June 13, 2003

VUMC first in region to offer vision-restoring surgery

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Dr. Jeffrey D. Horn performs the procedure to implant the miniature telescope into the eye of Gerald Torgersen.
(photos by Dana Johnson)

VUMC first in region to offer vision-restoring surgery

Dr. Jeffrey D. Horn prepares the miniature telescope for implantation. The device is assembled of plastic and glass and is half the size of a tiny watch battery.

Dr. Jeffrey D. Horn prepares the miniature telescope for implantation. The device is assembled of plastic and glass and is half the size of a tiny watch battery.

The implantable miniature telescope shows in the pupil of Torgersen’s eye.

The implantable miniature telescope shows in the pupil of Torgersen’s eye.

For most of his career Gerald Torgersen worked construction on the high steel beams as a structural ironworker helping build Chicago’s massive skyline until macular degeneration robbed him of his sight, bringing him back down to earth to an early retirement fraught with disability.

Last Friday at Vanderbilt University Medical Center the 69-year-old, now a resident of Red Boiling Springs, became Middle Tennessee’s first patient to receive an experimental telescopic device implanted in his eye that his physicians hope will help Torgersen regain a portion of his sight.

During the half-hour procedure performed under local anesthesia, the device, called the Implantable Miniature Telescope (IMT), constructed of plastic with a telescopic glass lens about the diameter and thickness of a tiny watch battery, was implanted into Torgersen’s right eye behind the iris.

Surgical implantation of the device is similar to routine cataract surgery, with the exception of a wider incision in the cornea necessary to insert the IMT.

People with macular degeneration typically begin to lose the center of their field of vision first, which appears to them as a black dot growing larger from the center out. Over time as the disease progresses, the size of the dot increases until there is no central vision; only peripheral vision remains.

Torgersen received the IMT as part of a phase-III clinical trial being conducted at VUMC by Drs. Jeffrey D. Horn, Paul Sternberg Jr., Anita Agarwal and Jeffrey Sonsino of the Department of Ophthalmology and Visual Sciences. The trial is for two groups of patients: those with age-related macular degeneration with cataracts, or those with another ocular disorder, Stargardt’s disease with cataracts.

“For most patients with macular degeneration, and there are many of them, there’s not much that can be done,” Horn said. “As a cataract surgeon I will offer to remove their cataracts, which may improve their peripheral vision allowing for better mobility, but without any expectation the procedure will improve their central vision.

“These patients often ask upon every return visit if there is anything new that can be done to help their sight. All too often the answer is no. But maybe if the clinical trial for this device proves effective, I may actually have something I can offer to improve the quality of their life.”

Torgersen says it’s been four or five years since he was last able to recognize faces. When he and his wife of 46 years Bonnie are separated out in public, the only way he is able to be sure it’s her is by using his peripheral vision to look for her familiar hair style. “I have to be careful in Walmart. If I run up and grab the wrong woman I might get my face slapped,” he joked.

The IMT functions like a telephoto lens mounted inside the front surface of the eyeball and works by magnifying the patient’s central vision. The IMT’s lens, coupled with a patient’s cornea, provides magnification that works to reduce the size of a patient’s central blind spot. Patients in the study will receive an IMT lens with either a 3.0X or 2.2X magnification, depending on their particular need.

Unlike external low vision aids, which can be cumbersome and even cause nausea in patients due to distortion of the visual field caused by rapid movement, the IMT becomes part of the eye and tracks with the patient’s normal line of sight.

Trial participants need to have been diagnosed with bilateral, stable, untreatable macular degeneration (AMD) or Stargardt’s disease. Patients with both dry and wet forms of AMD can be potential candidates for the device. Patients with wet AMD are eligible for the study only if their disease is inactive and have not received treatment for the disease within the last six months.

“Inclusion criteria for the trial is vision from 20/80 to 20/800 in either the wet or dry form of macular degeneration. Because this device is going into the eye in place of the human lens, patients must have a cataract as well,” said Horn.

Macular degeneration is the most common cause of central blindness in the United States in individuals 65 and older. “It’s all too common a disease which has very few treatment options that will result in improvement in vision and function,” Horn said. “What we now have is a potential option for some patients who can receive this device and have it with them all the time.”

Patients who receive the device will use the IMT-containing eye for close vision to again be able to perform once simple tasks, such as being able to fill a cup with water and tell it’s full. The other eye is left unaltered and is used for peripheral vision.

“The device is investigational and will go through the scrutiny of testing in certain centers across the U.S. and the FDA approval process. If the device shows it’s helpful, then I certainly think it will benefit a subset of patients with macular degeneration,” said Horn.

For Torgersen, the decision to participate in the trial was pretty simple. “Somebody’s got to do it,” he said. “I hope to regain a little of my vision so I can recognize people again. Heck, I just want to be able to go fishing and be able to see the bobber, or be able to see my grandchildren’s faces.”

As part of the nationwide study, the Vanderbilt Eye Clinic plans to enroll eight patients in the IMT trial. For more information about the IMT trial contact Sandy Owings, clinical trials specialist in the Department of Ophthalmology and Visual Sciences at 936-2020.