Clinical Experience with the Implantable Miniature Telescope for End-stage Age-related Macular Degeneration

The implantable miniature telescope (IMT) is the first approved surgical treatment for visually impaired people with bilateral central vision loss due to end-stage age-related macular degeneration. The IMT – which is implanted unilaterally in the capsular bag following cataract extraction – provides 2.2x or 2.7x magnification of the central visual field. Clinical trial data suggest that the IMT can provide substantial and sustained improvements in best-corrected distance, near visual acuity, and patient quality of life metrics. These positive outcomes are heavily dependent on patient selection and screening, surgical technique, and postoperative rehabilitation, a treatment process that must be managed on an interdisciplinary basis over the course of 3–4 months. Here, we review the clinical trial data examining the safety and efficacy of the IMT, report our preliminary results with 13 real-world patients implanted with the commercial device (11 with follow-up data), define the key surgical techniques that contribute to optimal outcomes, and describe the anterior segment surgeon’s role in supporting both pre- and postoperative care. Nine eyes (82%) gained 4 or more lines of vision and two eyes (18%) did not gain any lines of vision.

The implantable miniature telescope

Bilateral, end-stage, age-related macular degeneration (AMD) is a devastating condition of the eye. As the leading cause of blindness worldwide in the elderly, it leads to poor quality of life. While antivascular endothelium growth factor agents are used as front-line treatment for wet AMD, no current treatment exists for bilateral, end-stage AMD in Canada. The implantable miniature telescope (IMT), approved by the Food and Drug Administration in 2010, is a treatment option available for those over the age of 65 in the United States with stable severe to profound vision impairment (best-corrected visual acuity 20/160 to 20/800) caused by bilateral central scotomas associated with bilateral, end-stage AMD. Combining the fields of engineering and ophthalmology, intraocular implantation of the IMT provides improvements in patients’ functional vision and quality of life. As a relatively new treatment targeting the elderly, there are strict inclusion criteria as well as risks associated with the procedure. However, research and continuing development in this field is ongoing to minimize these risks.