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Abouelseoud G, Abouelseoud Y, Shoukry A, Ismail N, Mekky J. A mixed integer linear programming framework for improving cortical vision prosthesis designs. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2022.104253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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2
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Fauvel T, Chalk M. Human-in-the-loop optimization of visual prosthetic stimulation. J Neural Eng 2022; 19. [PMID: 35667363 DOI: 10.1088/1741-2552/ac7615] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 06/06/2022] [Indexed: 11/12/2022]
Abstract
Retinal prostheses are a promising strategy to restore sight to patients with retinal degenerative diseases. These devices compensate for the loss of photoreceptors by electrically stimulating neurons in the retina. Currently, the visual function that can be recovered with such devices is very limited. This is due, in part, to current spread, unintended axonal activation, and the limited resolution of existing devices. Here we show, using a recent model of prosthetic vision, that optimizing how visual stimuli are encoded by the device can help overcome some of these limitations, leading to dramatic improvements in visual perception. APPROACH We propose a strategy to do this in practice, using patients' feedback in a visual task. The main challenge of our approach comes from the fact that, typically, one only has access to a limited number of noisy responses from patients. We propose two ways to deal with this: first, we use a model of prosthetic vision to constrain and simplify the optimization. We show that, if one knew the parameters of this model for a given patient, it would be possible to greatly improve their perceptual performance. Second we propose a preferential Bayesian optimization to efficiently learn these model parameters for each patient, using minimal trials. MAIN RESULTS To test our approach, we presented healthy subjects with visual stimuli generated by a recent model of prosthetic vision, to replicate the perceptual experience of patients fitted with an implant. Our optimization procedure led to significant and robust improvements in perceived image quality, that transferred to increased performance in other tasks. SIGNIFICANCE Importantly, our strategy is agnostic to the type of prosthesis and thus could readily be implemented in existing implants.
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Affiliation(s)
- Tristan Fauvel
- Institut de la Vision, INSERM, 17 Rue Moreau, Paris, Île-de-France, 75014, FRANCE
| | - Matthew Chalk
- Institut de l a Vision, INSERM, 17 Rue Moreau, Paris, 75014, FRANCE
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What Is New in Glaucoma: From Treatment to Biological Perspectives. J Ophthalmol 2021; 2021:5013529. [PMID: 33936807 PMCID: PMC8060111 DOI: 10.1155/2021/5013529] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 02/24/2021] [Accepted: 03/24/2021] [Indexed: 11/30/2022] Open
Abstract
Glaucoma is a chronic silent disease and an irreversible cause of blindness worldwide. Research has made many efforts to improve disease control and especially to anticipate both early diagnosis and treatment of advanced stages of glaucoma. In terms of prevention, networking between professionals and nonprofessionals is an important goal to disseminate information and help diagnose the disease early. On the other hand, the most recent approaches to treat glaucoma outcomes in its advanced stages include electrical stimulation, stem cells, exosomes, extracellular vesicles, and growth factors. Finally, neuronal plasticity-based rehabilitation methods are being studied to reeducate patients in order to stimulate their residual visual capacity. This review provides an overview of new approaches to future possible glaucoma treatment modalities and gives insight into the perspectives available nowadays in this field.
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Abouelseoud G, Abouelseoud Y, Shoukry A, Ismail N, Mekky J. On the use of time division multiplexing to improve electrical brain stimulation focality. Biomed Signal Process Control 2020. [DOI: 10.1016/j.bspc.2020.102048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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5
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Ferrari U, Deny S, Sengupta A, Caplette R, Trapani F, Sahel JA, Dalkara D, Picaud S, Duebel J, Marre O. Towards optogenetic vision restoration with high resolution. PLoS Comput Biol 2020; 16:e1007857. [PMID: 32667921 PMCID: PMC7416966 DOI: 10.1371/journal.pcbi.1007857] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/10/2020] [Accepted: 04/07/2020] [Indexed: 11/19/2022] Open
Abstract
In many cases of inherited retinal degenerations, ganglion cells are spared despite photoreceptor cell death, making it possible to stimulate them to restore visual function. Several studies have shown that it is possible to express an optogenetic protein in ganglion cells and make them light sensitive, a promising strategy to restore vision. However the spatial resolution of optogenetically-reactivated retinas has rarely been measured, especially in the primate. Since the optogenetic protein is also expressed in axons, it is unclear if these neurons will only be sensitive to the stimulation of a small region covering their somas and dendrites, or if they will also respond to any stimulation overlapping with their axon, dramatically impairing spatial resolution. Here we recorded responses of mouse and macaque retinas to random checkerboard patterns following an in vivo optogenetic therapy. We show that optogenetically activated ganglion cells are each sensitive to a small region of visual space. A simple model based on this small receptive field predicted accurately their responses to complex stimuli. From this model, we simulated how the entire population of light sensitive ganglion cells would respond to letters of different sizes. We then estimated the maximal acuity expected by a patient, assuming it could make an optimal use of the information delivered by this reactivated retina. The obtained acuity is above the limit of legal blindness. Our model also makes interesting predictions on how acuity might vary upon changing the therapeutic strategy, assuming an optimal use of the information present in the retinal activity. Optogenetic therapy could thus potentially lead to high resolution vision, under conditions that our model helps to determinine. In many cases of blindness, ganglion cells, the retinal output, remain functional. A promising strategy to restore vision is to express optogenetic proteins in ganglion cells. However, it is not clear what is the resolution of this new light sensor. A major concern is that axons might become light sensitive, and a focal stimulation would activate a very broad area of the retina, dramatically impairing spatial resolution. Here we show that this is not the case. Ganglion cells are activated only by stimulations close to their soma. Using a combination of data analysis and modeling based on mouse and non-human primate retina recordings, we show that the acuity expected with this therapy could be above the level of legal blindness.
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Affiliation(s)
- Ulisse Ferrari
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, F-75012 Paris, France
| | - Stéphane Deny
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, F-75012 Paris, France
| | - Abhishek Sengupta
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, F-75012 Paris, France
| | - Romain Caplette
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, F-75012 Paris, France
| | - Francesco Trapani
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, F-75012 Paris, France
| | - José-Alain Sahel
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, F-75012 Paris, France
| | - Deniz Dalkara
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, F-75012 Paris, France
| | - Serge Picaud
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, F-75012 Paris, France
| | - Jens Duebel
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, F-75012 Paris, France
| | - Olivier Marre
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, F-75012 Paris, France
- * E-mail:
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Lyu Q, Lu Z, Li H, Qiu S, Guo J, Sui X, Sun P, Li L, Chai X, Lovell NH. A Three-Dimensional Microelectrode Array to Generate Virtual Electrodes for Epiretinal Prosthesis Based on a Modeling Study. Int J Neural Syst 2020; 30:2050006. [DOI: 10.1142/s0129065720500069] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Despite many advances in the development of retinal prostheses, clinical reports show that current retinal prosthesis subjects can only perceive prosthetic vision with poor visual acuity. A possible approach for improving visual acuity is to produce virtual electrodes (VEs) through electric field modulation. Generating controllable and localized VEs is a crucial factor in effectively improving the perceptive resolution of the retinal prostheses. In this paper, we aimed to design a microelectrode array (MEA) that can produce converged and controllable VEs by current steering stimulation strategies. Through computational modeling, we designed a three-dimensional concentric ring–disc MEA and evaluated its performance with different stimulation strategies. Our simulation results showed that electrode–retina distance (ERD) and inter-electrode distance (IED) can dramatically affect the distribution of electric field. Also the converged VEs could be produced when the parameters of the three-dimensional MEA were appropriately set. VE sites can be controlled by manipulating the proportion of current on each adjacent electrode in a current steering group (CSG). In addition, spatial localization of electrical stimulation can be greatly improved under quasi-monopolar (QMP) stimulation. This study may provide support for future application of VEs in epiretinal prosthesis for potentially increasing the visual acuity of prosthetic vision.
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Affiliation(s)
- Qing Lyu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200240, P. R. China
| | - Zhuofan Lu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200240, P. R. China
| | - Heng Li
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200240, P. R. China
| | - Shirong Qiu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200240, P. R. China
| | - Jiahui Guo
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200240, P. R. China
| | - Xiaohong Sui
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200240, P. R. China
| | - Pengcheng Sun
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200240, P. R. China
| | - Liming Li
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200240, P. R. China
| | - Xinyu Chai
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200240, P. R. China
| | - Nigel H. Lovell
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, NSW 2052, Australia
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Dooley JC, Krubitzer LA. Alterations in cortical and thalamic connections of somatosensory cortex following early loss of vision. J Comp Neurol 2018; 527:1675-1688. [PMID: 30444542 DOI: 10.1002/cne.24582] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/26/2018] [Accepted: 11/01/2018] [Indexed: 01/31/2023]
Abstract
Early loss of vision produces dramatic changes in the functional organization and connectivity of the neocortex in cortical areas that normally process visual inputs, such as the primary and second visual area. This loss also results in alterations in the size, functional organization, and neural response properties of the primary somatosensory area, S1. However, the anatomical substrate for these functional changes in S1 has never been described. In the present investigation, we quantified the cortical and subcortical connections of S1 in animals that were bilaterally enucleated very early in development, prior to the formation of retino-geniculate and thalamocortical pathways. We found that S1 receives dense inputs from novel cortical fields, and that the density of existing cortical and thalamocortical connections was altered. Our results demonstrate that sensory systems develop in tandem and that alterations in sensory input in one system can affect the connections and organization of other sensory systems. Thus, therapeutic intervention following early loss of vision should focus not only on restoring vision, but also on augmenting the natural plasticity of the spared systems.
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Affiliation(s)
- James C Dooley
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa
| | - Leah A Krubitzer
- Center for Neuroscience, University of California, Davis, California.,Department of Psychology, University of California, Davis, California
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Weiland JD, Humayun MS, Gonzalez Calle A. The Development of Visual Prosthetic Devices to Restore Vision to the Blind. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00101-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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9
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Nuzzi R, Tridico F. Glaucoma: Biological Trabecular and Neuroretinal Pathology with Perspectives of Therapy Innovation and Preventive Diagnosis. Front Neurosci 2017; 11:494. [PMID: 28928631 PMCID: PMC5591842 DOI: 10.3389/fnins.2017.00494] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/22/2017] [Indexed: 12/14/2022] Open
Abstract
Glaucoma is a common degenerative disease affecting retinal ganglion cells (RGC) and optic nerve axons, with progressive and chronic course. It is one of the most important reasons of social blindness in industrialized countries. Glaucoma can lead to the development of irreversible visual field loss, if not treated. Diagnosis may be difficult due to lack of symptoms in early stages of disease. In many cases, when patients arrive at clinical evaluation, a severe neuronal damage may have already occurred. In recent years, newer perspective in glaucoma treatment have emerged. The current research is focusing on finding newer drugs and associations or better delivery systems in order to improve the pharmacological treatment and patient compliance. Moreover, the application of various stem cell types with restorative and neuroprotective intent may be found appealing (intravitreal autologous cellular therapy). Advances are made also in terms of parasurgical treatment, characterized by various laser types and techniques. Moreover, recent research has led to the development of central and peripheral retinal rehabilitation (featuring residing cells reactivation and replacement of defective elements), as well as innovations in diagnosis through more specific and refined methods and inexpensive tests.
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Affiliation(s)
- Raffaele Nuzzi
- Eye Clinic Section, Department of Surgical Sciences, University of Turin, Ophthalmic HospitalTurin, Italy
| | - Federico Tridico
- Eye Clinic Section, Department of Surgical Sciences, University of Turin, Ophthalmic HospitalTurin, Italy
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10
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PDMS based multielectrode arrays for superior in-vitro retinal stimulation and recording. Biomed Microdevices 2017; 19:75. [DOI: 10.1007/s10544-017-0221-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Electrical Stimulation as a Means for Improving Vision. THE AMERICAN JOURNAL OF PATHOLOGY 2017; 186:2783-2797. [PMID: 27643530 DOI: 10.1016/j.ajpath.2016.07.017] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 07/12/2016] [Accepted: 07/14/2016] [Indexed: 12/31/2022]
Abstract
Evolving research has provided evidence that noninvasive electrical stimulation (ES) of the eye may be a promising therapy for either preserving or restoring vision in several retinal and optic nerve diseases. In this review, we focus on minimally invasive strategies for the delivery of ES and accordingly summarize the current literature on transcorneal, transorbital, and transpalpebral ES in both animal experiments and clinical studies. Various mechanisms are believed to underlie the effects of ES, including increased production of neurotrophic agents, improved chorioretinal blood circulation, and inhibition of proinflammatory cytokines. Different animal models have demonstrated favorable effects of ES on both the retina and the optic nerve. Promising effects of ES have also been demonstrated in clinical studies; however, all current studies have a lack of randomization and/or a control group (sham). There is thus a pressing need for a deeper understanding of the underlying mechanisms that govern clinical success and optimization of stimulation parameters in animal studies. In addition, such research should be followed by large, prospective, clinical studies to explore the full potential of ES. Through this review, we aim to provide insight to guide future research on ES as a potential therapy for improving vision.
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Sabatier Q, Ieng SH, Benosman R. Asynchronous Event-Based Fourier Analysis. IEEE TRANSACTIONS ON IMAGE PROCESSING : A PUBLICATION OF THE IEEE SIGNAL PROCESSING SOCIETY 2017; 26:2192-2202. [PMID: 28186889 DOI: 10.1109/tip.2017.2661702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This paper introduces a method to compute the FFT of a visual scene at a high temporal precision of around 1- [Formula: see text] output from an asynchronous event-based camera. Event-based cameras allow to go beyond the widespread and ingrained belief that acquiring series of images at some rate is a good way to capture visual motion. Each pixel adapts its own sampling rate to the visual input it receives and defines the timing of its own sampling points in response to its visual input by reacting to changes of the amount of incident light. As a consequence, the sampling process is no longer governed by a fixed timing source but by the signal to be sampled itself, or more precisely by the variations of the signal in the amplitude domain. Event-based cameras acquisition paradigm allows to go beyond the current conventional method to compute the FFT. The event-driven FFT algorithm relies on a heuristic methodology designed to operate directly on incoming gray level events to update incrementally the FFT while reducing both computation and data load. We show that for reasonable levels of approximations at equivalent frame rates beyond the millisecond, the method performs faster and more efficiently than conventional image acquisition. Several experiments are carried out on indoor and outdoor scenes where both conventional and event-driven FFT computation is shown and compared.
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Ha S, Khraiche ML, Akinin A, Jing Y, Damle S, Kuang Y, Bauchner S, Lo YH, Freeman WR, Silva GA, Cauwenberghs G. Towards high-resolution retinal prostheses with direct optical addressing and inductive telemetry. J Neural Eng 2016; 13:056008. [PMID: 27529371 DOI: 10.1088/1741-2560/13/5/056008] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Despite considerable advances in retinal prostheses over the last two decades, the resolution of restored vision has remained severely limited, well below the 20/200 acuity threshold of blindness. Towards drastic improvements in spatial resolution, we present a scalable architecture for retinal prostheses in which each stimulation electrode is directly activated by incident light and powered by a common voltage pulse transferred over a single wireless inductive link. APPROACH The hybrid optical addressability and electronic powering scheme provides separate spatial and temporal control over stimulation, and further provides optoelectronic gain for substantially lower light intensity thresholds than other optically addressed retinal prostheses using passive microphotodiode arrays. The architecture permits the use of high-density electrode arrays with ultra-high photosensitive silicon nanowires, obviating the need for excessive wiring and high-throughput data telemetry. Instead, the single inductive link drives the entire array of electrodes through two wires and provides external control over waveform parameters for common voltage stimulation. MAIN RESULTS A complete system comprising inductive telemetry link, stimulation pulse demodulator, charge-balancing series capacitor, and nanowire-based electrode device is integrated and validated ex vivo on rat retina tissue. SIGNIFICANCE Measurements demonstrate control over retinal neural activity both by light and electrical bias, validating the feasibility of the proposed architecture and its system components as an important first step towards a high-resolution optically addressed retinal prosthesis.
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Affiliation(s)
- Sohmyung Ha
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, 92093 USA. Institute of Engineering in Medicine, University of California, San Diego, La Jolla, CA, 92093 USA
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Jones IL, Russell TL, Farrow K, Fiscella M, Franke F, Müller J, Jäckel D, Hierlemann A. A method for electrophysiological characterization of hamster retinal ganglion cells using a high-density CMOS microelectrode array. Front Neurosci 2015; 9:360. [PMID: 26528115 PMCID: PMC4602149 DOI: 10.3389/fnins.2015.00360] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 09/18/2015] [Indexed: 11/24/2022] Open
Abstract
Knowledge of neuronal cell types in the mammalian retina is important for the understanding of human retinal disease and the advancement of sight-restoring technology, such as retinal prosthetic devices. A somewhat less utilized animal model for retinal research is the hamster, which has a visual system that is characterized by an area centralis and a wide visual field with a broad binocular component. The hamster retina is optimally suited for recording on the microelectrode array (MEA), because it intrinsically lies flat on the MEA surface and yields robust, large-amplitude signals. However, information in the literature about hamster retinal ganglion cell functional types is scarce. The goal of our work is to develop a method featuring a high-density (HD) complementary metal-oxide-semiconductor (CMOS) MEA technology along with a sequence of standardized visual stimuli in order to categorize ganglion cells in isolated Syrian Hamster (Mesocricetus auratus) retina. Since the HD-MEA is capable of recording at a higher spatial resolution than most MEA systems (17.5 μm electrode pitch), we were able to record from a large proportion of RGCs within a selected region. Secondly, we chose our stimuli so that they could be run during the experiment without intervention or computation steps. The visual stimulus set was designed to activate the receptive fields of most ganglion cells in parallel and to incorporate various visual features to which different cell types respond uniquely. Based on the ganglion cell responses, basic cell properties were determined: direction selectivity, speed tuning, width tuning, transience, and latency. These properties were clustered to identify ganglion cell types in the hamster retina. Ultimately, we recorded up to a cell density of 2780 cells/mm2 at 2 mm (42°) from the optic nerve head. Using five parameters extracted from the responses to visual stimuli, we obtained seven ganglion cell types.
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Affiliation(s)
- Ian L Jones
- Bio Engineering Laboratory, Department of Biosystems Science and Engineering, ETH Zurich Basel, Switzerland
| | - Thomas L Russell
- Bio Engineering Laboratory, Department of Biosystems Science and Engineering, ETH Zurich Basel, Switzerland
| | - Karl Farrow
- Visual Circuits Laboratory, Neuroelectronics Research Flanders Leuven, Belgium ; NERF, Imec Leuven, Belgium ; Department of Biology, KU Leuven Leuven, Belgium
| | - Michele Fiscella
- Bio Engineering Laboratory, Department of Biosystems Science and Engineering, ETH Zurich Basel, Switzerland
| | - Felix Franke
- Bio Engineering Laboratory, Department of Biosystems Science and Engineering, ETH Zurich Basel, Switzerland
| | - Jan Müller
- Bio Engineering Laboratory, Department of Biosystems Science and Engineering, ETH Zurich Basel, Switzerland
| | - David Jäckel
- Bio Engineering Laboratory, Department of Biosystems Science and Engineering, ETH Zurich Basel, Switzerland
| | - Andreas Hierlemann
- Bio Engineering Laboratory, Department of Biosystems Science and Engineering, ETH Zurich Basel, Switzerland
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3D-nanostructured boron-doped diamond for microelectrode array neural interfacing. Biomaterials 2015; 53:173-83. [DOI: 10.1016/j.biomaterials.2015.02.021] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 01/21/2015] [Accepted: 02/01/2015] [Indexed: 01/10/2023]
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Two Laskers and Counting: Learning From the Past Enables Future Innovations With Central Neural Prostheses. Brain Stimul 2015; 8:439-41. [DOI: 10.1016/j.brs.2014.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 10/23/2014] [Accepted: 10/23/2014] [Indexed: 12/20/2022] Open
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Schwander B. Early health economic evaluation of the future potential of next generation artificial vision systems for treating blindness in Germany. HEALTH ECONOMICS REVIEW 2014; 4:27. [PMID: 26208927 PMCID: PMC4531883 DOI: 10.1186/s13561-014-0027-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 10/17/2014] [Indexed: 06/10/2023]
Abstract
The next generation of artificial vision devices (AVDs), which is currently developed in pre-clinical settings, has the potential to improve the vision of blind patients with retinitis pigmentosa (RP) in a manner that they will be categorized as visual impaired but no more as blind. This unprecedented vision improvement will result in a mentionable quality of life gain which poses the question at which costs the next generation AVDs are to be regarded as cost-effective, from a German healthcare payer perspective. In order to answer this research question a Markov model was developed to simulate and to compare the costs and effects of next generation AVDs versus best supportive care (BSC). Applying the base case settings resulted in incremental costs of 107,925, in 2.03 incremental quality-adjusted life years (QALYs) and in a cost-effectiveness ratio of 53,165 per QALY gained. Probabilistic and deterministic sensitivity analyses as well as scenario analyses for the effect size and the AVD costs were performed in order to investigate the robustness of results. In these scenario analyses a strong variation of the cost-effectiveness results was obtained ranging from 23,512 (best case) to 176,958 (worst case) per QALY gained by AVD therapy. This early health economic evaluation has to handle with three main uncertainty factors: the effect size of next generation AVDs, the costs of next generation AVDs and the WTP threshold that might be applied in RP patients, which reflect the main limitations of the presented assessment. In conclusion the presented early cost-effectiveness evaluation has obtained that next generation AVDs have the potential to be a cost-effective therapy option in patients with RP in Germany. The innovative nature, the high unmet medical need and the expected unprecedented efficacy of next generation AVDs will highly likely lead to the case that even relatively high incremental cost-effectiveness ratios, that have been obtained when simulating various effect and pricing scenarios, will be regarded as acceptable from a German healthcare payer perspective.
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Affiliation(s)
- Bjoern Schwander
- AHEAD GmbH, Agency of Health Economic Assessment and Dissemination, Arndtstr. 19, 79539, Loerrach, Germany,
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Escobar MJ, Palacios AG. Beyond the retina neural coding: on models and neural rehabilitation. ACTA ACUST UNITED AC 2013; 107:335-7. [PMID: 23994100 DOI: 10.1016/j.jphysparis.2013.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- María-José Escobar
- Universidad Técnica Federico Santa María, Departmento de Electronica, 2390123 Valparaíso, Chile.
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