In the 1970s TV show, “The Six-Million-Dollar Man,” Steve Austin had, among his many super-human implements, a bionic eye with a tiny telescope to enhance his vision.
Four decades later, science fiction has become science fact in Sarasota. Dr. Marc Levy of the Sarasota Retina Institute (SRI) has been a leading player in a new internationally developed technology that restores vision to patients who are legally blind due to advanced dry macular degeneration, a previously incurable condition. Like Austin, the bionic superhero, some Southwest Florida senior citizens now see through a tiny telescope implanted into one of their eyes.
Nearly 11 million Americans have age-related macular degeneration (AMD), in which the cells of the macula (the light-sensitive “film” of the eye) break down. It affects the center of a person’s vision—whatever they’re trying to look at directly. To replicate the condition, Levy recommends holding your fists about six inches in front of your eyes; your peripheral vision remains, but you can’t see anything straight ahead.
AMD is a leading cause of irreversible blindness in people over 60. About 90 percent of current AMD cases are “dry” degeneration, which has no approved treatment beyond vitamin supplements, including a popular combo called AREDS2, that may in some cases slow the disease’s progress.
“Prior to 1999 the only thing we could do [for enhancing AMD-damaged vision] was to give people very, very strong magnifying glasses,” says Levy. “They could read, but they had to put the type very, very close to their nose.”
Dry AMD can progress to wet AMD, in which new, brittle blood vessels grow under the retina. While devastating, wet AMD can be treated with injections called anti-VEGF, which can slow the blood vessel growth and possibly reverse the condition back into dry AMD.
From 2002 to 2004, SRI was one of 28 centers throughout the U.S. to participate in FDA surgical trials for implantable telescope technology (brand name CentraSight) to improve vision and quality of life for people with advanced dry AMD. During that time, Levy performed five surgeries in which a miniaturized Galilean telescope was implanted into one eye of patients with advanced dry macular degeneration in both eyes.
While the telescope provides a precise window of clearer vision straight ahead, the eye without the telescope continues to provide peripheral vision. The brain quickly adapts to blend the two images together.
The five-year data from that initial study showed that patients on average went from 20/300 vision—legally blind—to about 20/100. Since FDA approval, the procedure is getting close to achieving 20/40 vision in patients who were previously crippled by AMD. In some states, this procedure may get to the point where previously blind patients will be able to drive again (though not Florida, which has driving prohibitions on telescopic lenses).
Meanwhile, Levy is the study investigator for Florida in a new FDA trial testing the telescope technology for patients who have previously had cataract surgery. In this case, the intraocular lens (which had been implanted after cataract removal) is removed before the telescope is implanted. Patients with intraocular implants had been excluded from the initial trial, but if this next version of the procedure is approved, many more people will be able to benefit from the CentraSight technology. After all, Levy points out, so many people over the age of 60 these days have already had cataract surgery.
Far from a $6 million solution for a single bionic man, this microscopic telescope has already benefitted hundreds of patients and may soon be available for thousands more. CentraSight is a technological advance that does more than improve vision; it affects a person’s entire health.
“If you have better vision, you can go out and walk, you get exercise,” Levy says. “You live a happier life.”