinary combination of low vision devices and rehabilitative services (i.e., eccentric viewing training, counselling, education) may enhance quality of life.
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Affiliation(s)
- Anne Macnamara
- Cognitive Ageing and Impairment Neurosciences Laboratory, UniSA Justice and Society, University of South Australia, Adelaide, Australia
| | - Celia S Chen
- Department of Ophthalmology, Flinders Medical Center and Flinders University, Adelaide, Australia
| | | | - Charlotte Sloan
- Cognitive Ageing and Impairment Neurosciences Laboratory, UniSA Justice and Society, University of South Australia, Adelaide, Australia
| | - Tobias Loetscher
- Cognitive Ageing and Impairment Neurosciences Laboratory, UniSA Justice and Society, University of South Australia, Adelaide, Australia
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Nipp GE, Lee T, Sarici K, Malek G, Hadziahmetovic M. Adult-onset foveomacular vitelliform dystrophy: epidemiology, pathophysiology, imaging, and prognosis. FRONTIERS IN OPHTHALMOLOGY 2023; 3:1237788. [PMID: 38983024 PMCID: PMC11182240 DOI: 10.3389/fopht.2023.1237788] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 07/25/2023] [Indexed: 07/11/2024]
Abstract
Adult-onset foveomacular dystrophy (AOFVD) is a retinal pattern dystrophy that may affect up to 1 in 7,400 individuals. There is much that is unknown regarding this disease's epidemiology, risk factors for development, and rate of progression through its four stages. Advancements in retinal imaging over the past 15 years have enabled improved characterization of the different stages of AOFVD. These imaging advancements also offer new ways of differentiating AOFVD from phenotypically similar retinal diseases like age-related macular degeneration and Best disease. This review synthesizes the most recent discoveries regarding imaging correlates within AOFVD as well as risk factors for the development of AOFVD, complications of AOFVD, and treatment options. Our aim is to provide ophthalmologists a succinct resource so that they may offer clarity, guidance, and appropriate monitoring and treatments for their patients with suspected AOFVD.
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Affiliation(s)
- Grace E Nipp
- School of Medicine, Duke University, Durham, NC, United States
| | - Terry Lee
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States
| | - Kubra Sarici
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States
| | - Goldis Malek
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States
- Department of Pathology, Duke University Medical Center, Durham, NC, United States
| | - Majda Hadziahmetovic
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States
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Borkenstein AF, Borkenstein EM, Augustin AJ. Implantable vision-enhancing devices and postoperative rehabilitation in advanced age-related macular degeneration. Eye (Lond) 2023; 37:597-606. [PMID: 35869389 PMCID: PMC9998400 DOI: 10.1038/s41433-022-02179-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 11/09/2022] Open
Abstract
Age-related macular degeneration (AMD) results in progressive vision loss that significantly impacts patients' quality of life and ability to perform routine daily activities. Although pharmaceutical treatments for AMD are available and in clinical development, patients with late-stage AMD are relatively underserved. Specialized rehabilitation programs and external low-vision aids are available to support visual performance for those with advanced AMD; but intraocular vision-improving devices, including implantable miniature telescope (IMT) and intraocular lens (IOL) implants, offer advantages regarding head motion, vestibular ocular reflex development, and depth perception. IMT and IOL technologies are rapidly evolving, and many patients who could benefit from them remain unidentified. This review of recent literature summarizes available information on implantable devices for improving vision in patients with advanced AMD. Furthermore, it discusses recent attempts of developing the quality of life tests including activities of daily life and objective assessments. This may offer the ophthalmologist but also the patient a better possibility to detect changes or improvements before and after surgery. It is evident that surgery with new implants/devices is no longer the challenge, but rather the more complex management of patients before and after surgery as well as the correct selection of cases.
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Affiliation(s)
- Andreas F Borkenstein
- Borkenstein & Borkenstein, Private Practice at Privatklinik der Kreuzschwestern, 8010, Graz, Austria.
| | - Eva-Maria Borkenstein
- Borkenstein & Borkenstein, Private Practice at Privatklinik der Kreuzschwestern, 8010, Graz, Austria
| | - Albert J Augustin
- Department of Ophthalmology, Städtisches Klinikum Karlsruhe, 76133, Karlsruhe, Germany
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Nekolova J, Kremlacek J, Lukavsky J, Sikl R, Sin M, Langrova J, Szanyi J, Jiraskova N. The intraocular implant and visual rehabilitation improve the quality of life of elderly patients with geographic atrophy secondary to age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2023; 261:263-272. [PMID: 35982247 PMCID: PMC9388354 DOI: 10.1007/s00417-022-05803-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/27/2022] [Accepted: 08/05/2022] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION The objective of this prospective study was to evaluate the effects of intraocular macular lens implantation and visual rehabilitation on the quality of life of patients with geographic atrophy (GA) secondary to age-related macular degeneration (AMD). METHODS Patients with bilaterally decreased near vision (not better than 0.3 logMAR with the best correction), pseudophakia, were included in the project. The Scharioth macula lens (SML) was implanted into the patients' better-seeing eye. Intensive visual rehabilitation of the ability to perform nearby activities was performed for 20 consecutive postoperative days. All subjects were examined before and after SML implantation ophthalmologically. The National Eye Institute 25-Item Visual Function Questionnaire (NEI VFQ-25) was administered before and 6 months after surgery. RESULTS Twenty eligible patients with mean age 81 years (63 to 92 years) were included in the project: 7 males and 13 females. Nineteen of them completed the 6-month follow-up. Near uncorrected visual acuity was 1.321 ± 0.208 logMAR before SML implantation and improved to 0.547 ± 0.210 logMAR after 6 months (dz = - 2.846, p < 0.001, BF10 = 3.29E + 07). In the composite score of the NEI VFQ-25, there was an improvement in the general score and the specific domains related to the implantation. Participants reported fewer difficulties in performing near activities (dz = 0.91, p = 0.001, BF10 = 39.718) and upturns in mental health symptoms related to vision (dz = 0.62, p = .014, BF10 = 3.937). CONCLUSION SML implantation, followed by appropriate rehabilitation, improved near vision and increased the quality of life of visually handicapped patients with AMD in our project.
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Affiliation(s)
- Jana Nekolova
- Department of Ophthalmology, University Hospital Hradec Kralove and Faculty of Medicine, Charles University, Hradec Kralove, Czech Republic
| | - Jan Kremlacek
- Department of Biophysics, Faculty of Medicine, Charles University, Simkova 870, 50003 Hradec Kralove, Czech Republic
- Department of Pathological Physiology, Faculty of Medicine, Charles University, Simkova 870, Hradec Kralove, 50003 Czech Republic
| | - Jiri Lukavsky
- Institute of Psychology, Czech Academy of Sciences, Brno, Czech Republic
| | - Radovan Sikl
- Institute of Psychology, Czech Academy of Sciences, Brno, Czech Republic
| | - Martin Sin
- Military University Hospital Prague, Department of Ophthalmology 1st Faculty of Medicine of Charles University and Military University Hospital Prague, Prague, Czech Republic
| | - Jana Langrova
- Department of Pathological Physiology, Faculty of Medicine, Charles University, Simkova 870, Hradec Kralove, 50003 Czech Republic
| | - Jana Szanyi
- Department of Pathological Physiology, Faculty of Medicine, Charles University, Simkova 870, Hradec Kralove, 50003 Czech Republic
| | - Nada Jiraskova
- Department of Ophthalmology, University Hospital Hradec Kralove and Faculty of Medicine, Charles University, Hradec Kralove, Czech Republic
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Savastano A, Caporossi T, Sasso P, De Vico U, Rizzo S. A new intraocular telescopic device for age-related macular degeneration. Ophthalmol Retina 2022; 6:971-972. [PMID: 35605958 DOI: 10.1016/j.oret.2022.05.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 05/10/2022] [Accepted: 05/16/2022] [Indexed: 10/18/2022]
Abstract
Age-related Macular Degeneration (AMD) is the third-leading cause of blindness worldwide after cataracts and glaucoma. We describe our recent surgical experience in managing the SING (Smaller-Incision New-Generation) implantable miniature telescope (IMT) that is designed to enlarge retinal images of the central visual field implanted monocularly in the capsular bag after lens extraction.
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Affiliation(s)
- Alfonso Savastano
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Tomaso Caporossi
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paola Sasso
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Umberto De Vico
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Stanislao Rizzo
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy; Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, Pisa - Italy
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12
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Borkenstein AF, Borkenstein EM, Murphy K, Primo SA. Testing Activities of Daily Living (ADL) in Patients with Age-Related Macular Degeneration Undergoing Cataract Surgery: Lessons Learned from the Past and Development of a New Quality of Life (QOL) Test. Clin Ophthalmol 2022; 16:385-387. [PMID: 35185330 PMCID: PMC8847117 DOI: 10.2147/opth.s356423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/02/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Andreas F Borkenstein
- Borkenstein & Borkenstein, Private Practice and Privatklinik der Kreuzschwestern, Graz, 8010, Austria
- Correspondence: Andreas F Borkenstein, Borkenstein & Borkenstein, Private Practice and Privatklinik der Kreuzschwestern, Kreuzgasse 35, Graz, 8010, Austria, Tel +433163313880, Email
| | - Eva-Maria Borkenstein
- Borkenstein & Borkenstein, Private Practice and Privatklinik der Kreuzschwestern, Graz, 8010, Austria
| | - Karen Murphy
- VisionWorks Rehabilitation, LLC, Novi, MI, 48374, USA
| | - Susan A Primo
- Emory University School of Medicine, Department of Ophthalmology, Atlanta, GA, 30322, USA
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Auffarth GU, Reiter J, Leitritz M, Bartz-Schmidt KU, Höhn F, Breyer D, Kaymak H, Rohrschneider K, Khoramnia R, Yildirim TM. High-addition segmented refractive bifocal intraocular lens in inactive age-related macular degeneration: A multicenter pilot study. PLoS One 2021; 16:e0256985. [PMID: 34473779 PMCID: PMC8412355 DOI: 10.1371/journal.pone.0256985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/19/2021] [Indexed: 01/15/2023] Open
Abstract
This multicenter, open-label study aimed to determine the safety and functional outcome of a high-addition segmented refractive bifocal intraocular lens (IOL) in late inactive age-related macular degeneration (AMD). Twenty eyes of 20 patients were enrolled and followed until 12 months after the intervention. Patients underwent cataract surgery with implantation of a LS-313 MF80 segmented refractive bifocal intraocular lens with a near addition of +8.0 D (Teleon Surgical Vertriebs GmbH, Berlin, Germany). The main outcome measures were distance corrected near visual acuity (DCNVA) and safety as determined by intra- and post-operative complications. Secondary outcomes included distance corrected visual acuity (CDVA), uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), the need for magnification to read newspaper, preferred reading distance, speed and performance (logRAD), as well as patient satisfaction. Mean DCNVA improved from 0.95 (±0.19) to 0.74 (±0.35) logMAR, until 6 months after surgery, P<0.05. CDVA improved from 0.70 (±0.23) to 0.59 (±0.30) logMAR, UDVA from 0.94 (±0.25) to 0.69 (±0.34) logMAR, UNVA from 1.08 (±0.19) to 0.87 (±0.43) logMAR. The mean need for magnification decreased from 2.9- to 2.3-fold, preferred reading distance from 23 to 20 cm. No intraoperative complications occurred during any of the surgeries. One patient lost > 2 lines of CDVA between 6 and 12 months, in another case, the study IOL was exchanged for a monofocal one due to dysphotopsia and decreased CDVA. Implantation of a segmented refractive bifocal IOL with +8.0 D addition improves near and distance vision in patients with late AMD and has a satisfactory safety profile.
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Affiliation(s)
- Gerd U. Auffarth
- International Vision Correction Research Centre, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
- * E-mail:
| | | | - Martin Leitritz
- Centre for Ophthalmology, University of Tübingen, Tübingen, Germany
| | | | - Fabian Höhn
- Marienhospital Osnabrück, Osnabrück, Germany
| | | | - Hakan Kaymak
- Breyer & Kaymak Augenchirurgie, Düsseldorf, Germany
| | - Klaus Rohrschneider
- International Vision Correction Research Centre, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Ramin Khoramnia
- International Vision Correction Research Centre, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Timur M. Yildirim
- International Vision Correction Research Centre, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
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Mehta H. Management of Cataract in Patients with Age-Related Macular Degeneration. J Clin Med 2021; 10:2538. [PMID: 34201114 PMCID: PMC8228734 DOI: 10.3390/jcm10122538] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/31/2021] [Accepted: 06/02/2021] [Indexed: 11/16/2022] Open
Abstract
Cataract and age-related macular degeneration (AMD) are two of the most common eye diseases of aging. This review addresses the pre-operative, intra-operative, and post-operative considerations in managing cataract in patients with age-related macular degeneration. Surgery for visually significant cataracts in patients with AMD can substantially improve the quality of life and reduce the risk of falls. Pre-operative optical coherence tomography is now recommended where possible to identify pre-existing macula disease. Careful counselling of patients is required before cataract surgery, especially with respect to the expected visual outcome, intraocular lens choice and potential risks of surgery. Real-world data has suggested 6 months of intravitreal anti-VEGF therapy for neovascular AMD before cataract surgery is compatible with optimum long-term visual outcomes. Patients receiving intravitreal therapy for neovascular AMD should be advised of the slightly higher risk of intraoperative complications and the surgeon should be prepared to manage these during the operation. During cataract surgery, unnecessary light exposure should be avoided to reduce phototoxicity. Careful planning of intravitreal therapy for neovascular AMD just before cataract surgery allows the eye greater recovery time in the post-operative period before further planned intravitreal therapy.
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Affiliation(s)
- Hemal Mehta
- Save Sight Registries, University of Sydney, Sydney, NSW 2000, Australia;
- Strathfield Retina Clinic, Strathfield, Sydney, NSW 2135, Australia
- Ophthalmology Department, Royal Free London NHS Foundation Trust, London NW3 2QG, UK
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