Advances in retinal prosthesis systems

Liquid-metal-based three-dimensional microelectrode arrays integrated with implantable ultrathin retinal prosthesis for vision restoration

Electronic retinal prostheses for stimulating retinal neurons are promising for vision restoration. However, the rigid electrodes of conventional retinal implants can inflict damage on the soft retina tissue. They also have limited selectivity due to their poor proximity to target cells in the degenerative retina. Here we present a soft artificial retina (thickness, 10 μm) where flexible ultrathin photosensitive transistors are integrated with three-dimensional stimulation electrodes of eutectic gallium-indium alloy. Platinum nanoclusters locally coated only on the tip of these three-dimensional liquid-metal electrodes show advantages in reducing the impedance of the stimulation electrodes. These microelectrodes can enhance the proximity to the target retinal ganglion cells and provide effective charge injections (72.84 mC cm-2) to elicit neural responses in the retina. Their low Young's modulus (234 kPa), owing to their liquid form, can minimize damage to the retina. Furthermore, we used an unsupervised machine learning approach to effectively identify the evoked spikes to grade neural activities within the retinal ganglion cells. Results from in vivo experiments on a retinal degeneration mouse model reveal that the spatiotemporal distribution of neural responses on their retina can be mapped under selective localized illumination areas of light, suggesting the restoration of their vision.

Stargardt macular dystrophy and therapeutic approaches

Stargardt macular dystrophy (Stargardt disease; STGD1; OMIM 248200) is the most prevalent inherited macular dystrophy. STGD1 is an autosomal recessive disorder caused by multiple pathogenic sequence variants in the large ABCA4 gene (OMIM 601691). Major advances in understanding both the clinical and molecular features, as well as the underlying pathophysiology, have culminated in many completed, ongoing and planned human clinical trials of novel therapies.The aims of this concise review are to describe (1) the detailed phenotypic and genotypic characteristics of the disease, multimodal imaging findings, natural history of the disease, and pathogenesis, (2) the multiple avenues of research and therapeutic intervention, including pharmacological, cellular therapies and diverse types of genetic therapies that have either been investigated or are under investigation and (3) the exciting novel therapeutic approaches on the translational horizon that aim to treat STGD1 by replacing the entire 6.8 kb ABCA4 open reading frame.

Towards biologically plausible phosphene simulation for the differentiable optimization of visual cortical prostheses

Blindness affects millions of people around the world. A promising solution to restoring a form of vision for some individuals are cortical visual prostheses, which bypass part of the impaired visual pathway by converting camera input to electrical stimulation of the visual system. The artificially induced visual percept (a pattern of localized light flashes, or 'phosphenes') has limited resolution, and a great portion of the field's research is devoted to optimizing the efficacy, efficiency, and practical usefulness of the encoding of visual information. A commonly exploited method is non-invasive functional evaluation in sighted subjects or with computational models by using simulated prosthetic vision (SPV) pipelines. An important challenge in this approach is to balance enhanced perceptual realism, biologically plausibility, and real-time performance in the simulation of cortical prosthetic vision. We present a biologically plausible, PyTorch-based phosphene simulator that can run in real-time and uses differentiable operations to allow for gradient-based computational optimization of phosphene encoding models. The simulator integrates a wide range of clinical results with neurophysiological evidence in humans and non-human primates. The pipeline includes a model of the retinotopic organization and cortical magnification of the visual cortex. Moreover, the quantitative effects of stimulation parameters and temporal dynamics on phosphene characteristics are incorporated. Our results demonstrate the simulator's suitability for both computational applications such as end-to-end deep learning-based prosthetic vision optimization as well as behavioral experiments. The modular and open-source software provides a flexible simulation framework for computational, clinical, and behavioral neuroscientists working on visual neuroprosthetics.

Wireless closed-loop deep brain stimulation using microelectrode array probes

Deep brain stimulation (DBS), including optical stimulation and electrical stimulation, has been demonstrated considerable value in exploring pathological brain activity and developing treatments for neural disorders. Advances in DBS microsystems based on implantable microelectrode array (MEA) probes have opened up new opportunities for closed-loop DBS (CL-DBS) in situ. This technology can be used to detect damaged brain circuits and test the therapeutic potential for modulating the output of these circuits in a variety of diseases simultaneously. Despite the success and rapid utilization of MEA probe-based CL-DBS microsystems, key challenges, including excessive wired communication, need to be urgently resolved. In this review, we considered recent advances in MEA probe-based wireless CL-DBS microsystems and outlined the major issues and promising prospects in this field. This technology has the potential to offer novel therapeutic options for psychiatric disorders in the future.

Bi-directional electrical recording and stimulation of the intact retina with a screen-printed soft probe: a feasibility study

Introduction

Electrophysiological investigations of intact neural circuits are challenged by the gentle and complex nature of neural tissues. Bi-directional electrophysiological interfacing with the retina, in its intact form, is particularly demanding and currently there is no feasible approach to achieve such investigations. Here we present a feasibility study of a novel soft multi-electrode array suitable for bi-directional electrophysiological study of the intact retina.

Methods

Screen-printed soft electrode arrays were developed and tested. The soft probes were designed to accommodate the curvature of the retina in the eye and offer an opportunity to study the retina in its intact form.

Results

For the first time, we show both electrical recording and stimulation capabilities from the intact retina. In particular, we demonstrate the ability to characterize retina responses to electrical stimulation and reveal stable, direct, and indirect responses compared with ex-vivo conditions.

Discussion

These results demonstrate the unique performances of the new probe while also suggesting that intact retinas retain better stability and robustness than ex-vivo retinas making them more suitable for characterizing retina responses to electrical stimulation.

Development of Specialized Microelectrode Arrays with Local Electroporation Functionality

When a cell or tissue is exposed to a pulsed electric field (100-1000 V/cm), the cellular membrane permeabilizes for biomolecules that cannot pass an intact cellular membrane. During this electropermeabilization (EP), plasmid deoxyribonucleic acid sequences encoding therapeutic or regulatory genes can enter the cell, which is called gene electrotransfer (GET). GET using micro-/nano technology provides higher spatial resolution and operates with lower voltage amplitudes compared to conventional bulk EP. Microelectrode arrays (MEAs), which are usually used for the recording and stimulation of neuronal signals, can be utilized for GET as well. In this study, we developed a specialized MEA for local EP of adherent cells. Our manufacturing process provides a most flexible electrode and substrate material selection. We used electrochemical impedance spectroscopy to characterize the impedance of the MEAs and the impact of an adherent cellular layer. We verified the local EP functionality of the MEAs by loading a fluorophore dye into human embryonic kidney 293T cells. Finally, we demonstrated a GET with a subsequent green fluorescent protein expression by the cells. Our experiments prove that a high spatial resolution of GET can be obtained using MEAs.

An update on visual prosthesis

PURPOSE

To review the available evidence on the different retinal and visual prostheses for patients with retinitis pigmentosa and new implants for other indications including dry age-related macular degeneration.

METHODS

The PubMed, GoogleScholar, ScienceDirect, and ClinicalTrials databases were the main resources used to conduct the medical literature search. An extensive search was performed to identify relevant articles concerning the worldwide advances in retinal prosthesis, clinical trials, status of devices and potential future directions up to December 2022.

RESULTS

Thirteen devices were found to be current and were ordered by stimulation location. Six have active clinical trials. Four have been discontinued, including the Alpha IMS, Alpha AMS, IRIS II, and ARGUS II which had FDA and CE mark approval. Future directions will be presented in the review.

CONCLUSION

This review provides an update of retinal prosthetic devices, both current and discontinued. While some devices have achieved visual perception in animals and/or humans, the main issues impeding the commercialization of these devices include: increased length of time to observe outcomes, difficulties in finding validated meaures for use in studies, unknown long-term effects, lack of funding, and a low amount of patients simultaneously diagnosed with RP lacking other comorbid conditions. The ARGUS II did get FDA and CE mark approval so it was deemed safe and also effective. However, the company became more focused on a visual cortical implant. Future efforts are headed towards more biocompatible, safe, and efficacious devices.

Multiple consecutive-biphasic pulse stimulation improves spatially localized firing of retinal ganglion cells in the degenerate retina

Retinal prostheses have shown some clinical success in restoring vision in patients with retinitis pigmentosa. However, the post-implantation visual acuity does not exceed that of legal blindness. The reason for the poor visual acuity might be that (1) degenerate retinal ganglion cells (RGCs) are less responsive to electrical stimulation than normal RGCs, and (2) electrically-evoked RGC spikes show a more widespread not focal response. The single-biphasic pulse electrical stimulation, commonly used in artificial vision, has limitations in addressing these issues. In this study, we propose the benefit of multiple consecutive-biphasic pulse stimulation. We used C57BL/6J mice and C3H/HeJ (rd1) mice for the normal retina and retinal degeneration model. An 8 × 8 multi-electrode array was used to record electrically-evoked RGC spikes. We compared RGC responses when increasing the amplitude of a single biphasic pulse versus increasing the number of consecutive biphasic pulses at the same stimulus charge. Increasing the amplitude of a single biphasic pulse induced more RGC spike firing while the spatial resolution of RGC populations decreased. For multiple consecutive-biphasic pulse stimulation, RGC firing increased as the number of pulses increased, and the spatial resolution of RGC populations was well preserved even up to 5 pulses. Multiple consecutive-biphasic pulse stimulation using two or three pulses in degenerate retinas induced as much RGC spike firing as in normal retinas. These findings suggest that the newly proposed multiple consecutive-biphasic pulse stimulation can improve the visual acuity in prosthesis-implanted patients.

Smart Contact Lenses as Wearable Ophthalmic Devices for Disease Monitoring and Health Management

The eye contains a complex network of physiological information and biomarkers for monitoring disease and managing health, and ocular devices can be used to effectively perform point-of-care diagnosis and disease management. This comprehensive review describes the target biomarkers and various diseases, including ophthalmic diseases, metabolic diseases, and neurological diseases, based on the physiological and anatomical background of the eye. This review also includes the recent technologies utilized in eye-wearable medical devices and the latest trends in wearable ophthalmic devices, specifically smart contact lenses for the purpose of disease management. After introducing other ocular devices such as the retinal prosthesis, we further discuss the current challenges and potential possibilities of smart contact lenses.

Effects on Retinal Stimulation of the Geometry and the Insertion Location of Penetrating Electrodes

Retinal implants have been developed and implanted to restore vision from outer retinal degeneration, but their performance is still limited due to the poor spatial resolution. To improve the localization of stimulation, microelectrodes in various three-dimensional (3D) shapes have been investigated. In particular, computational simulation is crucial for optimizing the performance of a novel microelectrode design before actual fabrication. However, most previous studies have assumed a uniform conductivity for the entire retina without testing the effect of electrodes placement in different layers. In this study, we used the finite element method to simulate electric fields created by 3D microelectrodes of three different designs in a retina model with a stratified conductivity profile. The three electrode designs included two conventional shapes - a conical electrode (CE) and a pillar electrode (PE); we also proposed a novel structure of pillar electrode with an insulating wall (PEIW). A quantitative comparison of these designs shows the PEIW generates a stronger and more confined electric field with the same current injection, which is preferred for high-resolution retinal prostheses. Moreover, our results demonstrate both the magnitude and the shape of potential distribution generated by a penetrating electrode depend not only on the geometry, but also substantially on the insertion depth of the electrode. Although epiretinal insertions are mainly discussed, we also compared results for subretinal insertions. The results provide valuable insights for improving the spatial resolution of retinal implants using 3D penetrating microelectrodes and highlight the importance of considering the heterogeneity of conductivities in the retina.

Direct laser writing of 3D electrodes on flexible substrates

This report describes a 3D microelectrode array integrated on a thin-film flexible cable for neural recording in small animals. The fabrication process combines traditional silicon thin-film processing techniques and direct laser writing of 3D structures at micron resolution via two-photon lithography. Direct laser-writing of 3D-printed electrodes has been described before, but this report is the first to provide a method for producing high-aspect-ratio structures. One prototype, a 16-channel array with 300 µm pitch, demonstrates successful electrophysiological signal capture from bird and mouse brains. Additional devices include 90 µm pitch arrays, biomimetic mosquito needles that penetrate through the dura of birds, and porous electrodes with enhanced surface area. The rapid 3D printing and wafer-scale methods described here will enable efficient device fabrication and new studies examining the relationship between electrode geometry and electrode performance. Applications include small animal models, nerve interfaces, retinal implants, and other devices requiring compact, high-density 3D electrodes.

High amplitude pulses on the same charge condition efficiently elicit bipolar cell-mediated retinal ganglion cell responses in the degenerate retina

Retinal pigmentosa (RP) patients lose vision due to the loss of photoreceptors. Retinal prostheses bypass the dead photoreceptors by electrically stimulating surviving retinal neurons, such as bipolar cells or retinal ganglion cells (RGCs). In previous studies, stimulus charge has been mainly optimized to maximize the RGC response to electrical stimulation. This study aimed to investigate the effect of amplitude and duration even under the same charge condition on eliciting RGC spikes in the wild-type and degenerate retinas. Wild-type (WT) Sprague-Dawley rats were used as the normal retinal model, and Pde6b knockout rats were used as a retinal degeneration (RD) model. Electrically-evoked RGC spikes were recorded from isolated rat retinas using an 8 × 8 multielectrode array. The same charge was maintained (10 or 20 nC), and electrical stimulation was applied to WT and RD retinas, adjusting the amplitude and duration of the 1st phase of biphasic pulses. In the pulse modulation of the 1st phase, high amplitude (short duration) pulses induced more RGC spikes than low amplitude (long duration) pulses. Both WT and RD retinas showed a significant reduction in the number of RGC spikes upon stimulation with lower amplitude (longer duration) pulses. In clinical trials where stimulus charges are delivered to the degenerate retina of blind patients, high amplitude (short duration) pulses would help elicit more RGC spikes.

Evaluation of the Long-Term Clinical Results of 3 Patients Implanted with the Argus II Retinal Prosthesis

This study presents the long-term clinical results of Argus II retinal prosthesis implantation in eyes with light perception and projection in 3 patients with end-stage retinitis pigmentosa. No conjunctival erosion, hypotony, or implant displacement was observed during postoperative follow-up. The electrical threshold values were lower in the macular region and higher close to the tack fixation region and peripherally. Optical coherence tomography scans showed fibrosis and retinoschisis formation at the retina-implant interface in two cases. This was attributed to mechanical and electrical effects on the tissue due to the active daily use of the system and the electrodes' proximity to the retina. The patients were able to integrate the system into their daily lives and perform activities that they could not do before. Studies on retinal prostheses for the rehabilitation of hereditary retinal diseases are ongoing, so both social and clinical observations and experiences related to the implant are valuable.

New frontiers of retinal therapeutic intervention: a critical analysis of novel approaches

A recent wave of pharmacologic and technologic innovations has revolutionized our management of retinal diseases. Many of these advancements have demonstrated efficacy and can increase the quality of life while potentially reducing complications and decreasing the burden of care for patients. Some advances, such as longer-acting anti-vascular endothelial growth factor agents, port delivery systems, gene therapy, and retinal prosthetics have been approved by the US Food and Drug Administration, and are available for clinical use. Countless other therapeutics are in various stages of development, promising a bright future for further improvements in the management of the retinal disease. Herein, we have highlighted several important novel therapies and therapeutic approaches and examine the opportunities and limitations offered by these innovations at the new frontier. KEY MESSAGESNumerous pharmacologic and technologic advancements have been emerging, providing a higher treatment efficacy while decreasing the burden and associated side effects.Anti-vascular endothelial growth factor (anti-VEGF) and its longer-acting agents have dramatically improved visual outcomes and have become a mainstay treatment in various retinal diseases.Gene therapy and retinal prosthesis implantation in the treatment of congenital retinal dystrophy can accomplish the partial restoration of vision and improved daily function in patients with blindness, an unprecedented success in the field of retina.

Optogenetic Prosthetization of Retinal Bipolar Cells

Abstract

Although the experience of optogenetic retinal prosthetics in animal models dates back to more than 16 years, the first results obtained on humans have only been reported in the last year. Over this period, the main challenges of prosthetics became clear and the approaches to their solution were proposed. In this review, we aim to present the achievements in the field of optogenetic prosthetization of retinal bipolar cells with a focus mainly on relatively recent publications. The review addresses the advantages and disadvantages of bipolar cell prosthetics as compared to the alternative target, retinal ganglion cells, and provides a comparative analysis of the effectiveness of ionotropic light-sensitive proteins (channelrhodopsins) or metabotropic receptors (rhodopsins) as prosthetic tools.

Optogenetic approaches to therapy for inherited retinal degenerations

Inherited retinal degenerations such as retinitis pigmentosa (RP) affect around one in 4000 people and are the leading cause of blindness in working age adults in several countries. In these typically monogenic conditions, there is progressive degeneration of photoreceptors; however, inner retinal neurons such as bipolar cells and ganglion cells remain largely structurally intact, even in end-stage disease. Therapeutic approaches aiming to stimulate these residual cells, independent of the underlying genetic cause, could potentially restore visual function in patients with advanced vision loss, and benefit many more patients than therapies directed at the specific gene implicated in each disorder. One approach investigated for this purpose is that of optogenetics, a method of neuromodulation that utilises light to activate neurons engineered to ectopically express a light-sensitive protein. Using gene therapy via adeno-associated viral vectors, a range of photosensitive proteins have been expressed in remaining retinal cells in advanced retinal degeneration with in vivo studies demonstrating restoration of visual function. Developing an effective optogenetic strategy requires consideration of multiple factors, including the light-sensitive protein that is used, the vector and method for gene delivery, and the target cell for expression because these in turn may affect the quality of vision that can be restored. Currently, at least four clinical trials are ongoing to investigate optogenetic therapies in patients, with the ultimate aim of reversing visual loss in end-stage disease.

Assessing people with visual impairments’ access to information, awareness and satisfaction with high-tech assistive technology

Assistive technology (AT) devices are designed to help people with visual impairments (PVIs) perform activities that would otherwise be difficult or impossible. Devices specifically designed to assist PVIs by attempting to restore sight or substitute it for another sense have a very low uptake rate. This study, conducted in England, aimed to investigate why this is the case by assessing accessibility to knowledge, awareness, and satisfaction with AT in general and with sensory restoration and substitution devices in particular. From a sample of 25 PVIs, ranging from 21 to 68 years old, results showed that participants knew where to find AT information; however, health care providers were not the main source of this information. Participants reported good awareness of different ATs, and of technologies they would not use, but reported poor awareness of specific sensory substitution and restoration devices. Only three participants reported using AT, each with different devices and varying levels of satisfaction. The results from this study suggest a possible breakdown in communication between health care providers and PVIs, and dissociation between reported AT awareness and reported access to AT information. Moreover, awareness of sensory restoration and substitution devices is poor, which may explain the limited use of such technology.

Implications of Neural Plasticity in Retinal Prosthesis

Retinal degenerative diseases such as retinitis pigmentosa cause a progressive loss of photoreceptors that eventually prevents the affected person from perceiving visual sensations. The absence of a visual input produces a neural rewiring cascade that propagates along the visual system. This remodeling occurs first within the retina. Then, subsequent neuroplastic changes take place at higher visual centers in the brain, produced by either the abnormal neural encoding of the visual inputs delivered by the diseased retina or as the result of an adaptation to visual deprivation. While retinal implants can activate the surviving retinal neurons by delivering electric current, the unselective activation patterns of the different neural populations that exist in the retinal layers differ substantially from those in physiologic vision. Therefore, artificially induced neural patterns are being delivered to a brain that has already undergone important neural reconnections. Whether or not the modulation of this neural rewiring can improve the performance for retinal prostheses remains a critical question whose answer may be the enabler of improved functional artificial vision and more personalized neurorehabilitation strategies.

Retinal ganglion cell desensitization is mitigated by varying parameter constant excitation pulse trains

Retinal prostheses partially restore vision in patients blinded by retinitis pigmentosa (RP) and age-related macular degeneration (AMD). One issue that limits the effectiveness of retinal stimulation is the desensitization of the retina response to repeated pulses. Rapid fading of percepts is reported in clinical studies. We studied the retinal output evoked by fixed pulse trains vs. pulse trains that have variable parameters pulse-to-pulse. We used the current clamp to record RGC spiking in the isolated mouse retina. Trains of biphasic current pulses at different frequencies and amplitudes were applied. The main results we report are: (1) RGC desensitization was induced by increasing stimulus frequency, but was unrelated to stimulus amplitude. Desensitization persisted when the 20 Hz stimulation pulses were applied to the retinal ganglion cells at 65 μA, 85 μA, and 105 μA. Subsequent pulses in the train evoked fewer spikes. There was no obvious desensitization when 2 Hz stimulation pulse trains were applied. (2) Blocking inhibitory GABA_A receptor increased spontaneous activity but did not reduce desensitization. (3) Pulse trains with constant charge or excitation (based on strength-duration curves) but varying pulse width, amplitude, and shape increased the number of evoked spikes/pulse throughout the pulse train. This suggests that retinal desensitization can be partially overcome by introducing variability into each pulse.

Light-induced charge generation in polymeric nanoparticles restores vision in advanced-stage retinitis pigmentosa rats

Retinal dystrophies such as Retinitis pigmentosa are among the most prevalent causes of inherited legal blindness, for which treatments are in demand. Retinal prostheses have been developed to stimulate the inner retinal network that, initially spared by degeneration, deteriorates in the late stages of the disease. We recently reported that conjugated polymer nanoparticles persistently rescue visual activities after a single subretinal injection in the Royal College of Surgeons rat model of Retinitis pigmentosa. Here we demonstrate that conjugated polymer nanoparticles can reinstate physiological signals at the cortical level and visually driven activities when microinjected in 10-months-old Royal College of Surgeons rats bearing fully light-insensitive retinas. The extent of visual restoration positively correlates with the nanoparticle density and hybrid contacts with second-order retinal neurons. The results establish the functional role of organic photovoltaic nanoparticles in restoring visual activities in fully degenerate retinas with intense inner retina rewiring, a stage of the disease in which patients are subjected to prosthetic interventions.

Retinal dystrophies such as Retinitis pigmentosa are among the most prevalent causes of inherited incurable legal blindness. Here the authors demonstrate that conjugated polymer nanoparticles reinstate visual functions in aged rats with fully degenerated and rewired retinas.

Visual neuroprosthesis: present and possible perspectives

The purpose of this study is to provide an overview of the replacements used in lost vision in the form of the bionic eye, to show their deficiencies and outline other possibilities for non-invasive stimulation of functional areas of the visual cortex. The review highlights the damage not only to the primary altered cellular structures, but also to all other horizontally and vertically localised structures. Based on the results of a large number of functional magnetic resonance imaging and electrophysiological methods, the authors focus on the pathology of the entire visual pathway in pigmentary retinopathy (PR) and age-related macular degeneration (AMD). This study provides a recent overview of the possible systems used to replace lost vision. These range from stimulation with intraocular implants, through stimulation of the optic nerve and lateral geniculate nucleus to the visual cortex. The second part deals with the design of image processing technology and its transformation into the form of transcranial stimulation of undamaged parts of the brain, which is protected by a patent. This is comprehensive overview of the current possibilities of replacement of lost vision and a proposal for a new non-invasive methods of stimulation of functional neurons of the visual cortex.

Correlated Activity in the Degenerate Retina Inhibits Focal Response to Electrical Stimulation

Retinal prostheses have shown some clinical success in patients with retinitis pigmentosa and age-related macular degeneration. However, even after the implantation of a retinal prosthesis, the patient’s visual acuity is at best less than 20/420. Reduced visual acuity may be explained by a decrease in the signal-to-noise ratio due to the spontaneous hyperactivity of retinal ganglion cells (RGCs) found in degenerate retinas. Unfortunately, abnormal retinal rewiring, commonly observed in degenerate retinas, has rarely been considered for the development of retinal prostheses. The purpose of this study was to investigate the aberrant retinal network response to electrical stimulation in terms of the spatial distribution of the electrically evoked RGC population. An 8 × 8 multielectrode array was used to measure the spiking activity of the RGC population. RGC spikes were recorded in wild-type [C57BL/6J; P56 (postnatal day 56)], rd1 (P56), rd10 (P14 and P56) mice, and macaque [wild-type and drug-induced retinal degeneration (RD) model] retinas. First, we performed a spike correlation analysis between RGCs to determine RGC connectivity. No correlation was observed between RGCs in the control group, including wild-type mice, rd10 P14 mice, and wild-type macaque retinas. In contrast, for the RD group, including rd1, rd10 P56, and RD macaque retinas, RGCs, up to approximately 400–600 μm apart, were significantly correlated. Moreover, to investigate the RGC population response to electrical stimulation, the number of electrically evoked RGC spikes was measured as a function of the distance between the stimulation and recording electrodes. With an increase in the interelectrode distance, the number of electrically evoked RGC spikes decreased exponentially in the control group. In contrast, electrically evoked RGC spikes were observed throughout the retina in the RD group, regardless of the inter-electrode distance. Taken together, in the degenerate retina, a more strongly coupled retinal network resulted in the widespread distribution of electrically evoked RGC spikes. This finding could explain the low-resolution vision in prosthesis-implanted patients.

Two-Way Communication Digital Power Controllers for Wireless Retinal Prosthesis Systems

Power-efficient digital controllers are proposed for wireless retinal prosthetic systems. Power management plays an important role in reducing the power consumption and avoiding malfunctions in implantable medical devices. In the case of implantable devices with only one-way communication, the received power level is uncertain because there is no feedback on the power status. Accordingly, system breakdown due to inefficient power management should be avoided to prevent harm to patients. In this study, digital power controllers were developed for achieving two-way communication. Three controllers—a forward and back telemetry control unit, a power control unit, and a preamble control unit—operated simultaneously to control the class-E amplifier input power, provided command data to stimulators, monitored the power levels of the implanted devices, and generated back telemetry data. For performance verification, we implemented a digital power control system using a field-programmable gate array and then demonstrated it by employing a wireless telemetry system.

Morphological Factors that Underlie Neural Sensitivity to Stimulation in the Retina

Retinal prostheses are a promising therapeutic intervention for patients afflicted by outer retinal degenerative diseases like retinitis pigmentosa and age-related macular degeneration. While significant advances in the development of retinal implants have been made, the quality of vision elicited by these devices remains largely sub-optimal. The variability in the responses produced by retinal devices is most likely due to the differences between the natural cell type-specific signaling that occur in the healthy retina vs. the non-specific activation of multiple cell types arising from artificial stimulation. In order to replicate these natural signaling patterns, stimulation strategies must be capable of preferentially activating specific RGC types. To design more selective stimulation strategies, a better understanding of the morphological factors that underlie the sensitivity to prosthetic stimulation must be developed. This review will focus on the role that different anatomical components play in driving the direct activation of RGCs by extracellular stimulation. Briefly, it will (1) characterize the variability in morphological properties of α-RGCs, (2) detail the influence of morphology on the direct activation of RGCs by electric stimulation, and (3) describe some of the potential biophysical mechanisms that could explain differences in activation thresholds and electrically evoked responses between RGC types.

An Infrared Image-Enhancement Algorithm in Simulated Prosthetic Vision: Enlarging Working Environment of Future Retinal Prostheses

BACKGROUND

Most existing retinal prostheses contain a built-in visible-light camera module that captures images of the surrounding environment. Thus, in case of insufficient or lack of visible light, the camera fails to work, and the retinal prostheses enter a dormant or "OFF" state. A simple and effective solution is replacing the visible-light camera with a dual-mode camera. The present research aimed to achieve two main purposes: (1) to explore whether the dual-mode camera in prosthesis recipients works under no visible-light conditions and (2) to assess its performance.

METHODS

To accomplish these aims, we enrolled subjects in a psychophysical experiment under simulated prosthetic vision (SPV) conditions. We found that the subjects could complete some simple visual tasks, but the recognition performance under the infrared mode was significantly inferior to that under the visible-light mode. These results inspired us to develop and propose a feasible infrared image-enhancement processing algorithm. Another psychophysical experiment was performed to verify the feasibility of the algorithm.

RESULTS

The obtained results showed that the average efficiency of the subjects completing visual tasks using our enhancement algorithm (0.014±0.001) was significantly higher (p < 0.001) than that of subjects using direct pixelization (0.007±0.001).

CONCLUSIONS

We concluded that a dual-mode camera could be a feasible solution to improving the performance of retinal prostheses as the camera adapted better to the specific existing ambient light conditions. Dual-mode cameras combined with this infrared image-enhancement algorithm could provide a promising direction for the design of future retinal prostheses.

An in-silico analysis of electrically-evoked responses of midget and parasol retinal ganglion cells in different retinal regions

BACKGROUND

Visual outcomes provided by present retinal prostheses that primarily target retinal ganglion cells (RGCs) through epiretinal stimulation remain rudimentary, partly due to the limited knowledge of retinal responses under electrical stimulation. Better understanding of how different retinal regions can be quantitatively controlled with high spatial accuracy, will be beneficial to the design of micro-electrode arrays (MEAs) and stimulation strategies for next-generation wide-view, high-resolution epiretinal implants.

METHODS

A computational model was developed to assess neural activity at different eccentricities (2 mm and 5 mm) within the human retina. This model included midget and parasol RGCs with anatomically accurate cell distribution and cell-specific morphological information. We then performed in silico investigations of region-specific RGC responses to epiretinal electrical stimulation using varied electrode sizes (5 µm - 210 µm diameter), emulating both commercialized retinal implants and recently-developed prototype devices.

RESULTS

Our model of epiretinal stimulation predicted RGC population excitation analogous to the complex percepts reported in human subjects. Following this, our simulations suggest that midget and parasol RGCs have characteristic regional differences in excitation under preferred electrode sizes. Relatively central (2 mm) regions demonstrated higher number of excited RGCs but lower overall activated receptive field (RF) areas under the same stimulus amplitudes (two-way ANOVA, p < 0.05). Furthermore, the activated RGC numbers per unit active RF area (number-RF ratio) were significantly higher in central than in peripheral regions, and higher in the midget than in the parasol population under all tested electrode sizes (two-way ANOVA, p < 0.05). Our simulations also suggested that smaller electrodes exhibit a higher range of controllable stimulation parameters to achieve pre-defined performance of RGC excitation. ..

Bone marrow-derived mononuclear stem cells in the treatment of retinal degenerations

Retinal degenerative diseases affecting the outer retina in its many forms (inherited, acquired or induced) are characterized by photoreceptor loss, and represent currently a leading cause of irreversible vision loss in the world. At present, there are very few treatments capable of preventing, recovering or reversing photoreceptor degeneration or the secondary retinal remodeling, which follows photoreceptor loss and can also cause the death of other retinal cells. Thus, these diseases are nowadays one of the greatest challenges in the field of ophthalmological research. Bone marrow derived-mononuclear stem cell transplantation has shown promising results for the treatment of photoreceptor degenerations. These cells may have the potential to slow down photoreceptor loss, and therefore should be applied in the early stages of photoreceptor degenerations. Furthermore, because of their possible paracrine effects, they may have a wide range of clinical applications, since they can potentially impact on several retinal cell types at once and photoreceptor degenerations can involve different cells and/or begin in one cell type and then affect adjacent cells. The intraocular injection of bone marrow derived-mononuclear stem cells also enhances the outcomes of other treatments aimed to protect photoreceptors. Therefore, it is likely that future investigations may combine bone marrow derived-mononuclear stem cell therapy with other systemic or intraocular treatments to obtain greater therapeutic effects in degenerative retinal diseases.

Targeting Ocular Drug Delivery: An Examination of Local Anatomy and Current Approaches

Ocular drug delivery remains the focus of much modern research. Primary routes of administration include the surface, the intravitreal space, the subretinal space, and the subconjunctival space, each with its own series of unique challenges, limitations, and advantages. Each of these approaches requires careful consideration of the local anatomy, physical barriers, and key cells as well as the interface between the anatomy and the drug or drug system being delivered. While least invasive, the topical route poses a challenge with the many physical barriers that prevent drug penetration into the eye; while injection into the intravitreal, subretinal, and subconjunctival spaces are direct and targeted but limited due to the many internal clearance mechanisms and potential for damage to the eye. Polymeric-based, sustained-release drug delivery systems have been identified as a potential solution to many of these challenges; however, the design and successful implementation of a sustained-release system that is well-tolerated, bioactive, biocompatible, and degradable remains, in many cases, only in the early stages. The drugs and biomaterials in question also require special attention as small chemical changes could result in vastly different outcomes. This paper explores the anatomy and key cells of these four primary drug delivery routes as well as the interface between drug and drug delivery systems and the anatomy, reviewing the recent developments and current state of research in each area. Finally, this paper also examines the frequently used drugs and biomaterials found in ocular drug delivery and summarizes the primary interactions observed.

Effects of tACS-Like Electrical Stimulation on Off- and On-Off Center Retinal Ganglion Cells: Part II

Purpose

Transcranial alternating current stimulation (tACS) is used as a brain stimulation mechanism to enhance learning, ameliorate some psychiatric disorders, and modify behavior. This study assessed the effects of near threshold tACS-like currents on Off-center and On-Off retinal ganglion cell responsiveness in the rabbit retina eyecup preparation as a model for central nervous system effects.

Materials and Methods

We made extracellular recordings in the isolated rabbit eyecup preparation using single electrodes and microelectrode arrays to measure light-evoked spike responses in different classes of Off-center and On-Off retinal ganglion cells before, during, and after brief applications of alternating currents of 1–2 microamperes, at frequencies of 10, 20, 30, and 40 Hz.

Results

tACS application sculpted the light-evoked response profiles without directly driving spiking activity of the 20 Off-center and On-Off ganglion cells we recorded from. During tACS application, Off responses were significantly enhanced for 6 cells and significantly suppressed for 14 cells, but after tACS application, Off responses were significantly enhanced for 7 cells and suppressed for 12 cells. The Off responses of the remaining two cells returned to baseline. On responses were less affected during and after tACS.

Conclusion

tACS sculpts Off-center and On-Off retinal ganglion cell responsiveness. The dissimilarity of effects in different cells within the same class and the differential effects on the On and Off components of the light response within the same cell are consistent with the hypothesis that tACS acts at threshold on amacrine cells in the inner plexiform layer.

Modern concepts of bionic vision

Loss of vision is a pressing medical and social problem leading to profound disability, loss of ability to work, serious alterations in the psycho-emotional state, and a decline of the quality of life. When conservative or surgical treatment can not help restore vision, the use of visual prosthesis - bionic eye - can be an effective solution. This review covers the main modern approaches to the development of visual prosthetic systems. Analysis of publications revealed that there are several main approaches to visual prosthesis differing primarily by the anatomical structure targeted for stimulation in order to activate visual sensations. The most significant among them are retinal prostheses, optic nerve stimulation, and cortical visual prostheses. Currently, retinal prostheses such as ARGUS II demonstrate the most successful results, since the stimulation of the surviving neural structures of the retina is a relatively easy task, but their field of application is limited to diseases associated with pathological changes in photoreceptors. The development of cortical visual prostheses is more difficult, but in the future they may allow using more stimulation channels to obtain a more detailed visual perception. In addition, cortical visual prostheses are universal, as they do not require preservation of any structures of the visual organ, only the primary visual cortex.

Electrophysiological investigation of intact retina with soft printed organic neural interface

Objective.Understanding how the retina converts a natural image or an electrically stimulated one into neural firing patterns is the focus of on-going research activities.Ex vivo, the retina can be readily investigated using multi electrode arrays (MEAs). However, MEA recording and stimulation from an intact retina (in the eye) has been so far insufficient.Approach.In the present study, we report new soft carbon electrode arrays suitable for recording and stimulating neural activity in an intact retina. Screen-printing of carbon ink on 20µm polyurethane (PU) film was used to realize electrode arrays with electrodes as small as 40µm in diameter. Passivation was achieved with a holey membrane, realized using laser drilling in a thin (50µm) PU film. Plasma polymerized 3.4-ethylenedioxythiophene was used to coat the electrode array to improve the electrode specific capacitance. Chick retinas, embryonic stage day 13, both explanted and intact inside an enucleated eye, were used.Main results.A novel fabrication process based on printed carbon electrodes was developed and yielded high capacitance electrodes on a soft substrate.Ex vivoelectrical recording of retina activity with carbon electrodes is demonstrated. With the addition of organic photo-capacitors, simultaneous photo-electrical stimulation and electrical recording was achieved. Finally, electrical activity recordings from an intact chick retina (inside enucleated eyes) were demonstrated. Both photosensitive retinal ganglion cell responses and spontaneous retina waves were recorded and their features analyzed.Significance.Results of this study demonstrated soft electrode arrays with unique properties, suitable for simultaneous recording and photo-electrical stimulation of the retina at high fidelity. This novel electrode technology opens up new frontiers in the study of neural tissuein vivo.

Neurosensory Prosthetics: An Integral Neuromodulation Part of Bioelectronic Device

Bioelectronic medicines (BEMs) constitute a branch of bioelectronic devices (BEDs), which are a class of therapeutics that combine neuroscience with molecular biology, immunology, and engineering technologies. Thus, BEMs are the culmination of thought processes of scientists of varied fields and herald a new era in the treatment of chronic diseases. BEMs work on the principle of neuromodulation of nerve stimulation. Examples of BEMs based on neuromodulation are those that modify neural circuits through deep brain stimulation, vagal nerve stimulation, spinal nerve stimulation, and retinal and auditory implants. BEDs may also serve as diagnostic tools by mimicking human sensory systems. Two examples of in vitro BEDs used as diagnostic agents in biomedical applications based on in vivo neurosensory circuits are the bioelectronic nose and bioelectronic tongue. The review discusses the ever-growing application of BEDs to a wide variety of health conditions and practices to improve the quality of life.

A Treatise on Electrode Carrier Dislocation in Visual Prosthetic Devices

Visual implants electrically activate adjacent neurons to induce artificial perception for visual impairment patients to restore some sight. Proximity of electrode carrier to the ganglion cell has attracted careful consideration due to its implications on secure electrochemical and single-localized stimulation. In this study, we postulate a novel strategy to treat the proximity of electrode-cell. A simulation framework includes the carrier dislocation using the geometric parameters of Argus II® epiretinal electrode carrier design. Lastly, we present results on the offset angle of displacement.Clinical Relevance- This postulates a novel strategy to treat the dislocation of electrode carrier confined with a single tack.

Functional Availability of ON-Bipolar Cells in the Degenerated Retina: Timing and Longevity of an Optogenetic Gene Therapy

Degenerative diseases of the retina are responsible for the death of photoreceptors and subsequent loss of vision in patients. Nevertheless, the inner retinal layers remain intact over an extended period of time, enabling the restoration of light sensitivity in blind retinas via the expression of optogenetic tools in the remaining retinal cells. The chimeric Opto-mGluR6 protein represents such a tool. With exclusive ON-bipolar cell expression, it combines the light-sensitive domains of melanopsin and the intracellular domains of the metabotropic glutamate receptor 6 (mGluR6), which naturally mediates light responses in these cells. Albeit vision restoration in blind mice by Opto-mGluR6 delivery was previously shown, much is left to be explored in regard to the effects of the timing of the treatment in the degenerated retina. We performed a functional evaluation of Opto-mGluR6-treated murine blind retinas using multi-electrode arrays (MEAs) and observed long-term functional preservation in the treated retinas, as well as successful therapeutical intervention in later stages of degeneration. Moreover, the treatment decreased the inherent retinal hyperactivity of the degenerated retinas to levels undistinguishable from healthy controls. Finally, we observed for the first time micro electroretinograms (mERGs) in optogenetically treated animals, corroborating the origin of Opto-mGluR6 signalling at the level of mGluR6 of ON-bipolar cells.

Ultrasound-Powered Implants: A Critical Review of Piezoelectric Material Selection and Applications

Ultrasound-powered implants (UPIs) represent cutting edge power sources for implantable medical devices (IMDs), as their powering strategy allows for extended functional lifetime, decreased size, increased implant depth, and improved biocompatibility. IMDs are limited by their reliance on batteries. While batteries proved a stable power supply, batteries feature relatively large sizes, limited life spans, and toxic material compositions. Accordingly, energy harvesting and wireless power transfer (WPT) strategies are attracting increasing attention by researchers as alternative reliable power sources. Piezoelectric energy scavenging has shown promise for low power applications. However, energy scavenging devices need be located near sources of movement, and the power stream may suffer from occasional interruptions. WPT overcomes such challenges by more stable, on-demand power to IMDs. Among the various forms of WPT, ultrasound powering offers distinct advantages such as low tissue-mediated attenuation, a higher approved safe dose (720 mW cm^-2 ), and improved efficiency at smaller device sizes. This study presents and discusses the state-of-the-art in UPIs by reviewing piezoelectric materials and harvesting devices including lead-based inorganic, lead-free inorganic, and organic polymers. A comparative discussion is also presented of the functional material properties, architecture, and performance metrics, together with an overview of the applications where UPIs are being deployed.

Testing of Newly Developed Wide-Field Dual-Array Suprachoroidal-Transretinal Stimulation Prosthesis in Dogs

Purpose

This study was conducted to investigate the feasibility of a newly developed wide-field dual-array suprachoroidal–transretinal stimulation (STS) prosthesis in dogs and to examine its biocompatibility and stability over a 4-month period.

Methods

Three types of STS dual arrays were designed and tested. The STS dual-array was implanted into a scleral pocket of the left eye of six healthy beagle dogs. Ophthalmic examinations, fundus photography, fluorescein angiography (FA), electroretinography (ERG), and functional testing of this system were conducted postoperatively. The dogs were euthanatized at the end of the experiment, and their eyes were enucleated and histologically examined.

Results

All prostheses were successfully implanted without complications, and no serious adverse event occurred during the postoperative period. Fundus photographs and FA showed no serious damage in the retina surrounding the arrays. The ERGs recorded from the implanted eyes showed no significant differences from those from control eyes. Histological evaluations demonstrated good preservation of the retina over the array. However, system failure occurred in 50% of the dogs owing to dog-specific habits.

Conclusions

Implantation of this prosthesis system in dogs is feasible and can be performed without significant damage to the eye. The biocompatibility and stability of the array were good during the observation period, but the low durability of the system against dogs (not humans) is an issue to be resolved in the future.

Translational Relevance

This study suggests that this wide-field dual-array prosthesis might widen the visual field and might be useful for patients with retinitis pigmentosa.

NEUROTRANSMISSION IN VISUAL ANALYZER AND BIONIC EYE. A REVIEW

AIMS

The aim of the work is to point out the transmission of electrical voltage changes in the visual analyser and thus the efficiency of the bionic eye.

MATERIAL AND METHODS

The review deals with the question of the transmission of electrical changes in visual path voltage under physiological and pathological conditions. In particular, it points to feedback autoregulatory damage not only of primarily altered cellular structures, but of all other, both horizontally and vertically localized. Based on the results of functional magnetic resonance imaging and electrophysiological methods, it shows the pathology of the entire visual pathway in three eye diseases: retinitis pigmentosa, age-related macular degeneration and glaucoma.

RESULTS

The thesis also provides an overview of possible systems that are used to replace lost vision, from epiretinal, subretinal, suprachoroidal implants, through stimulation of the optic nerve, corpus geniculatum laterale to the visual cortex.

CONCLUSION

Due to the pathology of neurotransmission, bionic eye systems cannot be expected to be restored after stabilization of binocular functions.

The impact of synchronous versus asynchronous electrical stimulation in artificial vision

Visual prosthesis devices designed to restore sight to the blind have been under development in the laboratory for several decades. Clinical translation continues to be challenging, due in part to gaps in our understanding of critical parameters such as how phosphenes, the electrically-generated pixels of artificial vision, can be combined to form images. In this review we explore the effects that synchronous and asynchronous electrical stimulation across multiple electrodes have in evoking phosphenes. Understanding how electrical patterns influence phosphene generation to control object binding and perception of visual form is fundamental to creation of a clinically successful prosthesis.

A machine-learning algorithm correctly classifies cortical evoked potentials from both visual stimulation and electrical stimulation of the optic nerve

Objective. Optic nerve's intraneural stimulation is an emerging neuroprosthetic approach to provide artificial vision to totally blind patients. An open question is the possibility to evoke individual non-overlapping phosphenes via selective intraneural optic nerve stimulation. To begin answering this question, first, we aim at showing in preclinical experiments with animals that each intraneural electrode could evoke a distinguishable activity pattern in the primary visual cortex.Approach. We performed both patterned visual stimulation and patterned electrical stimulation in healthy rabbits while recording evoked cortical activity with an electrocorticogram array in the primary visual cortex. Electrical stimulation was delivered to the optic nerve with the intraneural array OpticSELINE. We used a support vector machine algorithm paired to a linear regression model to classify cortical responses originating from visual stimuli located in different portions of the visual field and electrical stimuli from the different electrodes of the OpticSELINE.Main results. Cortical activity induced by visual and electrical stimulation could be classified with nearly 100% accuracy relative to the specific location in the visual field or electrode in the array from which it originated. For visual stimulation, the accuracy increased with the separation of the stimuli and reached 100% for separation higher than 7°. For electrical stimulation, at low current amplitudes, the accuracy increased with the distance between electrodes, while at higher current amplitudes, the accuracy was nearly 100% already for the shortest separation.Significance. Optic nerve's intraneural stimulation with the OpticSELINE induced discernible cortical activity patterns. These results represent a necessary condition for an optic nerve prosthesis to deliver vision with non-overlapping phosphene. However, clinical investigations will be required to assess the translation of these results into perceptual phenomena.

Inflammatory Foreign Body Response Induced by Neuro-Implants in Rat Cortices Depleted of Resident Microglia by a CSF1R Inhibitor and Its Implications

Inflammatory encapsulation of implanted cortical-neuro-probes [the foreign body response (FBR)] severely limits their use in basic brain research and in clinical applications. A better understanding of the inflammatory FBR is needed to effectively mitigate these critical limitations. Combining the use of the brain permeant colony stimulating factor 1 receptor inhibitor PLX5622 and a perforated polyimide-based multielectrode array platform (PPMP) that can be sectioned along with the surrounding tissue, we examined the contribution of microglia to the formation of inflammatory FBR. To that end, we imaged the inflammatory processes induced by PPMP implantations after eliminating 89-94% of the cortical microglia by PLX5622 treatment. The observations showed that: (I) inflammatory encapsulation of implanted PPMPs proceeds by astrocytes in microglia-free cortices. The activated astrocytes adhered to the PPMP's surfaces. This suggests that the roles of microglia in the FBR might be redundant. (II) PPMP implantation into control or continuously PLX5622-treated rats triggered a localized surge of microglia mitosis. The daughter cells that formed a "cloud" of short-lived (T 1 / 2 ≤ 14 days) microglia around and in contact with the implant surfaces were PLX5622 insensitive. (III) Neuron degeneration by PPMP implantation and the ensuing recovery in time, space, and density progressed in a similar manner in the cortices following 89-94% depletion of microglia. This implies that microglia do not serve a protective role with respect to the neurons. (IV) Although the overall cell composition and dimensions of the encapsulating scar in PLX5622-treated rats differed from the controls, the recorded field potential (FP) qualities and yield were undistinguishable. This is accounted for by assuming that the FP amplitudes in the control and PLX5622-treated rats were related to the seal resistance formed at the interface between the adhering microglia and/or astrocytes and the PPMP platform rather than across the scar tissue. These observations suggest that the prevention of both astrocytes and microglia adhesion to the electrodes is required to improve FP recording quality and yield.

An Introductory Tutorial on Brain–Computer Interfaces and Their Applications

The prospect and potentiality of interfacing minds with machines has long captured human imagination. Recent advances in biomedical engineering, computer science, and neuroscience are making brain–computer interfaces a reality, paving the way to restoring and potentially augmenting human physical and mental capabilities. Applications of brain–computer interfaces are being explored in applications as diverse as security, lie detection, alertness monitoring, gaming, education, art, and human cognition augmentation. The present tutorial aims to survey the principal features and challenges of brain–computer interfaces (such as reliable acquisition of brain signals, filtering and processing of the acquired brainwaves, ethical and legal issues related to brain–computer interface (BCI), data privacy, and performance assessment) with special emphasis to biomedical engineering and automation engineering applications. The content of this paper is aimed at students, researchers, and practitioners to glimpse the multifaceted world of brain–computer interfacing.

Oculomotor Responses to Dynamic Stimuli in a 44-Channel Suprachoroidal Retinal Prosthesis

Purpose

To investigate oculomotor behavior in response to dynamic stimuli in retinal implant recipients.

Methods

Three suprachoroidal retinal implant recipients performed a four-alternative forced-choice motion discrimination task over six sessions longitudinally. Stimuli were a single white bar (“moving bar”) or a series of white bars (“moving grating”) sweeping left, right, up, or down across a 42″ monitor. Performance was compared with normal video processing and scrambled video processing (randomized image-to-electrode mapping to disrupt spatiotemporal structure). Eye and head movement was monitored throughout the task.

Results

Two subjects had diminished performance with scrambling, suggesting retinotopic discrimination was used in the normal condition and made smooth pursuit eye movements congruent to the moving bar stimulus direction. These two subjects also made stimulus-related eye movements resembling optokinetic reflex (OKR) for moving grating stimuli, but the movement was incongruent with stimulus direction. The third subject was less adept at the task, appeared primarily reliant on head position cues (head movements were congruent to stimulus direction), and did not exhibit retinotopic discrimination and associated eye movements.

Conclusions

Our observation of smooth pursuit indicates residual functionality of cortical direction-selective circuits and implies a more naturalistic perception of motion than expected. A distorted OKR implies improper functionality of retinal direction-selective circuits, possibly due to retinal remodeling or the non-selective nature of the electrical stimulation.

Translational Relevance

Retinal implant users can make naturalistic eye movements in response to moving stimuli, highlighting the potential for eye tracker feedback to improve perceptual localization and image stabilization in camera-based visual prostheses.

Microfluidic and Microscale Assays to Examine Regenerative Strategies in the Neuro Retina

Bioengineering systems have transformed scientific knowledge of cellular behaviors in the nervous system (NS) and pioneered innovative, regenerative therapies to treat adult neural disorders. Microscale systems with characteristic lengths of single to hundreds of microns have examined the development and specialized behaviors of numerous neuromuscular and neurosensory components of the NS. The visual system is comprised of the eye sensory organ and its connecting pathways to the visual cortex. Significant vision loss arises from dysfunction in the retina, the photosensitive tissue at the eye posterior that achieves phototransduction of light to form images in the brain. Retinal regenerative medicine has embraced microfluidic technologies to manipulate stem-like cells for transplantation therapies, where de/differentiated cells are introduced within adult tissue to replace dysfunctional or damaged neurons. Microfluidic systems coupled with stem cell biology and biomaterials have produced exciting advances to restore vision. The current article reviews contemporary microfluidic technologies and microfluidics-enhanced bioassays, developed to interrogate cellular responses to adult retinal cues. The focus is on applications of microfluidics and microscale assays within mammalian sensory retina, or neuro retina, comprised of five types of retinal neurons (photoreceptors, horizontal, bipolar, amacrine, retinal ganglion) and one neuroglia (Müller), but excludes the non-sensory, retinal pigmented epithelium.

Colour-sensitive conjugated polymer inkjet-printed pixelated artificial retina model studied via a bio-hybrid photovoltaic device

In recent years, organic electronic materials have been shown to be a promising tool, even transplanted in vivo, for transducing light stimuli to non-functioning retinas. Here we developed a bio-hybrid optoelectronic device consisting of patterned organic polymer semiconductors interfaced with an electrolyte solution in a closed sandwich architecture in order to study the photo-response of photosensitive semiconducting layers or patterns in an environment imitating biological extracellular fluids. We demonstrate an artificial retina model composed of on an array of 42,100 pixels made of three different conjugated polymers via inkjet printing with 110 pixels/mm² packing density. Photo-sensing through three-colour pixelation allows to resolve incoming light spectrally and spatially. The compact colour sensitive optoelectronic device represents an easy-to-handle photosensitive platform for the study of the photo response of artificial retina systems.

Micro-Fabrication of Components for a High-Density Sub-Retinal Visual Prosthesis

We present a retrospective of unique micro-fabrication problems and solutions that were encountered through over 10 years of retinal prosthesis product development, first for the Boston Retinal Implant Project initiated at the Massachusetts Institute of Technology and at Harvard Medical School’s teaching hospital, the Massachusetts Eye and Ear—and later at the startup company Bionic Eye Technologies, by some of the same personnel. These efforts culminated in the fabrication and assembly of 256+ channel visual prosthesis devices having flexible multi-electrode arrays that were successfully implanted sub-retinally in mini-pig animal models as part of our pre-clinical testing program. We report on the processing of the flexible multi-layered, planar and penetrating high-density electrode arrays, surgical tools for sub-retinal implantation, and other parts such as coil supports that facilitated the implantation of the peri-ocular device components. We begin with an overview of the implantable portion of our visual prosthesis system design, and describe in detail the micro-fabrication methods for creating the parts of our system that were assembled outside of our hermetically-sealed electronics package. We also note the unique surgical challenges that sub-retinal implantation of our micro-fabricated components presented, and how some of those issues were addressed through design, materials selection, and fabrication approaches.

Ultrasonic Retinal Neuromodulation and Acoustic Retinal Prosthesis

Ultrasound is an emerging method for non-invasive neuromodulation. Studies in the past have demonstrated that ultrasound can reversibly activate and inhibit neural activities in the brain. Recent research shows the possibility of using ultrasound ranging from 0.5 to 43 MHz in acoustic frequency to activate the retinal neurons without causing detectable damages to the cells. This review recapitulates pilot studies that explored retinal responses to the ultrasound exposure, discusses the advantages and limitations of the ultrasonic stimulation, and offers an overview of engineering perspectives in developing an acoustic retinal prosthesis. For comparison, this article also presents studies in the ultrasonic stimulation of the visual cortex. Despite that, the summarized research is still in an early stage; ultrasonic retinal stimulation appears to be a viable technology that exhibits enormous therapeutic potential for non-invasive vision restoration.

Influence of field of view in visual prostheses design: Analysis with a VR system

OBJECTIVE

Visual prostheses are designed to restore partial functional vision in patients with total vision loss. Retinal visual prostheses provide limited capabilities as a result of low resolution, limited field of view and poor dynamic range. Understanding the influence of these parameters in the perception results can guide prostheses research and design.

APPROACH

In this work, we evaluate the influence of field of view with respect to spatial resolution in visual prostheses, measuring the accuracy and response time in a search and recognition task. Twenty-four normally sighted participants were asked to find and recognize usual objects, such as furniture and home appliance in indoor room scenes. For the experiment, we use a new simulated prosthetic vision system that allows simple and effective experimentation. Our system uses a virtual-reality environment based on panoramic scenes. The simulator employs a head-mounted display which allows users to feel immersed in the scene by perceiving the entire scene all around. Our experiments use public image datasets and a commercial head-mounted display. We have also released the virtual-reality software for replicating and extending the experimentation.

MAIN RESULTS

Results show that the accuracy and response time decrease when the field of view is increased. Furthermore, performance appears to be correlated with the angular resolution, but showing a diminishing return even with a resolution of less than 2.3 phosphenes per degree.

SIGNIFICANCE

Our results seem to indicate that, for the design of retinal prostheses, it is better to concentrate the phosphenes in a small area, to maximize the angular resolution, even if that implies sacrificing field of view.

Innovative strategies for treating retinal diseases

OBJECTIVE

The aim of this comprehensive paper is to acquaint the readers with innovative approaches in the treatment of retinal diseases, which could in the coming years to get into clinical practice. Retinal prostheses, retinal pigment epithelial (RPE) transplantation, gene therapy and optogenetics will be described in this paper.

METHODOLOGY

Describing the basic characteristics and mechanisms of different types of therapy and subsequently literary minireview clarifying the current state of knowledge in the area.

RESULTS

Retinal prostheses, RPE transplantation, gene therapy and optogenetics offer yet unexplored possibilities and are considered as the future of treatment of retinal diseases where classical pharmacotherapy or surgical treatment are no longer sufficient. However, all these methods challenge not only in the innovative technical implementation itself, but also for the ethical, administrative and economic demands.

CONCLUSION

There will be certainly interesting development in the treatment of retinal diseases, but it is not possible to fully estimate which modality of treatment will be dominant in the future.

In-Vivo Microsystems: A Review

In-vivo sensors yield valuable medical information by measuring directly on the living tissue of a patient. These devices can be surface or implant devices. Electrical activity in the body, from organs or muscles can be measured using surface electrodes. For short term internal devices, catheters are used. These include cardiac catheter (in blood vessels) and bladder catheters. Due to the size and shape of the catheters, silicon devices provided an excellent solution for sensors. Since many cardiac catheters are disposable, the high volume has led to lower prices of the silicon sensors. Many catheters use a single sensor, but silicon offers the opportunity to have multi sensors in a single catheter, while maintaining small size. The cardiac catheter is usually inserted for a maximum of 72 h. Some devices may be used for a short-to-medium period to monitor parameters after an operation or injury (1-4 weeks). Increasingly, sensing, and actuating, devices are being applied to longer term implants for monitoring a range of parameters for chronic conditions. Devices for longer term implantation presented additional challenges due to the harshness of the environment and the stricter regulations for biocompatibility and safety. This paper will examine the three main areas of application for in-vivo devices: surface devices and short/medium-term and long-term implants. The issues of biocompatibility and safety will be discussed.