Enhancing the Functional Performance of Patients with Late-Stage Age-Related Macular Degeneration Implanted with a Miniature Telescope using Rehabilitation Training

Abstract

Introduction: In this work, our aim is to report the functional outcomes of cataract surgery with smaller-incision new-generation miniature telescope (SING IMT) implantation followed by rehabilitation training in patients with central visual loss due to late-stage age-related macular degeneration (AMD).

Methods: This retrospective study included patients who were monocularly implanted with SING IMT and then followed a rehabilitation program based on 6 biweekly sessions focused on visual abilities, reading, writing, visual motor integration and mobility. A total of 11 participants were included in this study. Reading acuity (RA), reading speed (RS), and fixation stability (FS) were assessed biweekly at 6-, 8-, 10-, 12-, 14-, and 16-week follow-up visits after SING IMT implantation and at a final assessment at 24 weeks. Best-corrected distance visual acuity (BCDVA) was also measured at baseline and at the same postoperative timepoints.

Results: Mean baseline BCDVA was 12.5 ± 8.6 letter score. Both RA and RS were found to be significantly improved from the first rehabilitation session (6 weeks after surgery) to the last session (24 weeks after surgery). At the end of the rehabilitation program, mean RA was 0.45 ± 0.19 LogMAR and mean RS was 30.9 ± 17.6 words per minute. Moreover, all patients achieved a FS of 15 s or more after the last rehabilitation session. Most patients (55%) achieved an improvement of 15 letters in BCDVA at the end of the study.

Conclusions: This study suggests that rehabilitation training can improve visual functions of patients with late-stage AMD implanted with SING IMT in real-world tasks such as reading skills.

Keywords: Geographic atrophy; Implantable ophthalmic device; Intraocular lens; Late-stage age-related macular degeneration (AMD); Low vision, visual rehabilitation, speed reading, reading acuity, smaller-incision new generation implantable miniature telescope, SING IMT; Visual impairment.

Fig. 1

Key skills and different steps covered by the rehabilitation training program to improve functional performance of patients following monocular implantation of SING IMT. PRL preferred retinal locus, SING IMT smaller-incision new-generation miniature telescope

Fig. 2

Influence of rehabilitation program on the reading acuity of patients after SING IMT implantation. A Reading acuity of patients after SING IMT implantation and several rehabilitation sessions. *p < 0.05, **p < 0.005 compared to first rehabilitation session (corresponding to 6 weeks postoperatively). B Cumulative proportion of patients who achieved their maximal reading acuity value according to the number of rehabilitation sessions. RA reading acuity, SING IMT smaller-incision new-generation miniature telescope

Fig. 3

Influence of rehabilitation program on the reading speed of patients after SING IMT implantation. A Reading speed of patients after SING IMT implantation and several rehabilitation sessions. *p < 0.05 compared to 1st rehabilitation session (corresponding to 6 weeks postoperatively) B Cumulative proportion of patients who achieved their maximal reading speed value according to the number of rehabilitation sessions. RS reading speed, SING IMT smaller-incision new-generation miniature telescope

Fig. 4

Cumulative proportion of patients who achieved their maximal fixation stability value according to the number of rehabilitation sessions. FS fixation stability, SING IMT smaller-incision new-generation miniature telescope

Fig. 5

Cumulative proportion of patients who experienced a BCDVA improvement in letter score in the study eyes between baseline and the last follow-up visit after SING IMT implantation. BCDVA best-corrected distance visual acuity, SING IMT smaller-incision new-generation miniature telescope