An 81-year-old male with advanced dry age-related macular degeneration (AMD) was referred for the Compass, RestoRx(TM), Low Vision System, an innovative corneal laser designed to improve vision. The procedure has been used at the Bochner Eye Institute since 2018.
Best-corrected visual acuity was 20/100 in the right eye and 20/400 in the left eye. The patient was pseudophakic, having monofocal posterior chamber implants. Fundus examination revealed macular drusen and pigmentary changes. Computerized topography was normal. Optical coherence tomography (OCT) confirmed the presence of dry AMD.
Using the Gonzalez-Markowitz (GM) potential visual acuity charts, which display E letters of varying sizes, his near vision was assessed. The right eye showed an acuity 3 lines better than distance vision, while the left eye showed an improvement of 4 lines. This suggested the presence of functioning macular cells outside the fovea.
Based on these findings, the patient was deemed a suitable candidate for RestoRx. The procedure alters corneal topography by creating four superficial corneal spots in the mid-periphery, redirecting light 5–10 degrees away from the fovea. A quadrafocal corneal topographic pattern is created, and if the redirected light lands on functioning macular cells, vision can improve.
THE PROCEDURE:
Under topical anesthesia, the patient was positioned supine. A suction device was placed on the conjunctiva, centered over the pupil, and activated to secure it. A probe containing four laser cables was inserted into the suction device and locked in place magnetically. The laser was activated, creating four superficial corneal spots in the midperiphery to modify the corneal curvature and redirect light.
The procedure was painless, and the patient required no postoperative drops or medications. Since the laser does not disrupt the epithelial layer, the risk of infection is eliminated. A follow-up examination was scheduled for three months postoperatively.
POSTOPERATIVE OUTCOME:
At the three-month follow-up, the patient reported noticeable improvements in vision and daily activities. Visual acuity improved from 20/100 to 20/70 in the right eye and from 20/400 to 20/100 in the left eye.
A written note by the patient’s daughter:
“For the first time in many years, Dad is able see steps, put a key in a lock, see the TV screen better, and cut his own food. Thank you!”
KEY TAKEAWAYS:
1. CRITERIA FOR SUCCESS: The procedure is most effective when there are sufficient functioning macular cells 5–10 degrees from the fovea.
2. CANDIDATE SUITABILITY: Ideal candidates have vision loss of 20/60 to 20/800 in both eyes.
3. SCREENING WITH GM CHARTS: Patients who achieve a 3-line or more improvement in near acuity compared to distance acuity are strong candidates.
4. EFFICACY: Clinical studies have shown vision improvement in over 80% of AMD patients, with an average gain of 2–6 lines of acuity. This is based on scientific peer review papers published.
5. APPLICABILITY IN AMD: Both dry and wet AMD patients may benefit. However, wet AMD patients will still require intravitreal injections.
6. OTHER MACULAR DISORDERS: Conditions with other forms of central vision loss may benefit including Stargardt’s, Best Disease, etc.
7. ADVANTAGES OVER MAGNIFIERS: The Corneal laser procedure shifts the image to functioning retinal areas, whereas magnifiers only enlarge the image.
8. ADVANTAGES OVER PRISMS: The Corneal Laser procedure creates a quadrafocal cornea to distribute light in four directions 5-10 degrees from the fovea. Prisms only direct light in one direction.
9. NEUROADAPTATION: Neuroadaptation may further improve visual outcomes.
10. LIFESTYLE BENEFITS: The procedure can enhance independence by improving functional vision for tasks like opening doors with a key, recognizing loved ones, and writing checks—benefits that may not be reflected in Snellen acuity measurements.
FINAL THOUGHTS:
The RestoRx offers a promising option for individuals with AMD, with the potential of improving both visual acuity and quality of life.
Consultations are available at Bochner to determine candidacy in our all-new, state-of-the-art Bochner Innovation Centre. Contact us at 416-AMD (263)-1000 or AMD@bochner.com to schedule your personalized assessment.
REFERENCES:
1. Raymond M Stein, Samuel N Markowitz, Michael J Berry II, Michael J Berry, Corneal laser procedure for vision improvement in patients with late stage dry age-related macular degeneration-a retrospective observational cohort study, F1000Research 9, 1500, 2020
2. Robert Devenyi, Samuel N Markowitz, Michael Berry II, Michael Berry, Corneal laser procedure for vision improvement in patients with neovascular age-related macular degeneration and other retinal disorders involving central vision loss, F1000Research 11, 316, 2022
