Miami Lighthouse for the Blind and Visually Impaired Case Study: Vision Rehabilitation for the First Florida Resident to Receive the Argus II “Bionic Eye”

Abstract

In November, 2014, a totally blind woman became the first person in the State of Florida, and the 10th person in the United States, to receive the Argus II retinal implant, which was developed in California by Second Sight Medical Products (Second Sight, 2014). The device was implanted at Bascom Palmer Eye Institute in Miami (BPEI). The 58-year-old patient became blind at the age of 42 due to retinitis pigmentosa. The Argus II retinal system provides electrical stimulation of the retina to induce visual perception in individuals who are blind with severe to profound retinitis pigmentosa (Second Sight, 2014). A miniature video camera housed in glasses captures the image. The video is sent to a small, patient-worn, computerized video processing unit (VPU), where it is transformed into electrical impulses that are sent back to the glasses via a cable. These impulses are then transmitted wirelessly to an antenna in the retinal implant. The signals are next sent to the electrode array, which emits small pulses of electricity. These pulses bypass the damaged photoreceptors and stimulate the retina's remaining cells, which transmit the visual information along the optic nerve to the brain, creating the perception of patterns of light (Ho et al., 2015; Second Sight, 2014). After surgery, retinal implant recipients must learn to interpret these visual patterns and integrate the information with visual concepts. At the inception of the Argus II project, Miami Lighthouse for the Blind and Visually Impaired was chosen to partner with BPEI and Second Sight and to provide vision rehabilitation for retinal implant patients in Florida. In order to train the first recipient in Florida in the use of the implant's highly complicated technical system, Miami Lighthouse professionals developed a vision rehabilitation protocol integrating elements from the Argus II patient training manuals (concerning the technical aspects of the device) with vision rehabilitation therapy. In concert with a consultant from the Second Sight team, existing rehabilitation training strategies were adapted to create a plan tailored to specifically address the skills that are necessary for the successful use of the Argus II system. Unlike patients in traditional low vision rehabilitation therapy, Argus II patients require innovative blindness rehabilitation training as they learn to interpret the new visual input. Training that provided instruction on how to take full advantage of the device took place both in Miami, Florida, and in the patient's home. After each training session, the patient's achievements were reviewed, progress was documented and future activities were planned. In addition, Miami Lighthouse's certified low vision therapist (the second author) accompanied the implant recipient to California to work on software upgrades at the developer's laboratories. SYNTHESIS OF THE CASE REPORTS Over a three-month period spanning the end of 2014 and the start of 2015, the first and second authors spent 50 hours of training and working with the patient to adjust the device. Six vision rehabilitation sessions totaled 44 hours, and an additional 6 hours were spent in orientation and mobility training and accompanying the patient for device adjustment at BPEI. Also, 60 hours were spent in training in California. Approximately 50 follow-up telephone calls took place to address issues that came up after the initial 6 sessions. First session During the first session, which was five hours in duration and took place December 10, 2014, a check was made of all external components of the Argus II device, including the glasses, the VPU, the VPU pouch, batteries, charger, and cable that connects the VPU with the glasses. When the subject demonstrated her ability to handle these aspects of the device independently, she was seated at a table in front of a half-black, half-white metal board from the ARGUS II instructional kit on which black-and-white objects, lines, and shapes were displayed. …