Low Vision News: Edition 3 with Dr. Faye

ELEANOR E. FAYE, MD, FACS, has served as Medical Director of Lighthouse International since 1956. She also served as Director of Lighthouse Low Vision Services from 1965 to 1992. Dr. Faye has been Internationally-recognized as an outstanding pioneer, doctor, and researcher in low vision. She is the author of the text, Clinical Low Vision. She has received numerous awards for distinguished service, from the American Academy of Ophthalmology, the American Optometric Association, the State University of New York, and many other organizations.

Follow up:

Editor: The New York Times recently featured an article about a telescope implanted in the eye of a patient with macular degeneration, and this news has captured the imagination of the public. Do you have personal experience with intraocular telescopes?

Dr. Faye: I started investigating intraocular telescopes about 30 years ago. This study led to the development of a working prototype which I surgically implanted in two patients.

Editor: What was the initial response to the device?

Dr. Faye: When both patients were seen for their initial follow-up exams, they were very happy. Soon problems started to develop. Because the retinal image sizes were different, patients reported double vision, which also caused problems with mobility. Ultimately, the telescope interfered with the patients’ peripheral vision and in both cases had to be removed. Patients with macular degeneration rely on their peripheral vision. Anything that interferes with peripheral vision cannot be tolerated.

Editor: What, if any, changes were made with the new version of the telescope, compared to the one that you used?

Dr. Faye: The new telescope is lighter and smaller than the one I used, but it ultimately has the same limitations.

Editor: What are those limitations?

Dr. Faye: The length and size of the human eye limits the length of the telescope, which controls its power. The maximum power that is practical is 1.7X. The major obstacle to surgically implanting one of these telescopes is that you do not know exactly where you are focusing the image. You could be on healthy retina or scar tissue, without knowing which one you have chosen.

Editor: Are there any advantages to this design over standard spectacle-mounted telescopes?

Dr. Faye: Having an internally-mounted telescope in an eye is more cosmetically acceptable, but I also think that the principal advantage of the spectacle telescope over the intraocular version is that the person puts on the spectacle for specific tasks, which, when completed, allows a return to normal perspective by removing the glasses. That means for the patient, selective use when needed without interfering with a person’s binocular vision which is so important to a person with macular disease.

Editor: How optimistic are you about developing this type of technology?

Dr. Faye: I have some serious reservations about using implantable telescopes for macular disease. There has been no new invention that has altered my own experience in using them years ago. My major concern is that macular degeneration is a progressive disease. Once a telescope is implanted, we have lost both accessibility to treat the macula and visibility to monitor change in retinal health. This would certainly limit the use of the telescope to patients who have dry macular disease, with the real possibility that since a small percentage of dry AMD can convert to the wet form, it would be difficult not only to detect the disease, but also difficult to monitor treatment.

Editor: Thank you so much for sharing your extensive experience and wise concerns with our readers.