Past, present, future: a review on visual prostheses

This review presents the historic background, the present status and the future prospects of several visual implant types such as retinal implants, as well as optic nerve and thalamus stimulation, and stimulation of the visual cortex. Already achieved milestones, such as improved object recognition and letter reading, give hope that a breakthrough can be achieved in the coming years. Furthermore, clinical results from recent studies are presented in order to describe the obstacles that have to be overcome in the future. Currently, inner eye implants placed within the retina are the preferred option for electrical stimulation of the optic pathway. However, the limited number of stimulating electrodes and the non-focal activation of target neurons are still hindering the generation of percepts of higher quality. In the future, optogenetic approaches may be used to activate retinal neurons with a high temporal and spatial accuracy. The main challenge for all types of visual implants will be to utilize as many parts of the remaining optic pathway as possible and to focally activate functionally different pathways.

Modeling the response of ON and OFF retinal bipolar cells during electric stimulation

Retinal implants allowing blind people suffering from diseases like retinitis pigmentosa and macular degeneration to regain rudimentary vision are struggling with several obstacles. One of the main problems during external electric stimulation is the co-activation of the ON and OFF pathways which results in mutual impairment. In this study the response of ON and OFF cone retinal bipolar cells during extracellular electric stimulation from the subretinal space was examined. To gain deeper insight into the behavior of these cells sustained L-type and transient T-type calcium channels were integrated in the synaptic terminals of reconstructed 3D morphologies of ON and OFF cone bipolar cells. Intracellular calcium concentration in the synaptic regions of the model neurons was investigated as well since calcium influx is a crucial parameter for cell-to-cell activity between bipolar cells and retinal ganglion cells. It was shown that monophasic stimulation results in significant different calcium concentrations in the synaptic terminals of ON and OFF bipolar cells. Intracellular calcium increased to values up to fourfold higher in the OFF bipolar model neuron in comparison to the ON bipolar cell. Furthermore, geometric properties strongly influence the activation of bipolar cells. Monophasic, biphasic, single and repetitive pulses with similar lengths, amplitudes and polarities were applied to the two model neurons.

Influence of the sodium channel band on retinal ganglion cell excitation during electric stimulation--a modeling study

Electric stimulation using retinal implants allows blind people to re-experience a rudimentary kind of vision. The elicited percepts or so called 'phosphenes' are highly inconstant and therefore do not restore vision properly. The better knowledge of how retinal neurons, especially retinal ganglion cells, respond to electric stimulation will help to develop more sophisticated stimulation strategies. Special anatomic and physiologic properties like a band of highly dense sodium channels in retinal ganglion cells may help to achieve a focal activation of target cells and as a result better restoration of vision. A portion of retinal ganglion cell axons, about 40μm from the soma and between 25 and 40μm in length, shows a specific biophysical property. Electrode locations close to a band of highly dense sodium channels which were identified immunochemically show lowest thresholds during electric stimulation. The (modeled) thresholds for this kind of structure result in lowest thresholds as well. The influence on the location where action potentials are generated within the axon is far reaching. When a stimulating electrode is positioned far outside the actual band region the site of spike initiation still remains within the sodium channel band. These findings suggest to further examine the key mechanisms of activation for retinal ganglion cells because focal activation without influencing passing axons of neurons located far away can improve the outcome of electric stimulation and therefore the development of retinal implants.