scholarly journals Simultaneous Perception of Prosthetic and Natural Vision in AMD Patients

2021 ◽  
Author(s):  
Daniel Palanker ◽  
Yannick Le Mer ◽  
Saddek Mohand-Said ◽  
José-Alain Sahel
Keyword(s):  
Peripheral Vision ◽  
Clinical Results ◽  
Geographic Atrophy ◽  
Age Related Macular Degeneration ◽  
Central Vision ◽  
Lighting Conditions ◽  
Age Related ◽  
Natural Vision ◽  
Simultaneous Use ◽  
Room Lighting

Abstract Loss of photoreceptors in atrophic age-related macular degeneration (AMD) results in severe visual impairment. Since the low-resolution peripheral vision is retained in such conditions, restoration of central vision should not jeopardize the surrounding healthy retina and allow for simultaneous use of the natural and prosthetic sight. We report the first clinical results with a photovoltaic substitute of photoreceptors providing simultaneous use of the central prosthetic and peripheral natural vision in atrophic AMD. Four patients with geographic atrophy have been implanted subretinally with a wireless 2x2mm-wide 30 µm-thick device, having 378 pixels of 100 µm in size. They demonstrated Landolt acuity of 1.17 ± 0.13 pixels, corresponding to the Snellen range of 20/460–20/565. With electronic magnification of up to a factor of 8, patients demonstrated acuity in the range of 20/63 − 20/98. Under room lighting conditions, patients could simultaneously use prosthetic central vision and their remaining peripheral vision in the implanted eye and in the fellow eye.

Implantation of the First IMT Macular Lens in Age-Related Macular Degeneration (Literature Review)

2019 ◽  
Vol 4 (4) ◽  
pp. 56-60
Author(s):  
M. M. Bikbov ◽  
O. I. Orenburkina ◽  
A. E. Babushkin
Keyword(s):  
Visual Field ◽  
Macular Degeneration ◽  
Peripheral Vision ◽  
Age Related Macular Degeneration ◽  
Central Vision ◽  
Central Visual Field ◽  
Visual Rehabilitation ◽  
Age Related ◽  
Terminal Form ◽  
Special Programs

This review presents the characteristics and results of clinical studies of patients with age-related macular degeneration implanted with the developed for this purpose first macular IOL – intraocular macular telescope (IMT). This lens was designed specifically for patients with the most severe or terminal form of age-related macular degeneration and is designed for monocular implantation to provide central vision while maintaining peripheral vision of the paired eye, which is important for maintaining the balance and orientation of patients. This device allows patients to see both in dynamic and static situations in the near, intermediate and far ranges. The disadvantages of this lens are a decrease in the visual field and depth of focus (which excludes its bilateral implantation), the need for a large (10–12 mm) incision for implantation, which can cause an increase in corneal astigmatism and the risk of complications, in particular, the pupillary block with an increase in intraocular pressure. There are also difficulties in the study of the fundus after its implantation to assess the small changes in the macula or to identify possible postoperative complications after cataract surgery (macular oedema, etc.). Also after the implantation of this lens, there is need for special programs of visual rehabilitation. The patient’s commitment to the rehabilitation measures for the adaptation of the central visual field of the operated eye with the peripheral vision of the second eye is crucial for success of the IMT macular telescope implantation procedure.

scholarly journals Acceptability of intravitreal injections in geographic atrophy: protocol for a mixed-methods pilot study

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e049495
Author(s):  
Jamie Enoch ◽  
Arevik Ghulakhszian ◽  
David P Crabb ◽  
Christiana Dinah ◽  
Deanna J Taylor
Keyword(s):  
Mixed Methods ◽  
Pilot Study ◽  
Geographic Atrophy ◽  
Age Related Macular Degeneration ◽  
Intravitreal Injections ◽  
Advisory Group ◽  
Central Vision ◽  
Age Related ◽  
Wet Amd ◽  
Medical Retina

IntroductionAge-related macular degeneration (AMD) is a common cause of visual impairment, affecting central vision. Geographic atrophy (GA) is an advanced form of the non-neovascular (dry) type of AMD. Late-stage clinical trials suggest that intravitreal injections of novel therapeutics may slow down the rate of GA progression by up to 30% in 1 year, thus allowing people with GA to preserve central vision for a longer period. While intravitreal injections have become an established treatment modality for neovascular (wet) AMD, it is unknown whether patients with (more gradually progressing) GA would accept regular injections that slow down, but do not stop or reverse, vision loss. Therefore, this mixed-methods pilot study will aim to explore whether regular intravitreal injections will be acceptable as treatment for patients with GA, and the factors that may affect treatment acceptability.Methods and analysisA mixed-methods survey has been designed in collaboration with a GA patient advisory group. The survey comprises of structured questionnaires, semi-structured interview questions regarding patients’ perceptions of intravitreal injections and the burden of treatment, and a task eliciting preferences between different potential treatments. Due to COVID-19 restrictions, this study will be conducted remotely by telephone. Thirty individuals will be recruited from NHS Medical Retina clinics at Central Middlesex Hospital, London. Half of the participants will be naïve to intravitreal injections, while half will have previous experience of intravitreal injections for neovascular (wet) AMD. Qualitative data analysis will be conducted using the Framework Method of analysis to identify key themes from participants’ accounts.Ethics and disseminationThe study received Health Research Authority approval on 23 March 2021 (IRAS Project ID: 287824). Findings will be disseminated through peer-reviewed publications and conference presentations to the medical retina community, as well as through dialogue with patients and macular disease charities.

scholarly journals Impact of living with a bilateral central vision loss due to geographic atrophy—qualitative study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e047861
Author(s):  
Gopinath Madheswaran ◽  
S Ve Ramesh ◽  
Shahina Pardhan ◽  
Raju Sapkota ◽  
Rajiv Raman
Keyword(s):  
Qualitative Study ◽  
Thematic Analysis ◽  
Vision Loss ◽  
Negative Impact ◽  
Geographic Atrophy ◽  
Age Related Macular Degeneration ◽  
Central Vision ◽  
Central Vision Loss ◽  
Age Related ◽  
The Impact

ObjectiveGeographic atrophy (GA), a type of dry age-related macular degeneration, affects vision as central vision loss (CVL). The challenges faced due to bilateral CVL in activities of daily living and strategies taken to overcome those challenges are not very well understood in the Indian population. This qualitative study aims to understand the impact on everyday life activities and related adaptive and coping strategies in people with long-standing bilateral CVL due to GA in India.Design, participants, setting and methodsA qualitative study using a semistructured face-to-face interview was conducted on 10 people with bilateral CVL after obtaining written informed consent. The interviews were audio-recorded, and were transcribed verbatim. Thematic analysis was carried out to understand the challenges faced and adaptive methods due to the impact of CVL.ResultsTen participants (50% male) with a median age (IQR) of 72 (70, 74) years were interviewed. All the participants had best-corrected visual acuity of ≤6/60 in the better eye and reported an absolute central scotoma with the home Amsler chart. Qualitative thematic analysis identified four main themes: challenges in everyday living (difficulty in face identification, reading), challenges with lifestyle and socialisation (driving, cooking, reading for a longer duration, watching TV, socially inactive), psychological implications (depression, poor self-esteem, fear due to poor vision) and strategies to overcome the challenges (voice identification, technology support).ConclusionGA has a severe negative impact on the quality of life in people with CVL. Inability to recognise faces was the main reason for dependency on others and being socially disconnected. The findings will help clinicians in providing improved rehabilitative care.

scholarly journals A Review of Completed and Ongoing Complement Inhibitor Trials for Geographic Atrophy Secondary to Age-Related Macular Degeneration

2021 ◽  
Vol 10 (12) ◽  
pp. 2580
Author(s):  
Omar A. Halawa ◽  
Jonathan B. Lin ◽  
Joan W. Miller ◽  
Demetrios G. Vavvas
Keyword(s):  
Macular Degeneration ◽  
Geographic Atrophy ◽  
Age Related Macular Degeneration ◽  
Western World ◽  
Complement Factor ◽  
Complement Protein ◽  
Pivotal Phase ◽  
Complement Inhibition ◽  
Exudative Amd ◽  
Age Related

Age-related macular degeneration (AMD) is a leading cause of irreversible blindness among older adults in the Western world. While therapies exist for patients with exudative AMD, there are currently no approved therapies for non-exudative AMD and its advanced form of geographic atrophy (GA). The discovery of genetic variants in complement protein loci with increased susceptibility to AMD has led to the investigation of the role of complement inhibition in AMD with a focus on GA. Here, we review completed and ongoing clinical trials evaluating the safety and efficacy of these studies. Overall, complement inhibition in GA has yielded mixed results. The inhibition of complement factor D has failed pivotal phase 3 trials. Studies of C3 and C5 inhibition meeting their primary endpoint are limited by high rates of discontinuation and withdrawal in the treatment arm and higher risks of conversion to exudative AMD. Studies evaluating other complement members (CFB, CFH, CFI and inhibitors of membrane attack complex—CD59) are ongoing and could offer other viable strategies.

scholarly journals Outer retinal tubulation formation and clinical course of advanced age-related macular degeneration

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Alessandro Arrigo ◽  
Emanuela Aragona ◽  
Ottavia Battaglia ◽  
Andrea Saladino ◽  
Alessia Amato ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Müller Cells ◽  
Geographic Atrophy ◽  
Age Related Macular Degeneration ◽  
Advanced Age ◽  
Age Related ◽  
Dry Amd ◽  
Foveal Sparing ◽  
Wet Amd

AbstractOuter retinal tubulations (ORT) are a relatively new finding characterizing outer retinal atrophy. The main aim of the present study was to describe ORT development in advanced age-related macular degeneration (AMD) and to assess its relationship with disease’s severity. Patients with advanced AMD characterized either by macular neovascularization or geographic atrophy, showing signs of outer retinal disruption or retinal pigment epithelium atrophy on structural optical coherence tomography (OCT) at the inclusion examination were prospectively recruited. All the patients underwent complete ophthalmologic evaluation, structural OCT scans and fundus autofluorescence imaging. The planned follow-up was of 3-years. Main outcome measures were ORT prevalence, mechanism of ORT formation, mean time needed for complete ORT formation, best-corrected visual acuity (BCVA), definitely decreased autofluorescence (DDAF) area, questionably decreased autofluorescence (QDAF) area, retinal layer thickness, foveal sparing, number of intravitreal injections. We also assessed the possible role of external limiting membrane (ELM) and Müller cells in ORT pathogenesis. Seventy eyes (70 patients) were included; 43 showed dry AMD evolving to geographic atrophy, while 27 displayed the features of wet AMD. Baseline BCVA was 0.5 ± 0.5 LogMAR, decreasing to 0.9 ± 0.5 LogMAR at the 3-year follow-up (p < 0.01). We detected completely formed ORT in 26/70 eyes (37%), subdivided as follows: 20 eyes (77%) wet AMD and 6 eyes (23%) dry AMD (p < 0.01). ORT took 18 ± 8 months (range 3–35 months) to develop fully. We described the steps leading to ORT development, characterized by progressive involvement of, and damage to the photoreceptors, the ELM and the RPE. Eyes displaying ORT were associated with a smaller QDAF area, less retinal layers damage and lower rate of foveal sparing than eyes free of ORT (p < 0.01). We also described pigment accumulations simulating ORT, which were detected in 16/70 eyes (23%), associated with a greater loss of foveal sparing, increased DDAF area and smaller QDAF area at the 3-year follow-up (p < 0.01). In conclusion, this study provided a description of the steps leading to ORT development in AMD. ELM and Müller cells showed a role in ORT pathogenesis. Furthermore, we described a subtype of pigment hypertrophy mimicking ORT, evaluating its clinical utility.

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