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    Device creates intraocular telescopic effect

    An intraocular device (Lipshitz Macular Implant [LMI]) is a new concept in the treatment of age-related macular degeneration (AMD) that taps into telescopic mirror technology to redesign patients' vision, said its inventor, Isaac Lipshitz, MD, Herzlia, Israel.

    The implant—an IOL with a magnifying telescope inside—increases the central visual field by a factor of 2.5 while preserving normal peripheral vision, a feat not possible with regular lenses, he explained.

    "The 21st century will be an era of aging populations, and in addition to finding surgical solutions for presbyopia, treating AMD will become a significant challenge for ophthalmologists," Dr. Lipshitz said.

    New frontier

    AMD could be a new frontier for cataract surgery with implants such as the intraocular mirror telescope, he added.
    The device looks like a regular IOL but incorporates two miniature mirrors, which create an intraocular telescopic effect that magnifies only the central image. It is fully implanted in the bag, can be implanted in both eyes, preserves good retinal visibility for future treatments, and can be used for any type and any stage of AMD or other retinal diseases, according to Dr. Lipshitz.

    The device does not decrease the total amount of light entering the eye since the pupillary opening is not disturbed, as it is in other IOLs fitted with a non-mirrored telescope.

    With this device, the amount of light that enters the eye and is reflected onto the retina is controlled by the special coatings on the mirrors that collect the light and improve contrast.

    The modified and enlarged image is projected on the central retina, creating an enlarged image over a wide area in order to improve central vision.

    According to Dr. Lipshitz, the patient selection criteria for implantation of the lens are based on evaluating the potential visual improvement that could be reached with an external telescope.

    As the implant can be done bilaterally, it is not necessary for patients to have similar visual acuity in both eyes or acuity below a certain standard.

    Since the peripheral vision is preserved, the lens can be implanted in one eye regardless of the visual acuity of the other.

    Similar dimensions

    This second-generation of the company's implantable mirror telescope is similar to a traditional IOL in its dimensions (6.50 mm, 13.50 mm loops, 2.1 mm central thickness), and the implantation technique is comparable with that used with other PMMA IOLs.
    The device is CE certified and is available in all markets not regulated by the FDA.

    New concepts

    Intraocular mirror technology has contributed a number of new concepts to ophthalmology, Dr. Lipshitz said.

    These include implanting reflecting surfaces (mirrors) inside an eye, creating an intraocular projector, implanting an entire telescope in the bag, stopping an image from reaching the retina, acquiring it, modifying it, and only then projecting it onto the retina, and magnifying only the central visual field, leaving the peripheral field normal, according to Dr. Lipshitz.

    The device could be modified for treatment of macular diseases other than AMD and for conditions such as albinism, diabetic maculopathy, other maculopathies, Stargardt's disease, malignant myopia, bilateral amblyopia, and others.

    A pilot study evaluating the visual and surgical outcomes of the device for AMD and other macular conditions was performed in 2007 by Amar Agarwal, MS, FRCS, FRCOphth, at Dr. Agarwal's Eye Hospital and Eye Research Centre, Chennai, India.

    Six eyes of six patients had surgery; results published in the Journal of Cataract and Refractive Surgery showed that there were no intraoperative complications; the mean gain in distance visual acuity was 3.66 lines 1.88 SD, and the mean increase in the Early Treatment Diabetic Retinopathy Study. score for near acuity was 50.83 9.15 logMAR.

    Nancy Groves
    Nancy Groves is a freelance medical writer.

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