July 2016

Bright New World

Legally Blind Patients of Dr. Jack Abrams are Given the Gift of Sight Thanks to a Mini Telescope

By Lisa Stark



“I used to see black, but now I see light” is how Shems Yakkar describes the world around her. Her once-darkened view is now alive with color, shape and detail.

Thanks to a revolutionary new technology to treat the most severe form of age-related macular degeneration, or AMD, legally blind people like Yakkar can see again. It sounds like a miracle promise, but improved vision is a reality for the spritely 76-year-old.

“I can see your face and your eyes,” she says. Before, I would only see black where your head is. But now I can clearly see the pattern of your blouse and an outline of you.”

This is how Yakkar, sitting in her kitchen in Las Vegas, explains what I look like. Three months ago, Dr. Jack Abrams surgically inserted an IMT – Implantable Miniature Telescope – into her right eye after AMD robbed her of her central vision.

“When I first heard about this breakthrough I thought, ‘wow, this is magnificent!’” says Abrams, part of an elite group of surgeons worldwide to have access to the IMT. “Patients with this stage of advanced AMD had no hope. I was frustrated I didn’t have anything substantive to offer them. In the past we tried handheld magnifiers and glasses, but we never had anything custom made to the eye like the telescope.”

The first-of-its-kind telescope implant is integral to CentraSight®, a new way of treating patients with End-stage AMD, the leading cause of legal blindness in older Americans. The FDA-approved implant is the only surgical option that improves visual acuity by reducing the impact of the central vision blind spot End-stage AMD causes.

Smaller than a pea, the IMT is a miniaturized Galilean telescope inserted in place of the eye’s natural lens. The device uses micro-optical technology to magnify images that normally would be seen in one’s “straight ahead,” or central, vision. The roughly three-times larger images are projected onto the part of the retina not affected by the disease. That makes it possible for patients to see or discern the central vision object of interest. It takes patients about six months to assimilate their new vision. The vision improves gradually over time.

“This is the most innovative procedure to help people who are legally blind, people who are forgotten,” says Abrams. “This gives them a second chance to see loved ones’ faces and do the everyday things we take for granted, such as pouring a cup of coffee, opening the mail or watching TV.”

For Yakkar the improvement has been incremental but significant. Before surgery her vision was 20/200. Now it’s 20/100, which means three lines of vision improvement on the eye chart.

“I have to train myself to look with both eyes,” she says. “I use my right eye, the telescope eye, for central vision and my left eye for periphery.”

It takes a certain tenacity to learn how to assimilate the telescope and retrain the brain. The Germany-born Yakkar went through a diligent screening process to determine if she could benefit from the telescope implant. Spend a few minutes with her, and you’ll see why she was picked.

Strong, independent and feisty, she raised three kids while enjoying a professional career outside the home. As manager of export licensing for a software company, she worked with the National Security Agency and traveled the world, prowling museums wherever she went. “I love history and I love to learn,” Yakkar says.

The many books that line her shelves hint at the life she once had.

“I used to read six or seven books a week,” she says. “I loved knitting and crocheting. It reached a point where I just couldn’t do any of it anymore.”

AMD is an insidious disease. It starts slowly but eventually robs a person’s central vision, leaving an ever-growing black spot where the primary focus was. The peripheral vision is not affected.

Up to 11 million people Americans have some form of AMD, a number that’s expected to nearly double by 2050.

For Yakkar, the problem began three years ago. Even as she lost her vision, she held on to her sense of humor.

“I was walking around my neighborhood early in the morning,” she recalls. “I must have been weaving because a car stopped and a young man said, ‘I can’t believe you are drunk at 8 am!’ I waved at him and said, ‘But at least I am having fun!’”

Deep down she was enormously frustrated. “I had been so active. And then I couldn’t do anything anymore.”

Bionic Eye

Smaller than a pea, the IMT is surgically inserted in place of the eye’s natural lens.

At her lowest point, Yakkar found Abrams, a fellowship-trained cornea specialist involved with the CentraSight treatment program in Las Vegas. VisionCare Inc., a privately held company with research facilities in Petah Tikva, Israel, developed the IMT and its corresponding CentraSight program.

Although the device is Medicare-eligible and FDA-approved, only 600 IMT surgeries have been done globally. Abrams is one of 200 surgeons worldwide to perform the IMT insertion. He was chosen for his experience, skill and collaborative approach.

“This is an advanced procedure,” says Reena Mishra, a Vision Care executive, “so you need a surgeon with a high level of technical expertise, and (who is) open to a collaborative approach with other eye care specialists. Dr. Abrams is extremely committed to his patients, and we are appreciative of his willingness to be part of a life-changing event.”

For Abrams it was a no-brainer. “I looked at this as an opportunity to help,” he says, and a natural step for someone whose practice has been based on acquiring the most cutting-edge technology available. He brought laser technology for cataract surgery to Nevada in 2012, and is the most experienced surgeon for laser-assisted cataract surgery and lens implantation.

IMT “is a very challenging surgery,” he says, “because we have to insert the telescope, which is five times larger than an average lens. Then you have to center it properly. And that is where the laser comes in.”

The laser creates a perfect circular opening in the eye, a delicate organ in a miniature setting. The slightest movement makes a difference. For that reason, the laser is the most effective tool.

Yakkar wasn’t nervous the day of her surgery. “I had nothing to lose,” she says with a smile, “and everything to gain.”

Back From The Black

People who suffer from Macular Degeneration slowly lose their center vision.

Sitting across from Yakkar, the telescope is clearly visible, a gold fleck where the black pupil is in the other eye.

Three months post-surgery, “I am reading fantasy novels on my Nook again,” she says. “I can also watch my favorite PBS programs.”

She still needs her son to help balance her checkbook and read her mail. And she’s learning how to merge her vision so her two eyes work in tandem. At times, she sees two images.

These are challenges still to be overcome and Yakkar is laser-focused on reaching her goal.

“I am very optimistic and willing to work hard,” she says.

There is good reason for her optimism. A five-year study on the long-term impact of the IMT shows substantial retention of gains in visual acuity over time. According to the analysis, younger (65 to under 75) and older patients (75-plus) showed clinically significant visual acuity gains at two years and five years after telescope implant.

Yakkar hopes her story will reach other people with AMD. She learned about the surgery from a cousin in Germany.

“The IMT should be publicized and promoted in the United States,” she says. “It can change lives.”

Abrams cautions that the IMT is not a panacea, nor “a cure for the disease. It is just another aid in helping these patients see better.” What’s more, only a small percentage of those with AMD are suitable for the IMT surgery. The treatment program focuses on comprehensive patient care, requiring prospective patients to undergo medical, visual and functional evaluations to determine their suitability as candidates.

“Since this is such a new technology, the patient inclusion criteria are very selective,” Abrams says. “We are working on expanding the pool to include more people in the future.”

These breakthroughs inspire Abrams and his fascination with ophthalmology, where something new is always on the horizon.

“We are constantly seeking and finding ways to offer more options to more patients,” he says. “Every day we are discovering new technology and improving existing technology to improve the vision of people suffering from many different conditions.”

For Yakkar, the end goal is in sight, so to speak.

“I want to be able to see clearly,” she says. “Then I would like to get back into crafting, do more reading and go to a movie. I believe these are attainable.”

She’d also like to get some of her identity and her old life back, along with a measure of freedom that would come with it.

“I want to be able to function on my own again,” she says, “to be the person that I used to be.”

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