A team of specialists in Kaiser Permanente San Diego’s (KPSD) Ophthamology department is the first of all Kaiser Permanente facilities to offer Implantable Miniature Telescopes (IMT) that are surgically placed in the eye during an outpatient visit to improve vision. Nationally, there are only 50 sites to provide this cutting-edge technology, and approximately only 200 IMTs have been implanted around the world since the pea-sized device became available in 2010.
Under the direction of Dr. Peter Custis, chief of ophthalmology for KPSD, and Drs. Leslie Purcell and Tim Yee, VE, who are the only two certified low-vision specialists at KPSD, the technology offers invaluable benefits for the right candidate. For example, it could allow a person to see their family member’s face at the dinner table again. However, not everyone with low-vision is a good fit for the procedure.
“The screening of endstage macular degeneration patients for the new implantable telescope requires a very specific battery of tests, and not every patient is a good candidate for this technology” said Purcell. She added that an ideal candidate would be someone who is in stable health, mobile and motivated to do the pre-and post-training necessary to fully utilize the IMT. That training can take up to a year to complete.
In addition to Drs. Yee and Purcell, a panel of experts works collaboratively to assess each potential candidate. This includes Dr. Custis, a retinal specialist, to assess the health of the eye tissue in the back of the eye; Dr. Weinstein, a corneal specialist, to see if the IMT would fit between the iris and cornea; Dr. Terhorst, a general ophthalmologic surgeon, who implants the device, and an occupational therapist.
So far, they have screened several patients but none have been ideal yet for the procedure. “We are looking forward to working with our first IMT patient,” said Yee.
At a minimum, potential IMT patients must meet the following criteria to be considered for the procedure.
· They can't have had cataract surgery in the eye
· They must have dry macular degeneration (not wet)
· They must have vision impairment (usually 20/100 or worse) that has potential for significant vision improvement with the IMT device
· They must be able and willing to undergo extensive training to learn how to use the vision changes that occur following the IMT surgery.
According to Dr. Peter Custis, chief of ophthalmology for KPSD “there are approximately 250 KP optometrists in the Southern California region, and San Diego’s Yee and Purcell are the first to be certified to screen and evaluate low-vision patients for the IMT technology. Kaiser Permanente Los Angeles also will soon begin to screen potential IMT patients. Dr. Custis has developed the protocols for the comprehensive program and is overseeing the roll-out in San Diego.
Dr. Leslie Purcell joined Kaiser Permanente in 1989. A graduate of the State University of New York College of Optometry, Dr. Purcell also practiced optometry in the Navy at Naval Hospital San Diego and was part of the original team responsible for building a Low Vision Clinic there from the ground up.
Dr. Tim Yee joined Kaiser Permanente in 2009. A graduate of the Southern California College of Optometry, he previously worked at two ophthalmology offices practicing full-scope optometry. He also worked at a Lasik center where he screened patients for Lasik candidacy and evaluated them post operatively.
Dr. Peter Custis is the Ophthalmology Chief of Service. He joined Kaiser Permanente in 2003 as an ophthalmologist specializing in Ophthalmic Retina Vitreal Surgery. Dr. Custis is a graduate of Duke University School of Medicine and performed his Medical and Surgical Retina Fellowship at Wilmer Eye Institute at Johns Hopkins University in Baltimore. He served as a Navy Physician and is Board Certified with the American Board of Ophthalmology.
Dr. Dan Terhorst is a past Ophthalmology Chief of Service for San Diego Kaiser Permanente. Dr. Terhorst joined Kaiser Permanente in 1980 as an ophthalmologist specializing in ophthalmic disease and anterior segment surgery. Dr. Terhorst is a graduate of Northwestern University School of Medicine in Chicago. He is Board Certified with the American Board of Ophthalmology.
Dr. Barry Weinstein joined Kaiser Permanente in 1990 as an ophthalmologist specializing in cornea and external eye diseases and surgery. Dr. Weinstein is a graduate of New York Medical College and performed his Cornea and External Disease Fellowship at UCSD School of Medicine. He is Board Certified with the American Board of Ophthalmology.
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