Make a fist and cover one eye.
Now, slowly move the fist about 6 inches away from the eye. Notice the fist has become a large blind spot in the middle of the central vision?
That is exactly how Dr. Marc Levy of the Sarasota Retina Institute at 3400 Bee Ridge Road, Suite 200, describes what end-stage, age-related, macular degeneration is like for the sufferer. It's a condition where a part of the eye's retina called the macula has suffered damage over time possibly due to one or a combination of the following reasons -- over-exposure to sunlight, fatty diet, high blood pressure or simply genetic pre-disposition, Levy said.
Patients with end-stage macular degeneration find it difficult or impossible to see faces, read and perform activities of daily living, Levy said.
But Levy can now offer hope to some, but not all, of the estimated more than 500,000 patients in the United States today with this end-stage vision loss.
Levy is the first doctor in Florida who has removed the cloudy natural lens in a patient's eyes and implanted a miniature telescope in its place.
In January, the U.S. Food and Drug Administration lowered the age requirement from 75 to 65 for those eligible for the surgery.
"Technically, it's more complicated than a routine cataract surgery," Levy said last Monday. "It takes about an hour. It requires a larger incision in the eye and requires stitches. The patient is awake. They are numbed and sedated. I'm very happy with what I am seeing. The procedure works. In some cases, my patients have been able to recognize the faces of family and friends again. Some of our patients have improved five to seven lines of vision on the eye chart. Many have marked improvement in daily living."
Levy has now done 13 of these surgeries since 2002, including five in FDA trials and eight after FDA approval. He has performed eight implant surgeries in the last two years, an average of one every two or three months.
"You have to find the right patients," Levy said when asked why he has done so few of the surgeries.
A personal commitment to vision
One might think that a doctor who inserts telescopes in people's eyes might tend to project a brainy quality no layman could penetrate. But Levy is pretty much a regular guy who likes to play tennis and power walk across the Ringling Causeway in his free time. He has two granddaughters, Shelby and Millie, he adores, and revels in being the ophthalmologist for the Tampa Bay Rays. "Yes, their eyesight is sensational," Levy said with a grin about baseball players.
Growing up in Miami, Levy was a devoted "Trekkie." In fact, as a teenager, Levy won the eighth grade division of the Dade County Science Fair with a Star Trek "phaser" he made out of a laser.
Levy's love affair with vision may have started with his grandmother, Lillian Townsend, who suffered from severe macular degeneration in the 1970s before Levy went to medical school, way before he would study to become a specialist in neuro-ophthalmology and orbital surgery.
But he knows why he made the choices he did.
"Lillian kept waiting for something to help her vision," Levy said. "She has since passed away, but I think of her. She couldn't see the big letter E on the eye chart."
The implantable miniature telescope that may have helped Lillian was invented by Dr. Isaac Lipshitz of Israel in the 1990s, Levy said.
"The device was a joint effort between Israel and the U.S.," Levy said. "Although Dr. Lipshitz created it, Israel didn't have all the technology to do the implant. For that, a Saratoga, Calif., company called VisionCare assembled the Israeli optics."
VisionCare owns the device and CentraSight is the program involving the telescope, said Peggy Jelemensky, research coordinator for Sarasota Retina Institute and the person who helped Levy through 10 years of U.S. Food and Drug Administration clinical trials before the telescope was approved in 2010.
"Whenever a patient wants information about the telescope CentraSight will route them to a surgeon close to them," Jelemensky said. "They coordinate things for VisionCare."
The telescope actually minimizes the size of the "blind spot," technically known as a scotoma, because it magnifies everything else around it, Levy said.
"The blind spot becomes one third of its size," Levy said.
This special surgery, which costs around $20,000, is Medicare approved, Levy added.
The telescope has two little spring-like devices with supporting arms that hold it in place in the eye.
"In all the surgeries I have done, none have become dislodged," Levy said of the telescope's arms.
The procedure is outpatient with the patient getting a patch and returning the next day, Levy said.
"We ask them to stop using the other eye and start looking through the telescope eye," Levy said. "One of the training methods is to put a patch over the non-telescopic eye."
Some of the patient stories are so dramatic they can cause tears, from both the patient and clinic staff, Jelemensky said.
"During a recent surgery Dr. Levy did this year, I was in the room when he took the patch off the patient," Jelemensky said. "That patient started laughing. I started crying. It was so moving."
The telescopes are fixed at three-times power, are sterile and don't require adjusting or cleaning once they are implanted, Levy said.
Frustration for cataract surgery patients
Jelemensky takes calls at Sarasota Retina Institute from people who are interested in the implant. She is always positive and encouraging with the patients. The toughest part of her job, she says, is telling people who have had cataract surgery on both eyes that they are not eligible at this time for the telescope.
The implant is only federally approved for people who have not had surgery of any kind in the eye that gets the implant, Levy said.
"A lot of patients over a certain age have had cataract surgery and that has been the biggest disappointment on the phone," Jelemensky added. "Until we can do it for those patients we just try to keep track of them. If we get the go-ahead it would open things up a lot."
Said Levy of the FDA rule: "They want them to be a virgin to eye surgery. They are keeping it simple."
For now, the only way around the cataract rule is to go to Europe for the implant, Jelemensky said.
"I tell them they are welcome to keep calling me and that's what some will do," Jelemensky said. "I tell them to also call CentraSight and be asked to be put on a list of people who have had cataract surgery and are waiting for it to be approved."
The surgery right now is also just approved for those 65 and older, but Jelemensky doesn't discourage 62 and 63-year-olds, believing age reduction will happen.
"The age recently was lowered so it could go down again," Jelemensky said. "I am not discouraging anyone because of age."
It also matters a bit if the client is suffering from "wet" or "dry" macular degeneration. The wet form, which usually requires treatment injections, occurs when new blood vessels sprout beneath the retina and leak blood, Levy said.
The damage that the leakage does to rods and cones make these "wet" patients less than perfect candidates for the telescope, Levy said. Dry is better for the implant but a wet patient could qualify if their condition has been stable for six months, Jelemensky said.
"Even if they are getting injections we can have them come into the office and try a hand-held telescope," Jelemensky said. "If they can't see with the telescope or it doesn't improve them enough, we say, 'Ok, once you are stable let's try again.'"
For information call CentraSight at 1-877-99SIGHT or Peggy Jelemensky at 941-921-5335.
Richard Dymond, Herald reporter, can be reached at 941-745-7072 or contact him via Twitter@RichardDymond.