The miracle of restoring sight to the blind, told in legends and myths throughout human cultures and history, is moving from dream to possibility in our times. Several dozen groups around the world now claim that electronic or neurochemical prostheses may soon restore some measure of functional vision. This editorial examines such claims by reviewing the proposed approaches and assessing their promise. We base our opinions on our involvement with some of these efforts and on presentations and discussions during the most recent biennial Eye and the Chip: World Congress on Artificial Vision organized by the Detroit Institute of Ophthalmology in June 2006; for a recent overview of many current activities in this area, see Dagnelie [1]. The retina extensively preprocesses and reduces image information, and the cortical map and magnification add further complexity; therefore, functional replacement of neural elements should be done at the earliest available stage of visual processing to limit surrogate processing that provides but a poor substitute for the native system. Thus, for example, a retinal prosthesis should be used if the nerve fibers and optic nerve are intact, such that the prosthesis stimulates the most distal remaining cell population available. Despite such considerations, the first attempts at vision restoration almost 40 years ago were directed at the visual cortex [2]. Early cortical implants used electrodes placed between the meninges, avoiding the complications of glial cell encapsulation plaguing most penetrating electrodes. A mapping procedure is used to determine the location of each electrode's phosphene in the visual field, and real-time image processing and stimulation software then extracts and projects contours onto the best-matching electrodes. These phosphenes do not convey real-form vision, yet they do allow the wearer crude localization of outlines in the scene. Newer penetrating probes such as the 100-electrode array developed at the University of Utah--currently being considered for use by the European CortiVis consortium--and the hatpin electrodes--developed at the National Institute of Neurological Disorders and Stroke and since adopted by the group at the Illinois Institute of Technology --may provide smaller phosphenes, and thus better resolution, at much lower and safer charge injection levels. In the early 1990s, intraoperative stimulation in patients with late-stage retinitis pigmentosa (RP) showed that phosphenes could be elicited from blind retinal areas long after photoreceptor degeneration [3]. Researchers are working on various implants in which a matrix of electrodes stimulates the surviving retinal cells with imagery collected by an external camera and reduced to match the resolution of the electrode array. Two research groups have progressed to the stage of prototype implants in patients with late-stage RP. A consortium formed by Second Sight Medical Products LLC and by the Doheny Retina Institute has performed six implants of 4 x 4 electrode arrays based on cochlear implant electronics; these patients can detect phosphenes at individual electrodes, discriminate crude shapes upon multiple electrode stimulation, and recognize simple stimuli presented via a head-mounted camera. A consortium formed by IIP Technologies GmbH and German universities has performed several 50-electrode implants and is reporting that patients have similar discrimination abilities with computer-generated stimuli. Other retinal prosthesis groups are exploring integrated concepts in which the eye's optics become part of a prosthetic imaging device, which in turn generates the signals to drive the secondary neurons. The simplest implementation of such a device, an array of small photodiodes under the retina, appears to have a neurotrophic beneficial effect in RP patients with some remaining vision; 30 patients have received this Optobionics ASR implant in Food and Drug Administration trials [4]. …
Read full abstract