Focal activation of the feline retina via a suprachoroidal electrode array

Nature-inspired saccadic-like electrical stimulation paradigm promotes sustained retinal ganglion cell responses by spatiotemporally alternating activation of contiguous multi-electrode patterns

Objective. Retinal electrical stimulation using multi-electrode arrays (MEAs) aims to restore visual object perception in blind patients. However, the rate and duration of the artificial visual sensations are limited due to the rapid response decay of the stimulated neurons. Hence, we investigated a novel nature-inspired saccadic-like stimulation paradigm (biomimetic) to evoke sustained retinal responses. For implementation, the macroelectrode was replaced by several contiguous microelectrodes and activated non-simultaneously but alternating topologically.Approach.MEAs with hexagonally arranged electrodes were utilized to simulate and record mouse retinal ganglion cells (RGCs). Two shapes were presented electrically using MEAs: a 6e-hexagon (six hexagonally arranged 10µm electrodes; 6e-hexagon diameter: 80µm) and a double-bar (180µm spaced, 320µm in length). Electrodes of each shape were activated in three different modes (simultaneous, circular, and biomimetic ('zig-zag')), stimulating at different frequencies (1-20 Hz).Main results.The biomimetic stimulation generated enhanced RGC responses increasing the activity rate by 87.78%. In the spatiotemporal context, the electrical representation of the 6e-hexagon produced sustained and local RGC responses (∼130µm corresponding to ∼2.5° of the human visual angle) for up to 90 s at 10 Hz stimulation and resolved the electrically presented double-bar. In contrast, during conventional simultaneous stimulation, the responses were poor and declined within seconds. Similarly, the applicability of the biomimetic mode for retinal implants (7 × 8 pixels) was successfully demonstrated. An object shape impersonating a smile was presented electrically, and the recorded data were used to emulate the implant's performance. The spatiotemporal pixel mapping of the activity produced a complete retinal image of the smile.Significance.The application of electrical stimulation in the biomimetic mode produced locally enhanced RGC responses with significantly reduced fading effects and yielded advanced spatiotemporal performance reflecting the presented electrode shapes in the mapped activity imprint. Therefore, it is likely that the RGC responses persist long enough to evoke visual perception and generate a seamless image, taking advantage of the flicker fusion. Hence, replacing the implant's macroelectrodes with microelectrodes and their activation in a topologically alternating biomimetic fashion may overcome the patient's perceptual image fading, thereby enhancing the spatiotemporal characteristics of artificial vision.

Suppression of crosstalk in multielectrode arrays with local shielding

Electrical crosstalk can constrain the performance of multielectrode arrays in electro- and neurophysiology, in terms of both stimulation and recording. This is especially so at high electrode density, desirable for spatiotemporal mapping of bioelectrical signals from multiple cells. Channel interference due to crosstalk is currently only partially addressed, via continuous interleaved sampling or post-data acquisition spike sorting. Here, we show that a locally-shielded electrode architecture significantly suppresses crosstalk, and enables multi-site recording at high electrode density without the need for spike sorting. Arrays of shielded electrodes, prepared by micro- and nanofabrication techniques in a vertically-oriented coaxial geometry, demonstrate at least a 400 times improvement in spatial density over the unshielded case.

Three-dimensional multilayer concentric bipolar electrodes restrict spatial activation in optic nerve stimulation

OBJECTIVE

Intraneural nerve interfaces often operate in a monopolar configuration with a common and distant ground electrode. This configuration leads to a wide spreading of the electric field. Therefore, this approach is suboptimal for intraneural nerve interfaces when selective stimulation is required.

APPROACH

We designed a multilayer electrode array embedding three-dimensional concentric bipolar electrodes. First, we validated the higher stimulation selectivity of this new electrode array compared to classical monopolar stimulation using simulations. Next, we compared them in-vivo by intraneural stimulation of the rabbit optic nerve and recording evoked potentials in the primary visual cortex.

MAIN RESULTS

Simulations showed that three-dimensional concentric bipolar electrodes provide a high localisation of the electric field in the tissue so that electrodes are electrically independent even for high electrode density. Experiments in-vivo highlighted that this configuration restricts spatial activation in the visual cortex due to the fewer fibres activated by the electric stimulus in the nerve.

SIGNIFICANCE

Highly focused electric stimulation is crucial to achieving high selectivity in fibre activation. The multilayer array embedding three-dimensional concentric bipolar electrodes improves selectivity in optic nerve stimulation. This approach is suitable for other neural applications, including bioelectronic medicine.

Computational challenges and opportunities for a bi-directional artificial retina

A future artificial retina that can restore high acuity vision in blind people will rely on the capability to both read (observe) and write (control) the spiking activity of neurons using an adaptive, bi-directional and high-resolution device. Although current research is focused on overcoming the technical challenges of building and implanting such a device, exploiting its capabilities to achieve more acute visual perception will also require substantial computational advances. Using high-density large-scale recording and stimulation in the primate retina with an ex vivo multi-electrode array lab prototype, we frame several of the major computational problems, and describe current progress and future opportunities in solving them. First, we identify cell types and locations from spontaneous activity in the blind retina, and then efficiently estimate their visual response properties by using a low-dimensional manifold of inter-retina variability learned from a large experimental dataset. Second, we estimate retinal responses to a large collection of relevant electrical stimuli by passing current patterns through an electrode array, spike sorting the resulting recordings and using the results to develop a model of evoked responses. Third, we reproduce the desired responses for a given visual target by temporally dithering a diverse collection of electrical stimuli within the integration time of the visual system. Together, these novel approaches may substantially enhance artificial vision in a next-generation device.

Fabrication and modeling of recessed traces for silicon-based neural microelectrodes

OBJECTIVE

Chronically-implanted neural microelectrodes are powerful tools for neuroscience research and emerging clinical applications, but their usefulness is limited by their tendency to fail after months in vivo. One failure mode is the degradation of insulation materials that protect the conductive traces from the saline environment.

APPROACH

Studies have shown that material degradation is accelerated by mechanical stresses, which tend to concentrate on raised topographies such as conducting traces. Therefore, to avoid raised topographies, we developed a fabrication technique that recesses (buries) the traces in dry-etched, self-aligned trenches.

MAIN RESULTS

The fabrication technique produced flatness within approximately 15 nm. Finite element modeling showed that the recessed geometry would be expected to reduce intrinsic stress concentrations in the insulation layers. Finally, in vitro electrochemical tests confirmed that recessed traces had robust recording and stimulation capabilities that were comparable to an established non-recessed device design.

SIGNIFICANCE

Our recessed trace fabrication technique requires no extra masks, is easy to integrate with existing processes, and is likely to improve the long-term performance of implantable neural devices.

A 3D flexible microelectrode array for subretinal stimulation

OBJECTIVE

Various retinal prostheses have been developed to restore the vision for blind patients, and some of them are already in clinical use. In this paper, we present a three-dimensional (3D) microelectrode array for a subretinal device that can effectively stimulate retinal cells.

APPROACH

To investigate the effect of electrode designs on the electric field distribution, we simulated various electrode shapes and sizes using finite element analysis. Based on the simulation results, the 3D microelectrode array was fabricated and evaluated in in vitro condition.

MAIN RESULTS

Through the simulation, we verified that an electrode design of square frustum was effective to stimulate with high contrast. Also, the 3D flexible and transparent microelectrode array based on silicon and polydimethylsiloxane was fabricated using micro-electro-mechanical system technologies. In in vitro experiments, the subretinally positioned 3D microelectrodes properly evoked spikes in retinal ganglion cells. The mean threshold current was 7.4 µA and the threshold charge density was 33.64 µC·cm^-2 per phase.

SIGNIFICANCE

The results demonstrate the feasibility of the fabricated 3D microelectrodes as the subretinal prosthesis. The developed microelectrode array would be integrated with the stimulation circuitry and implanted in animals for further in vivo experiments.

The influence of visual field position induced by a retinal prosthesis simulator on mobility

PURPOSE

Our aim is to develop a new generation of suprachoroidal-transretinal stimulation (STS) retinal prosthesis using a dual-stimulating electrode array to enlarge the visual field. In the present study, we aimed to examine how position and size of the visual field-created by a retinal prosthesis simulator-influenced mobility.

METHODS

Twelve healthy subjects wore retinal prosthesis simulators. Images captured by a web camera attached to a head-mounted display (HMD) were processed by a computer and displayed on the HMD. Three types of artificial visual fields-designed to imitate phosphenes-obtained by a single (5 × 5 electrodes; visual angle, 15°) or dual (5 × 5 electrodes ×2; visual angle, 30°) electrode array were created. Visual field (VF)1 is an inferior visual field, which corresponds to a dual-electrode array implanted in the superior hemisphere. VF2 is a superior visual field, which corresponds to a single-electrode array implanted in the inferior hemisphere. VF3 is a superior visual field, which corresponds to a dual-electrode array implanted in the inferior hemisphere. In each type of artificial visual field, a natural circular visual field (visual angle, 5°) which imitated the vision of patients with advanced retinitis pigmentosa existed at the center. Subjects were instructed to walk along a black carpet (6 m long × 2.2 m wide) without stepping on attached white circular obstacles. Each obstacle was 20 cm in diameter, and obstacles were installed at 40-cm intervals. We measured the number of footsteps on the obstacles, the time taken to complete the obstacle course, and the extent of head movement to scan the area (head-scanning). We then compared the results recorded from these 3 types of artificial visual field.

RESULTS

The number of footsteps on obstacles was lowest in VF3 (One-way ANOVA; P = 0.028, Fisher's LSD; VF 1 versus 3 P = 0.039, 2 versus 3 P = 0.012). No significant difference was observed for the time to complete the obstacle course or the extent of head movement between the 3 visual fields.

CONCLUSION

The superior and wide visual field (VF3) obtained by the retinal prosthesis simulator resulted in better mobility performance than the other visual fields.

Response of Mouse Visual Cortical Neurons to Electric Stimulation of the Retina

Retinal prostheses strive to restore vision to the blind by electrically stimulating the neurons that survive the disease process. Clinical effectiveness has been limited however, and much ongoing effort is devoted toward the development of improved stimulation strategies, especially ones that better replicate physiological patterns of neural signaling. Here, to better understand the potential effectiveness of different stimulation strategies, we explore the responses of neurons in the primary visual cortex to electric stimulation of the retina. A 16-channel implantable microprobe was used to record single unit activities in vivo from each layer of the mouse visual cortex. Layers were identified by electrode depth as well as spontaneous rate. Cell types were classified as excitatory or inhibitory based on their spike waveform and as ON, OFF, or ON-OFF based on the polarity of their light response. After classification, electric stimulation was delivered via a wire electrode placed on the surface of cornea (extraocularly) and responses were recorded from the cortex contralateral to the stimulated eye. Responses to electric stimulation were highly similar across cell types and layers. Responses (spike counts) increased as a function of the amplitude of stimulation, and although there was some variance across cells, the sensitivity to amplitude was largely similar across all cell types. Suppression of responses was observed for pulse rates ≥3 pulses per second (PPS) but did not originate in the retina as RGC responses remained stable to rates up to 5 PPS. Low-frequency sinusoids delivered to the retina replicated the out-of-phase responses that occur naturally in ON vs. OFF RGCs. Intriguingly, out-of-phase signaling persisted in V1 neurons, suggesting key aspects of neural signaling are preserved during transmission along visual pathways. Our results describe an approach to evaluate responses of cortical neurons to electric stimulation of the retina. By examining the responses of single cells, we were able to show that some retinal stimulation strategies can indeed better match the neural signaling patterns used by the healthy visual system. Because cortical signaling is better correlated to psychophysical percepts, the ability to evaluate which strategies produce physiological-like cortical responses may help to facilitate better clinical outcomes.

Cortical Brain Stimulation with Endovascular Electrodes

Electrical stimulation of neural tissue and recording of neural activity are the bases of emerging prostheses and treatments for spinal cord injury, stroke, sensory deficits, and drug-resistant neurological disorders. Safety and efficacy are key aspects for the clinical acceptance of therapeutic neural stimulators. The cortical vasculature has been shown to be a safe site for implantation of electrodes for chronically recording neural activity, requiring no craniotomy to access high-bandwidth, intracranial EEG. This work presents the first characterization of endovascular cortical stimulation measured using cortical subdural surface recordings. Visual stimulation was used to verify electrode viability and cortical activation was compared with electrically evoked activity. Due to direct activation of the neural tissue, the latency of responses to electrical stimulation was shorter than for that of visual stimulation. We also found that the center of neural activation was different for visual and electrical stimulation indicating an ability of the stentrode to provide localized activation of neural tissue.

A Multi-Domain Continuum Model of Electrical Stimulation of Healthy and Degenerate Retina

A continuum multi-domain model of electrical stimulation of the retina is presented and validated against retinal ganglion cell (RGC) excitation thresholds reported in a recently published in vitro experimental study. We applied our model to investigate the response of the RGC layer to electrical stimulation during mid-to-late stage retinal degeneration for both epiretinal and suprachoroidal configurations. Interestingly, our model predicted that suprachoroidal stimulation of the degenerate retina required increased current thresholds, mainly because of the presence of the glial scar layer. In contrast, epiretinal stimulation thresholds were almost similar for both healthy and degenerate models. The latter finding implies that there is no influence of the glial scar layer on epiretinal stimulation current thresholds.

Epiretinal stimulation with local returns enhances selectivity at cellular resolution

OBJECTIVE

Epiretinal prostheses are designed to restore vision in people blinded by photoreceptor degenerative diseases, by directly activating retinal ganglion cells (RGCs) using an electrode array implanted on the retina. In present-day clinical devices, current spread from the stimulating electrode to a distant return electrode often results in the activation of many cells, potentially limiting the quality of artificial vision. In the laboratory, epiretinal activation of RGCs with cellular resolution has been demonstrated with small electrodes, but distant returns may still cause undesirable current spread. Here, the ability of local return stimulation to improve the selective activation of RGCs at cellular resolution was evaluated.

APPROACH

A custom multi-electrode array (512 electrodes, 10 μm diameter, 60 μm pitch) was used to simultaneously stimulate and record from RGCs in isolated primate retina. Stimulation near the RGC soma with a single electrode and a distant return was compared to stimulation in which the return was provided by six neighboring electrodes.

MAIN RESULTS

Local return stimulation enhanced the capability to activate cells near the central electrode (<30 μm) while avoiding cells farther away (>30 μm). This resulted in an improved ability to selectively activate ON and OFF cells, including cells encoding immediately adjacent regions in the visual field.

SIGNIFICANCE

These results suggest that a device that restricts the electric field through local returns could optimize activation of neurons at cellular resolution, improving the quality of artificial vision.

Progress in artificial vision through suprachoroidal retinal implants

Retinal implants have proven their ability to restore visual sensation to people with degenerative retinopathy, characterized by photoreceptor cell death and the retina's inability to sense light. Retinal bionics operate by electrically stimulating the surviving neurons in the retina, thus triggering the transfer of visual sensory information to the brain. Suprachoroidal implants were first investigated in Australia in the 1950s. In this approach, the neuromodulation hardware is positioned between the sclera and the choroid, thus providing significant surgical and safety benefits for patients, with the potential to maintain residual vision combined with the artificial input from the device. Here we review the latest advances and state of the art devices for suprachoroidal prostheses, highlight future technologies and discuss challenges and perspectives towards improved rehabilitation of vision.

Differential electrical responses in retinal ganglion cell subtypes: effects of synaptic blockade and stimulating electrode location

OBJECTIVE

Visual prostheses have shown promising results in restoring visual perception to blind patients. The ability to differentially activate retinal ganglion cell (RGC) subtypes could further improve the efficacy of these medical devices.

APPROACH

Using whole-cell patch clamp, we investigated membrane potential differences between ON and OFF RGCs in the mouse retina when their synaptic inputs were blocked by synaptic blockers, and examined the differences in stimulation thresholds under such conditions. By injecting intracellular current, we further confirmed the relationship between RGC stimulation thresholds and resting membrane potentials (RMPs). In addition, we investigated the effects of stimulating electrode location on the differences in stimulation thresholds between ON and OFF RGCs.

MAIN RESULTS

With synaptic blockade, ON RGCs became significantly more hyperpolarized (from  -61.8  ±  1.4 mV to  -70.8  ±  1.6 mV), while OFF RGCs depolarized slightly (from  -60.5  ±  0.7 mV to  -58.6  ±  0.9 mV). RGC stimulation thresholds were negatively correlated with their RMPs (Pearson r value:  -0.5154; p-value: 0.0042). Thus, depriving ON RGCs of synaptic inputs significantly increased their thresholds (from 14.7  ±  1.3 µA to 22.3  ±  2.1 µA) over those of OFF RGCs (from 13.2  ±  0.7 µA to 13.1  ±  1.1 µA). However, with control solution, ON and OFF RGC stimulation thresholds were not significantly different. Finally, placement of the stimulating electrode away from the axon enhanced differences in stimulation thresholds between ON and OFF RGCs, facilitating preferential activation of OFF RGCs.

SIGNIFICANCE

Since ON and OFF RGCs have antagonistic responses to natural light, achieving differential RGC activation could convey more natural visual information, leading to better visual prosthesis outcomes.

Light localization with low-contrast targets in a patient implanted with a suprachoroidal-transretinal stimulation retinal prosthesis

PURPOSE

To evaluate the improvement in targeted reaching movements toward targets of various contrasts in a patient implanted with a suprachoroidal-transretinal stimulation (STS) retinal prosthesis.

METHODS

An STS retinal prosthesis was implanted in the right eye of a 42-year-old man with advanced Stargardt disease (visual acuity: right eye, light perception; left eye, hand motion). In localization tests during the 1-year follow-up period, the patient attempted to touch the center of a white square target (visual angle, 10°; contrast, 96, 85, or 74%) displayed at a random position on a monitor. The distance between the touched point and the center of the target (the absolute deviation) was averaged over 20 trials with the STS system on or off.

RESULTS

With the left eye occluded, the absolute deviation was not consistently lower with the system on than off for high-contrast (96%) targets, but was consistently lower with the system on for low-contrast (74%) targets. With both eyes open, the absolute deviation was consistently lower with the system on than off for 85%-contrast targets. With the system on and 96%-contrast targets, we detected a shorter response time while covering the right eye, which was being implanted with the STS, compared to covering the left eye (2.41 ± 2.52 vs 8.45 ± 3.78 s, p < 0.01).

CONCLUSIONS

Performance of a reaching movement improved in a patient with an STS retinal prosthesis implanted in an eye with residual natural vision. Patients with a retinal prosthesis may be able to improve their visual performance by using both artificial vision and their residual natural vision.

CLINICAL TRIAL REGISTRATION

Beginning date of the trial: Feb. 20, 2014 Date of registration: Jan. 4, 2014 Trial registration number: UMIN000012754 Registration site: UMIN Clinical Trials Registry (UMIN-CTR) http://www.umin.ac.jp/ctr/index.htm.

Conductive Hydrogel Electrodes for Delivery of Long-Term High Frequency Pulses

Nerve block waveforms require the passage of large amounts of electrical energy at the neural interface for extended periods of time. It is desirable that such waveforms be applied chronically, consistent with the treatment of protracted immune conditions, however current metal electrode technologies are limited in their capacity to safely deliver ongoing stable blocking waveforms. Conductive hydrogel (CH) electrode coatings have been shown to improve the performance of conventional bionic devices, which use considerably lower amounts of energy than conventional metal electrodes to replace or augment sensory neuron function. In this study the application of CH materials was explored, using both a commercially available platinum iridium (PtIr) cuff electrode array and a novel low-cost stainless steel (SS) electrode array. The CH was able to significantly increase the electrochemical performance of both array types. The SS electrode coated with the CH was shown to be stable under continuous delivery of 2 mA square pulse waveforms at 40,000 Hz for 42 days. CH coatings have been shown as a beneficial electrode material compatible with long-term delivery of high current, high energy waveforms.

Feasibility study of imaging fast neural activity in retinal tissue using Electrical Impedance Tomography

Electrical Impedance Tomography has been recently applied to image fast neural activity in the somatosensory cerebral cortex. This non-invasive imaging modality has the unique advantage of high spatial-temporal resolution in millimeters over milliseconds. This work was designed to test an existing 32-channel EIT system, a modified UCL ScouseTom, and to discuss the feasibility of imaging neural activity in retinal tissue through computer simulation. The finite element method was used to model a retinal slice with a realistic conductivity-depth profile of the macaque eye. The conductivity perturbation was simulated in five different layers of the model. 5μV_RMS white noise was added to boundary voltages. Simulation results showed that it is feasible to apply EIT in retinal tissue but the injection current is near threshold of unwanted phosphenes induction. Therefore the suggested future work are validating threshold current through animal experiments, developing electrodes with low contact impedance and mitigating noise through averaging.

In vitro biocompatibility and electrical stability of thick-film platinum/gold alloy electrodes printed on alumina

OBJECTIVE

High-density electrode arrays are a powerful tool in both clinical neuroscience and basic research. However, current manufacturing techniques require the use of specialised techniques and equipment, which are available to few labs. We have developed a high-density electrode array with customisable design, manufactured using simple printing techniques and with commercially available materials.

APPROACH

Electrode arrays were manufactured by thick-film printing a platinum-gold alloy (Pt/Au) and an insulating dielectric on 96% alumina ceramic plates. Arrays were conditioned in serum and serum-free conditions, with and without 1 kHz, 200 µA, charge balanced stimulation for up to 21 d. Array biocompatibility was assessed using an extract assay and a PC-12 cell contact assay. Electrode impedance, charge storage capacity and charge injection capacity were before and after array conditioning.

MAIN RESULTS

The manufactured Pt/Au electrodes have a highly porous surface and exhibit electrical properties comparable to arrays manufactured using alternative techniques. Materials used in array manufacture were found to be non-toxic to L929 fibroblasts by extract assay, and neuronal-like PC-12 cells adhered and extended neurites on the array surfaces. Arrays remained functional after long-term delivery of electrical pulses while exposed to protein-rich environments. Charge storage capacities and charge injection capacities increased following stimulation accounted for by an increase in surface index (real surface area) observed by vertical scanning interferometry. Further, we observed accumulation of proteins at the electrode sites following conditioning in the presence of serum.

SIGNIFICANCE

This study demonstrates the in vitro biocompatibility of commercially available thick-film printing materials. The printing technique is both simple and versatile, with layouts readily modified to produce customized electrode arrays. Thick-film electrode arrays are an attractive tool that may be implemented for general tissue engineering and neuroscience research.

Probing the functional impact of sub-retinal prosthesis

Retinal prostheses are promising tools for recovering visual functions in blind patients but, unfortunately, with still poor gains in visual acuity. Improving their resolution is thus a key challenge that warrants understanding its origin through appropriate animal models. Here, we provide a systematic comparison between visual and prosthetic activations of the rat primary visual cortex (V1). We established a precise V1 mapping as a functional benchmark to demonstrate that sub-retinal implants activate V1 at the appropriate position, scalable to a wide range of visual luminance, but with an aspect-ratio and an extent much larger than expected. Such distorted activation profile can be accounted for by the existence of two sources of diffusion, passive diffusion and activation of ganglion cells’ axons en passant. Reverse-engineered electrical pulses based on impedance spectroscopy is the only solution we tested that decreases the extent and aspect-ratio, providing a promising solution for clinical applications.

DOI:http://dx.doi.org/10.7554/eLife.12687.001

One of the most common causes of blindness is a disorder called retinitis pigmentosa. In a healthy eye, the surface at the back of the eye – called the retina – contains cells called photoreceptors that detect light and convert it into electrical signals for the brain to process. In people with retinitis pigmentosa, these photoreceptor cells die off gradually, which leads to loss of vision.

The only treatment available for retinitis pigmentosa is to have an artificial retina implanted into the eye. The artificial retina consists of an array of tiny electrodes, which take over from the damaged photoreceptors and generate electrical signals. The person with the implant perceives these electrical signals as bright flashes called “phosphenes”. However, the phosphenes are too large and imprecise to provide the person with vision that is good enough for tasks such as walking unaided or reading.

To find out why artificial retinas produce such poor resolution, Roux et al. compared how a rat’s brain responds to either natural visual stimuli or activation of implanted an array of micro-electrodes. Both the micro-electrodes and the natural stimuli activated the same areas of the brain. However, the micro-electrodes produced larger and more elongated patterns of activation. This is because the electrical currents generated by the micro-electrodes diffused throughout the retinal tissue and activated other neurons besides those intended. To overcome this problem, Roux et al. tested different ways of stimulating the micro-electrodes in order to identify those that induce the desired patterns of brain activity. This approach – known as reverse engineering – did indeed improve the performance of the micro-electrode array.

The next step is to extend these findings, which were obtained in healthy rats, to non-human primates or animal models of retinitis pigmentosa to better understand the condition in humans. In addition, combining the current approach with other existing techniques should further improve the vision that can be achieved with artificial retinas.

DOI:http://dx.doi.org/10.7554/eLife.12687.002

Electrically evoked potentials in an ovine model for the evaluation of visual prosthesis efficacy

Visual prostheses are becoming a reality as a therapy to restore functional vision to the blind. New stimulation strategies and novel electrode designs are contributing to accelerate the development of such devices triggering the interest of scientists, clinicians and the blind community worldwide. In this scenario, there is a need for large animal models that are suitable for preclinical testing of retinal neuroprostheses. This study presents an electrophysiology assessment of an ovine model for single and simultaneous electrode stimulation from the suprachoroidal space, using symmetric biphasic current pulses with a monopolar return configuration. Visually and electrically evoked potentials were recorded using supradural surface electrodes, showing charge thresholds comparable to those in humans. This model represents an alternative to feline or canine models with analogous activation levels and an eye anatomy similar to that of humans.

Enhancing scene structure in prosthetic vision using iso-disparity contour perturbance maps

We present a novel approach for enhancing structurally significant features in a scene to facilitate safe mobility with prosthetic vision. Previous approaches rely on visually salient features (e.g., intensity gradients, size, texture), or surface fitting (e.g., ground plane extraction), to determine and convey regions of structural change in the scene. Such approaches can be costly to compute, and/or are not guaranteed to detect all features relevant to the needs of safe mobility (e.g., small, low-contrast trip hazards). Assuming a dense disparity image, we propose a novel feature using iso-disparity contours. Regions of significant structural change are detected via a cost function based on local comparisons of iso-disparity contour orientations. Through this, structurally interesting features such as surface boundaries and general clutter are extracted and emphasised in the output visual representation. Our approach is real-time, and requires no surface fitting. Experimental results quantitatively and qualitatively validate our approach.

neuroBi: A Highly Configurable Neurostimulator for a Retinal Prosthesis and Other Applications

To evaluate the efficacy of a suprachoroidal retinal prosthesis, a highly configurable external neurostimulator is required. In order to meet functional and safety specifications, it was necessary to develop a custom device. A system is presented which can deliver charge-balanced, constant-current biphasic pulses, with widely adjustable parameters, to arbitrary configurations of output electrodes. This system is shown to be effective in eliciting visual percepts in a patient with approximately 20 years of light perception vision only due to retinitis pigmentosa, using an electrode array implanted in the suprachoroidal space of the eye. The flexibility of the system also makes it suitable for use in a number of other emerging clinical neurostimulation applications, including epileptic seizure suppression and closed-loop deep brain stimulation. Clinical trial registration number NCT01603576 (www.clinicaltrials.gov).

Spatial characteristics of evoked potentials elicited by a MEMS microelectrode array for suprachoroidal-transretinal stimulation in a rabbit

BACKGROUND

Suprachoroidal-transretinal stimulation (STS) can potentially restore vision. This study investigated the spatial characteristics of cortical electrical evoked potentials (EEPs) elicited by STS.

METHODS

A 4 × 4 thin-film platinum microelectrode stimulating array (200 μm electrode diameter and 400 μm center-to-center distance) was fabricated by a micro-electro-mechanical systems (MEMS) techniques and implanted into the suprachoroidal space of albino rabbits.

RESULTS

The current threshold to elicit reliable EEPs by a single electrode was 41.6 ± 12.6 μA, corresponding to a 66.2 ± 20.1 μC · cm(-2) charge density per phase, which was lower than the reported safety limits. Spatially differentiated cortical responses could be evoked by STS through different rows or columns of electrical stimulation; furthermore, shifts in the location of the maximum cortical activities were consistent with cortical visuotopic maps; increasing the number of simultaneously stimulating electrodes increased the response amplitudes of EEPs and expanded the spatial spread as well. In addition, long-term implantation and electrical stimulation of the MEMS electrode array in suprachoroidal space are necessary to evaluate systematically the safety and biocompatibility of this approach.

CONCLUSIONS

This study indicates that the STS approach by a MEMS-based platinum electrode array is a feasible alternative for visual restoration, and relatively high spatial discrimination may be achieved.

Investigating the interfacial properties of electrochemically roughened platinum electrodes for neural stimulation

Platinum electrodes have been electrochemically roughened (roughness factors up to 430) and evaluated for use as neural stimulation electrodes. The roughened electrodes show superior interfacial properties with increasing surface roughness. The roughened electrode (fR = 250) has a charge injection limit of 1.0 mC cm(-2) (400 μs pulse width), which is superior to that of titanium nitride (0.87 mC cm(-2)) but comparable to that of carbon nanotubes (1.0-1.6 mC cm(-2)). The surface roughness can also be optimized for different neural stimulation applications based on the available charge density at a particular pulse width of stimulation. The roughened platinum electrodes demonstrated good mechanical stability under harsh ultrasonication and electrochemical stability under continuous biphasic stimulation, indicating the potential of this biological interface to be safe and stable.

[Blindness and visual rehabilitation]

Blindness and visual impairment are a major public health problem all over the world and in all societies. A large amount of basic science and clinical research aims to rehabilitate patients and help them become more independent. Various methods are explored from cell and molecular therapy to prosthetic interfaces. We review the various treatment alternatives, describing their results and their limitations.

Operational challenges of retinal prostheses

Two computational models for research on retinal implants are presented. In the first model, the electric field produced by a multi-electrode array in a uniform retina is calculated. It is shown how cross talk of activated electrodes and the resulting bunching of field lines in monopole and dipole activation prevent high resolution imaging with retinal implants. Furthermore, it is demonstrated how sequential stimulation and multipolar stimulation may overcome this limitation. In the second model a target volume, i.e., a probe cylinder approximating a bipolar cell, in the retina is chosen, and the passive Heaviside cable equation is solved inside this target volume to calculate the depolarization of the cell membrane. The depolarization as a function of time indicates that shorter signals stimulate better as long as the current does not change sign during stimulation of the retina, i.e., mono-phasic stimulation. Both computational models are equally applicable to epiretinal, subretinal, and suprachoroidal vision implants.

Performance optimization of current focusing and virtual electrode strategies in retinal implants

The electrode configuration in an implanted visual prosthesis array affects the spatial electric field distribution within the retina, contributing to current focusing and virtual electrode (VE) stimulation strategies. In this paper, a finite element model incorporating various electrode configurations was used to study the interaction between electrode size and electrode-to-cell distance in current focusing and VE stimulation paradigms. The electrode array unit comprises an active electrode, six flanking return electrodes and a distant monopolar return. A quasi-monopolar (QMP) fraction is defined as the proportion of current which can be preferentially returned through the distant return, in comparison with the more adjacent flanking electrodes. The simulation results indicate that current focusing and VE strategies can be optimized by tuning the QMP fraction. The QMP fraction is adjusted to optimize the electric field spread based on retinal ganglion cell (RGC) density in the degenerate retina, thereby offsetting the effect of inhomogeneous distribution of surviving RGCs and leading to a uniform stimulation paradigm across electrodes. Importantly, there is negligible difference in functional performance across electrode configurations for distances less than the electrode diameter, implying that the stimulation mode does not significantly affect activation threshold or activated retinal area for electrode diameters greater than the retinal thickness. Furthermore, the QMP fraction has a significant effect on VE performance, defined by activation threshold and activated retinal area, when threshold current is evenly divided between two adjacent active electrodes.

Safety and efficacy of explanting or replacing suprachoroidal electrode arrays in a feline model

BACKGROUND

A key requirement for retinal prostheses is the ability for safe removal or replacement. We examined whether suprachoroidal electrode arrays can be removed or replaced after implantation.

METHODS

Suprachoroidal electrode arrays were unilaterally implanted into 13 adult felines. After 1 month, arrays were surgically explanted (n = 6), replaced (n = 5) or undisturbed (n = 2). The retina was assessed periodically using fundus photography and optical coherence tomography. Three months after the initial implantation, the function of replaced or undisturbed arrays was assessed by measuring the responses of the visual cortex to retinal electrical stimulation. The histopathology of tissues surrounding the implant was examined.

RESULTS

Array explantation or replacement was successful in all cases. Fundus photography showed localized disruption to the tapetum lucidum near the implant's tip in seven subjects following implantation. Although optical coherence tomography showed localized retinal changes, there were no widespread statistically significant differences in the thickness of the retinal layers or choroid. The distance between the electrodes and retina increased after device replacement but returned to control values within eight weeks (P < 0.03). Staphylomas developed near the scleral wound in five animals after device explantation. Device replacement did not alter the cortical evoked potential threshold. Histopathology showed localized outer nuclear layer thinning, tapetal disruption and pseudo-rosette formation, but the overall retinal morphology was preserved.

CONCLUSIONS

It is feasible to remove or replace conformable medical grade silicone electrode arrays implanted suprachoroidally. The scleral wound requires careful closure to minimize the risk of staphylomas.

Artificial vision support system (AVS(2)) for improved prosthetic vision

State-of-the-art and upcoming camera-driven, implanted artificial vision systems provide only tens to hundreds of electrodes, affording only limited visual perception for blind subjects. Therefore, real time image processing is crucial to enhance and optimize this limited perception. Since tens or hundreds of pixels/electrodes allow only for a very crude approximation of the typically megapixel optical resolution of the external camera image feed, the preservation and enhancement of contrast differences and transitions, such as edges, are especially important compared to picture details such as object texture. An Artificial Vision Support System (AVS(2)) is devised that displays the captured video stream in a pixelation conforming to the dimension of the epi-retinal implant electrode array. AVS(2), using efficient image processing modules, modifies the captured video stream in real time, enhancing 'present but hidden' objects to overcome inadequacies or extremes in the camera imagery. As a result, visual prosthesis carriers may now be able to discern such objects in their 'field-of-view', thus enabling mobility in environments that would otherwise be too hazardous to navigate. The image processing modules can be engaged repeatedly in a user-defined order, which is a unique capability. AVS(2) is directly applicable to any artificial vision system that is based on an imaging modality (video, infrared, sound, ultrasound, microwave, radar, etc.) as the first step in the stimulation/processing cascade, such as: retinal implants (i.e. epi-retinal, sub-retinal, suprachoroidal), optic nerve implants, cortical implants, electric tongue stimulators, or tactile stimulators.

Inner retinal preservation in rat models of retinal degeneration implanted with subretinal photovoltaic arrays

Photovoltaic arrays (PVA) implanted into the subretinal space of patients with retinitis pigmentosa (RP) are designed to electrically stimulate the remaining inner retinal circuitry in response to incident light, thereby recreating a visual signal when photoreceptor function declines or is lost. Preservation of inner retinal circuitry is critical to the fidelity of this transmitted signal to ganglion cells and beyond to higher visual targets. Post-implantation loss of retinal interneurons or excessive glial scarring could diminish and/or eliminate PVA-evoked signal transmission. As such, assessing the morphology of the inner retina in RP animal models with subretinal PVAs is an important step in defining biocompatibility and predicting success of signal transmission. In this study, we used immunohistochemical methods to qualitatively and quantitatively compare inner retinal morphology after the implantation of a PVA in two RP models: the Royal College of Surgeons (RCS) or transgenic S334ter-line 3 (S334ter-3) rhodopsin mutant rat. Two PVA designs were compared. In the RCS rat, we implanted devices in the subretinal space at 4 weeks of age and histologically examined them at 8 weeks of age and found inner retinal morphology preservation with both PVA devices. In the S334ter-3 rat, we implanted devices at 6-12 weeks of age and again, inner retinal morphology was generally preserved with either PVA design 16-26 weeks post-implantation. Specifically, the length of rod bipolar cells and numbers of cholinergic amacrine cells were maintained along with their characteristic inner plexiform lamination patterns. Throughout the implanted retinas we found nonspecific glial reaction, but none showed additional glial scarring at the implant site. Our results indicate that subretinally implanted PVAs are well-tolerated in rodent RP models and that the inner retinal circuitry is preserved, consistent with our published results showing implant-evoked signal transmission.

Laser patterning of platinum electrodes for safe neurostimulation

OBJECTIVE

Laser surface modification of platinum (Pt) electrodes was investigated for use in neuroprosthetics. Surface modification was applied to increase the surface area of the electrode and improve its ability to transfer charge within safe electrochemical stimulation limits.

APPROACH

Electrode arrays were laser micromachined to produce Pt electrodes with smooth surfaces, which were then modified with four laser patterning techniques to produce surface structures which were nanosecond patterned, square profile, triangular profile and roughened on the micron scale through structured laser interference patterning (SLIP). Improvements in charge transfer were shown through electrochemical impedance spectroscopy (EIS), cyclic voltammetry (CV) and biphasic stimulation at clinically relevant levels. A new method was investigated and validated which enabled the assessment of in vivo electrochemically safe charge injection limits.

MAIN RESULTS

All of the modified surfaces provided electrical advantage over the smooth Pt. The SLIP surface provided the greatest benefit both in vitro and in vivo, and this surface was the only type which had injection limits above the threshold for neural stimulation, at a level shown to produce a response in the feline visual cortex when using an electrode array implanted in the suprachoroidal space of the eye. This surface was found to be stable when stimulated with more than 150 million clinically relevant pulses in physiological saline.

SIGNIFICANCE

Critical to the assessment of implant devices is accurate determination of safe usage limits in an in vivo environment. Laser patterning, in particular SLIP, is a superior technique for improving the performance of implant electrodes without altering the interfacial electrode chemistry through coating. Future work will require chronic in vivo assessment of these electrode patterns.

Cortical activation following chronic passive implantation of a wide-field suprachoroidal retinal prosthesis

OBJECTIVE

The research goal is to develop a wide-field retinal stimulating array for prosthetic vision. This study aimed at evaluating the efficacy of a suprachoroidal electrode array in evoking visual cortex activity after long term implantation.

APPROACH

A planar silicone based electrode array (8 mm × 19 mm) was implanted into the suprachoroidal space in cats (ntotal = 10). It consisted of 20 platinum stimulating electrodes (600 μm diameter) and a trans-scleral cable terminated in a subcutaneous connector. Three months after implantation (nchronic = 6), or immediately after implantation (nacute = 4), an electrophysiological study was performed. Electrode total impedance was measured from voltage transients using 500 μs, 1 mA pulses. Electrically evoked potentials (EEPs) and multi-unit activity were recorded from the visual cortex in response to monopolar retinal stimulation. Dynamic range and cortical activation spread were calculated from the multi-unit recordings.

MAIN RESULTS

The mean electrode total impedance in vivo following 3 months was 12.5 ± 0.3 kΩ. EEPs were recorded for 98% of the electrodes. The median evoked potential threshold was 150 nC (charge density 53 μC cm(-2)). The lowest stimulation thresholds were found proximal to the area centralis. Mean thresholds from multiunit activity were lower for chronic (181 ± 14 nC) compared to acute (322 ± 20 nC) electrodes (P < 0.001), but there was no difference in dynamic range or cortical activation spread.

SIGNIFICANCE

Suprachoroidal stimulation threshold was lower in chronic than acute implantation and was within safe charge limits for platinum. Electrode-tissue impedance following chronic implantation was higher, indicating the need for sufficient compliance voltage (e.g. 12.8 V for mean impedance, threshold and dynamic range). The wide-field suprachoroidal array reliably activated the retina after chronic implantation.

Quasi-monopolar electrical stimulation of the retina: a computational modelling study

OBJECTIVE

In this study we investigated the feasibility of quasi-monopolar (QMP) electrical stimulation for retinal implant devices, using a computational model of the retinal ganglion cell layer.

APPROACH

When used with hexagonally arrayed multiple electrodes, QMP stimulation is a hybrid of hexapolar and conventional monopolar stimulus modes. In hexapolar mode, each active electrode is surrounded by six guards which collectively return the stimulus current, whereas in monopolar mode the injected stimulus current is returned through a distant return electrode. The QMP paradigm, on the other hand, distributes the return current between the guard electrodes as well as the distant return. The electrodes tested were 25, 50 and 100 µm in diameter, with hexagonally arranged centre-to-centre spacing of either double or quadruple this diameter.

MAIN RESULTS

Simulation results indicated that electrode size had minimal effects on subretinal threshold currents, whilst electrode configuration and centre-to-centre spacing played major roles in determining thresholds and spatial activation patterns. Threshold charge densities for 50 and 100 µm electrodes were generally within the safe limit.

SIGNIFICANCE

We found that QMP stimulation offers greater advantages compared to monopolar and hexapolar stimulation, in that it combines the low thresholds of monopolar stimulation with the localized spatial activation achieved with hexapolar electrodes during parallel stimulation.

Development of a surgical procedure for implantation of a prototype suprachoroidal retinal prosthesis

BACKGROUND

Current surgical techniques for retinal prosthetic implantation require long and complicated surgery, which can increase the risk of complications and adverse outcomes.

METHOD

The suprachoroidal position is known to be an easier location to access surgically, and so this study aimed to develop a surgical procedure for implanting a prototype suprachoroidal retinal prosthesis. The array implantation procedure was developed in 14 enucleated eyes. A full-thickness scleral incision was made parallel to the intermuscular septum and superotemporal to the lateral rectus muscle. A pocket was created in the suprachoroidal space, and the moulded electrode array was inserted. The scleral incision was closed and scleral anchor point sutured. In 9 of the 14 eyes examined, the device insertion was obstructed by the posterior ciliary neurovascular bundle. Subsequently, the position of this neurovascular bundle in 10 eyes was characterized. Implantation and lead routing procedure was then developed in six human cadavers. The array was tunnelled forward from behind the pinna to the orbit. Next, a lateral canthotomy was made. Lead fixation was established by creating an orbitotomy drilled in the frontal process of the zygomatic bone. The lateral rectus muscle was detached, and implantation was carried out. Finally, pinna to lateral canthus measurements were taken on 61 patients in order to determine optimal lead length.

RESULTS

These results identified potential anatomical obstructions and informed the anatomical fitting of the suprachoroidal retinal prosthesis.

CONCLUSION

As a result of this work, a straightforward surgical approach for accurate anatomical suprachoroidal array and lead placement was developed for clinical application.

A simulation of current focusing and steering with penetrating optic nerve electrodes

OBJECTIVE

Current focusing and steering are both widely used to shape the electric field and increase the number of distinct perceptual channels in neural stimulation, yet neither technique has been used for an optic nerve (ON)-based visual prosthesis. In order to evaluate the effects of current focusing and steering in penetrative stimulation, we built an integrated computational model to simulate and investigate the influence of stimulating parameters on ON fibre recruitment.

APPROACH

Finite element models with extremely fine meshes were first established to compute the 3D electric potential distribution under different stimulating parameters. Then the external electric potential was fed to randomized multi-compartment cable models to predict the distribution of fibres generating an action potential. Finally a statistical process was conducted to quantify the recruitment region.

MAIN RESULTS

The simulation results show that a two-electrode mode is superior to a three-electrode mode in current steering. The three-electrode mode performs poorly in current focusing, albeit the localized recruitment from both configurations implies that current focusing might be unnecessary in penetrative ON stimulation.

SIGNIFICANCE

This study provides useful information for the optimized design of penetrating ON electrodes and stimulating strategies. The Monte Carlo style computation paradigm is designed to simulate neural responses of an ensemble of ON fibres, which can be immediately transferred to other similar problems.

Electrical stimulation of inner retinal neurons in wild-type and retinally degenerate (rd/rd) mice

Electrical stimulation of the retina following photoreceptor degeneration in diseases such as retinitis pigmentosa and age-related macular degeneration has become a promising therapeutic strategy for the restoration of vision. Many retinal neurons remain functional following photoreceptor degeneration; however, the responses of the different classes of cells to electrical stimuli have not been fully investigated. Using whole-cell patch clamp electrophysiology in retinal slices we investigated the response to electrical stimulation of cells of the inner nuclear layer (INL), pre-synaptic to retinal ganglion cells, in wild-type and retinally degenerate (rd/rd) mice. The responses of these cells to electrical stimulation were extremely varied, with both extrinsic and intrinsic evoked responses observed. Further examination of the intrinsically evoked responses revealed direct activation of both voltage-gated Na⁺ channels and K⁺ channels. The expression of these channels, which is particularly varied between INL cells, and the stimulus intensity, appears to dictate the polarity of the eventual response. Retinally degenerate animals showed similar responses to electrical stimulation of the retina to those of the wild-type, but the relative representation of each response type differed. The most striking difference between genotypes was the existence of a large amplitude oscillation in the majority of INL cells in rd/rd mice (as previously reported) that impacted on the signal to noise ratio following electrical stimulation. This confounding oscillation may significantly reduce the efficacy of electrical stimulation of the degenerate retina, and a greater understanding of its origin will potentially enable it to be dampened or eliminated.

Electrically elicited visual evoked potentials in Argus II retinal implant wearers

PURPOSE

We characterized electrically elicited visual evoked potentials (eVEPs) in Argus II retinal implant wearers.

METHODS

eVEPs were recorded in four subjects, and analyzed by determining amplitude and latency of the first two positive peaks (P1 and P2). Subjects provided subjective feedback by rating the brightness and size of the phosphenes. We established eVEP input-output relationships, eVEP variability between and within subjects, the effect of stimulating different areas of the retina, and the maximal pulse rate to record eVEPs reliably.

RESULTS

eVEP waveforms had low signal-to-noise ratios, requiring long recording times and substantial signal processing. Waveforms varied between subjects, but showed good reproducibility and consistent parameter dependence within subjects. P2 amplitude overall was the most robust outcome measure and proved an accurate indicator of subjective threshold. Peak latencies showed small within-subject variability, yet their correlation with stimulus level and subjective rating were more variable than that of peak amplitudes. Pulse rates of up to (2)/3 Hz resulted in reliable eVEP recordings. Perceived phosphene brightness declined over time, as reflected in P1 amplitude, but not in P2 amplitude or peak latencies. Stimulating-electrode location significantly affected P1 and P2 amplitude and latency, but not subjective percepts.

CONCLUSIONS

While recording times and signal processing are more demanding than for standard visually evoked potential (VEP) recordings, the eVEP has proven to be a reliable tool to verify retinal implant functionality. eVEPs correlated with various stimulus parameters and with perceptual ratings. In view of these findings, eVEPs may become an important tool in functional investigations of retinal prostheses. (ClinicalTrials.gov number NCT00407602.) Dutch Abstract.

Efficacy of the hexpolar configuration in localizing the activation of retinal ganglion cells under electrical stimulation

Retinal visual prostheses provide hope of restoring sight to patients suffering from retinal degeneration such as retinitis pigmentosa and age-related macular degeneration. Retinal prostheses are used to electrically stimulate residual neurons that are spared in these diseases, namely the retinal ganglion cells (RGCs), eliciting percepts of light termed 'phosphenes'. The elicitation of multiple phosphenes via an electrode array allows patterns to be produced, resulting in a rudimentary form of vision. For such patterns to be produced effectively, the prosthesis must generate well-defined phosphenes. To this end, the hexpolar configuration has been proposed as an alternative to the traditional monopolar or bipolar configurations. It utilizes six electrodes surrounding the stimulating electrode to serve as a combined return, or 'hex guard', purportedly localizing the activation to cells located within them. In this study, the efficacy of the hexpolar configuration in localizing activity was investigated by using patch-clamp electrophysiology to measure the activation thresholds of RGCs to electrical stimulation in isolated rabbit retina. Cells located outside the hex guard were found to have significantly higher relative hexpolar thresholds (>2 fold) as compared to cells located within the hex guard. This confirms the efficacy of the hexpolar configuration in localizing activity to within the hex guard. Furthermore, the effect of using cathodic-first versus anodic-first stimulation on hexpolar threshold and localization was investigated. No significant difference was observed between the two groups, in terms of lowering thresholds or improving localization.

Convolution based method for calculating inputs from dendritic fields in a continuum model of the retina

Computational models are valuable tools that can be used to aid the design and test the efficacy of electrical stimulation strategies in prosthetic vision devices. In continuum models of retinal electrophysiology, the effective extracellular potential can be considered as an approximate measure of the electrotonic loading a neuron's dendritic tree exerts on the soma. A convolution based method is presented to calculate the local spatial average of the effective extracellular loading in retinal ganglion cells (RGCs) in a continuum model of the retina which includes an active RGC tissue layer. The method can be used to study the effect of the dendritic tree size on the activation of RGCs by electrical stimulation using a hexagonal arrangement of electrodes (hexpolar) placed in the suprachoroidal space.