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Paul Namkoong, Yianni Yiannakou, Lynnette Hoai Nguyen, Keshav Narain, Randal Pham; Use of Microperimetry and Visual Electrophysiology to Improve Success of Implantable Miniature Telescopic Lens in Patients with Central Macular Atrophy. Invest. Ophthalmol. Vis. Sci. 2018;59(9):74.
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To determine if utilization of currently available office-based diagnostic technologies can improve success with an intraocular implantable miniature telescope (IMT) of patients with central macular degenerative disease.
Using our criteria, we identified 16 patients as IMT candidates. We carried out standardized visual evoked potential (VEP) and electroretinography (ERG) (Diopsys) along with microperimetry (MP) (MAIA) and wide field retinal imaging (Optos) on all 16 patients. We then assessed the postoperative visual function and compared it to expected outcomes based on the IMT simulator. Of the 16 candidates, 3 were selected for surgery and 2 have thus far underwent implantation of the IMT.
Two patients completed surgical implantation with the IMT. Patient 1 had pre-op BCVA of +1.3(logMAR) and +0.8(logMAR) postop. Patient 2 had preop BCVA of +0.54(logMAR) and postop of +0.40(logMAR). Both patients had central geographic atrophy along with areas of healthy retina per MP. Additionally, both patients had normal optic nerve latencies on VEP and were able to identify some projected points via fundus directed MP. This allowed for the cataract surgeon to orient the IMT lens towards functionally healthier areas of the retina.
We propose that the use of electrophysiology, MP, and wide field imaging will benefit any patient considered for the IMT. These tests enable optimization of lens type and orientation and help identify patients that may benefit from the IMT. IMT may also be considered in other macular disorders. First, ERG and VEP enables determination of retinal and optic nerve function1. This facilitates objective comparison between the two eyes and helps determine which eye may be better suited for the IMT. Second, MP combined with wide field imaging enables enables the surgeon to appreciate boundaries between functional and nonfunctional retina, allowing for optimal orientation of the IMT. Current on-label use is limited to patients with dry AMD. Nonetheless, utilization of our pre-IMT testing protocol can improve the likelihood of postoperative success in patients with other retinal diseases characterized by static areas of central retinal dysfunction.1 Visual Evoked Potentials in Glaucoma and Alzheimer's Disease.E Cerri-C Fabiani-C Criscuolo-L Domenici - https://www.ncbi.nlm.nih.gov/pubmed/29190019
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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