May 2010

 

CATARACT/ IOL

 

Looking at a new macular implant


by Isaac Lipshitz, M.D.

 

Despite the incredible advances in the treatment of wet macular degeneration, there are still many patients who develop poor central vision resulting in impaired daily function. One attempt to help these patients has been the use of an implantable miniaturized telescope (IMT) that can be inserted into the capsular bag at the time of cataract surgery yielding enhanced central vision similar to that of external telescopes but without the disadvantages inherent in an external device. As a clinical investigator for this device I could appreciate the improved visual function that resulted in some of the patients and their enhanced quality of life. Isaac Lipshitz, M.D., one of the developers of the IMT, has also been working on an implantable low vision aid that utilizes mirrors for enhanced vision. This device is touted to improve visual function without restricting peripheral vision and may represent a leap forward in implantable low vision aids for patients with macular disease. In this column, Dr. Lipshitz reviews the latest advances in the Lipshitz Macular Implant (LMI).

Richard Hoffman, M.D., Column Editor

 

In spite of the recent advances in IOLs, we have to remember that there is still a large and growing group of patients that cannot enjoy the results of modern cataract surgery. These are the AMD patients. For these patients, vision may be improved by intraocular optical telescopic implants.

OptoLight Vision Technology (Hertzlia , Israel) is developing and manufacturing several new concepts for creating advanced intraocular telescopic implants for AMD: •Implanting mirrors inside the eye for directing light instead of lenses •Creating a visual field that magnifies only the central visual field and leaves the peripheral field unchanged •Blocking the entering image before it reaches the macula, modifying it and only then projecting the modified image onto the macula •Developing an “intarocular projector” that acquires an image & modifies it according to patient’s need, projecting on the retina •Creating a small telescope that can fit entirely into the capsular bag Recently, German and British researchers found a fish called Dlichopteryx Iogipes that lives 700-1000 meters deep and uses mirrors inside its eye instead of lenses to direct light. Not only was the finding—reported in the December 2008 issue of Current Biology—incredible, it was validation that using implantable mirrors for low-vision patients—something we have been working on at OptoLight Vision Technology—is not only possible, but exists in nature. As the inventor of the implantable miniature telescope (IMT, VisionCare Ophthalmic Technologies, Saratoga, Calif.), which is close to Food and Drug Administration (FDA) approval, I found that the intraocular Galilean technology—while good —has limitations that OptoLight’s mirror telescopic technology can improve. Using mirrors, our new technology, the Lipshitz Macular Implant (LMI), allows for normal peripheral vision while magnifying only the central image.

Essentially, by using mirrors, the LMI doesn’t depend on the index of refraction of the media. That is why we could design a smaller telescope that fits entirely in the capsular bag.

In AMD, most photoreceptor cells on the center of the macula do not function and cannot detect light, but photoreceptor cells in the more peripheral area are still alive and functioning. By implanting mirrors inside the eye and magnifying the image the light can be diverted in any way we want, thus creating magnification only of the central visual field. A patient with the LMI, therefore, could look around orientate and see the world normally using his normal peripheral vision. The LMI will be an incredibly useful device for other diseases such as hemianopsia or other field defects, albinism, and macular holes, to name a few. The widest use of the LMI likely would be for AMD patients, most of whom have the dry type and have no current treatment options. We have a system to test candidates before implantation to determine whether they need the LMI. The test is performed with an external telescope of the same magnification, and we can determine how much improvement the patient would experience postoperatively. The patient can then decide if he or she wants the procedure or not. The LMI implantation is a complementary treatment to all other retinal medical treatment so the patients also can receive any other kind of AMD treatment for his disease. The LMI is CE–approved and distributed in all non–FDA regulated markets.

Editors’ note: Dr. Lipshitz is CEO of OptoLight Vision Technology (Herzlia, Israel).

Contact information

Lipshitz: 972-9-9541560, info@optolight.net

Looking at a new macular implant Looking at a new macular implant
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