Development and implantation of a minimally invasive wireless subretinal neurostimulator

A 4.49nW/Pixel Light-to-Stimulus Duration Converter-Based Retinal Prosthesis Chip

This paper presents a 288-pixel retinal prosthesis (RP) chip implemented in a 0.18 μm CMOS process. The proposed light-to-stimulus duration converter (LSDC) and biphasic stimulator generate a wide range of retinal stimuli proportional to the incident light intensity at a low supply voltage of 1V. The implemented chip shows 25.5 dB dynamic stimulation range and the state-of-the art low power consumption of 4.49 nW/pixel. Ex-vivo experiments were performed with a mouse retina and patch-clamp recording. The electrical artifact recorded by the patch electrode demonstrates that the proposed chip can generate electrical stimuli that have different pulse durations depending on the light intensity. Correspondingly, the spike counts in a retinal ganglion cell (RGC) were successfully modulated by the brightness of the light stimuli.

Minimizing Iridium Oxide Electrodes for High Visual Acuity Subretinal Stimulation

Vision loss from diseases of the outer retina, such as age-related macular degeneration, is among the leading causes of irreversible blindness in the world today. The goal of retinal prosthetics is to replace the photo-sensing function of photoreceptors lost in these diseases with optoelectronic hardware to electrically stimulate patterns of retinal activity corresponding to vision. To enable high-resolution retinal prosthetics, the scale of stimulating electrodes must be significantly decreased from current designs; however, this reduces the amount of stimulating current that can be delivered. The efficacy of subretinal stimulation at electrode sizes suitable for high visual acuity retinal prosthesis are not well understood, particularly within the safe charge injection limits of electrode materials. Here, we measure retinal ganglion cell (RGC) responses in a mouse model of blindness to evaluate the stimulation efficacy of 10, 20, and 30 μm diameter iridium oxide electrodes within the electrode charge injection limits, focusing on measures of charge threshold and dynamic range. Stimulation thresholds were lower for smaller electrodes, but larger electrodes could elicit a greater dynamic range of spikes and recruited more ganglion cells within charge injection limits. These findings suggest a practical lower limit for planar electrode size and indicate strategies for maximizing stimulation thresholds and dynamic range.

Residual voltage as an ad-hoc indicator of electrode damage in biphasic electrical stimulation

Objective.We derive and demonstrate how residual voltage (RV) from a biphasic electrical stimulation pulse can be used to recognize degradation at the electrode-tissue interface.Approach.Using a first order model of the electrode-tissue interface and a rectangular biphasic stimulation current waveform, we derive the equations for RV as well as RV growth over several stimulation pulses. To demonstrate the use of RV for damage detection, we simulate accelerated damage on sputtered iridium oxide film (SIROF) electrodes using potential cycling. RV measurements of the degraded electrodes are compared against standard characterization methods of cyclic voltammetry and electrochemical impedance spectroscopy.Main results.Our theoretical discussion illustrates how an intrinsic RV arises even from perfectly balanced biphasic pulses due to leakage via the charge-transfer resistance. Preliminary data inin-vivorat experiments follow the derived model of RV growth, thereby validating our hypothesis that RV is a characteristic of the electrode-tissue interface. RV can therefore be utilized for detecting damage at the electrode. Our experimental results for damage detection show that delamination of SIROF electrodes causes a reduction in charge storage capacity, which in turn reflects a measurable increase in RV.Significance.Chronically implanted electrical stimulation systems with multi-electrode arrays have been the focus of physiological engineering research for the last decade. Changes in RV over time can be a quick and effective method to identify and disconnect faulty electrodes in large arrays. Timely diagnoses of electrode status can ensure optimal long term operation, and prevent further damage to the tissue near these electrodes.

A Dual-Mode Multifunctional Pulsed Radio-Frequency Stimulator for Trigeminal Neuralgia Relief and its Animal Model

This work proposed a programmable pulsed radio-frequency (PRF) stimulator for trigeminal neuralgia (TN) relief on demand. The implantable stimulator is a miniaturized micro-system which integrates a wireless interface circuit, a sensor interface circuit, a PRF pattern generation circuit and a logic controller. The multifunctional stimulator capable of delivering current/voltage stimulation provides the choice of the biphasic sinusoidal, square and patterned waveform for PRF treatment researches. The external handheld device can wirelessly transmit the parameters of frequency, amplitude, pulse duration and repetition rate of the pulse train to the implanted stimulator. While stimulating, the temperature sensor can monitor the operating temperature. The feedback signal is transmitted in medical implanted communication system (MICS). The micro-system is fabricated in a 0.35 μm CMOS process with a chip size of 3.1 × 2.7 mm². The fabricated chip was mounted on a 2.6 × 2.1 cm² test board for studying the in vivo efficacy of pain relief by PRF. Animal studies of PRF stimulation and commonly-used medication for trigeminal neuralgia are also demonstrated and the presented results prove that PRF stimulation has greater effectiveness on trigeminal neuralgia relief comparing to the medication. The effectiveness period lasts at least 14 days. The results of neural recording show that the PRF stimulation of trigeminal ganglion (TG) attenuated neuron activities without being severely damaged. Pathology also revealed no lesion found on the stimulated area.

Ab-interno surgical technique for the implantation of a wireless subretinal prosthesis in mini-pigs

We sought to describe the surgical techniques required in the ab-interno method to implant subretinal prostheses in mini-pigs and suggest tips to facilitate optimal outcomes. During vitrectomy, the use of valved trocar cannulas was essential to stabilize the detached retina and implanted chip. As a first step in retinal detachment, a 23-gauge cannula with very small amount of viscoelastic material was used to establish the retinal hole and promote retinal detachment. Then, balanced salt solution was applied to increase the retinal detachment and diathermy was used to make opening for subretinal prosthesis. For easy positioning of the subretinal prosthesis, a curved laser probe was adopted when handling the subretinal prosthesis under the retina. After surgery, the sclerotomy sites were tightly sutured to prevent silicone oil leakage. Without special equipment, such as a 41-gauge tip, retinal detachment could be induced easily, while the prosthesis was also successfully inserted and manipulated under the retina without an iatrogenic retinal tear. Two weeks after the operation, the oil fully occupied the intraocular volume without leakage. The subretinal prosthesis remained stable without complication. Understanding the principle of the ab-interno method and considering several tips for improving surgical access may help to enhance surgical success rates of subretinal prostheses implantation.

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.

Wireless Power Transfer for Implanted Medical Application: A Review

With ever-increasing concerns on health and environmental safety, there is a fast-growing interest in new technologies for medical devices and applications. Particularly, wireless power transfer (WPT) technology provides reliable and convenient power charging for implant medical devices without additional surgery. For those WPT medical systems, the width of the human body restricts the charging distance, while the specific absorption rate (SAR) standard limits the intensity of the electromagnetic field. In order to develop a high-efficient charging strategy for medical implants, the key factors of transmission distance, coil structure, resonant frequency, etc. are paid special attention. In this paper, a comprehensive overview of near-field WPT technologies in medical devices is presented and discussed. Also, future development is discussed for the prediction of different devices when embedded in various locations of the human body. Moreover, the key issues including power transfer efficiency and output power are addressed and analyzed. All concerning characteristics of WPT links for medical usage are elaborated and discussed. Thus, this review provides an in-depth investigation and the whole map for WPT technologies applied in medical applications.

Acute Rabbit Eye Model for Testing Subretinal Prostheses

Purpose

Subretinal prostheses are a novel technology for restoring useful vision in patients with retinitis pigmentosa or age-related macular degeneration. We characterize the surgical implantation technique and functional time window of an acute rabbit eye model for testing of human subretinal prostheses.

Methods

Retinal prostheses were implanted subretinally in 26 rabbits using a two-step technique. Fundus imaging, fluorescein fundus angiography, and optical coherence topography (OCT) were conducted postoperatively from days 1 to 21 to monitor prosthesis positioning and retinal anatomic changes.

Results

Successful implantation and excellent retina apposition were achieved in 84.6% of the rabbits. OCTs showed the overlying retina at full thickness for the first 2 days after implantation. Histology confirmed intact inner layers of the overlying retina until day 3. Progressive atrophy of the overlying retina was revealed by repeated OCTs; approximately 40% of the retina thickness remained on postoperative days 5 and 6.

Conclusions

The two-step implantation technique works well for the rabbit eye model with human prostheses. Rabbit retina may be used for acute electrophysiologic testing of a retinal prosthesis, but is unsuitable for chronic studies due to the merangiotic retina and its limited time window of validity.

Translational Relevance

The improved efficacy in prosthesis surgery using this technique will circumvent the challenges in animal models that provide human-like features critical for the transition into human clinical trials.

The development of neural stimulators: a review of preclinical safety and efficacy studies

OBJECTIVE

Given the rapid expansion of the field of neural stimulation and the rigorous regulatory approval requirements required before these devices can be applied clinically, it is important that there is clarity around conducting preclinical safety and efficacy studies required for the development of this technology.

APPROACH

The present review examines basic design principles associated with the development of a safe neural stimulator and describes the suite of preclinical safety studies that need to be considered when taking a device to clinical trial.

MAIN RESULTS

Neural stimulators are active implantable devices that provide therapeutic intervention, sensory feedback or improved motor control via electrical stimulation of neural or neuro-muscular tissue in response to trauma or disease. Because of their complexity, regulatory bodies classify these devices in the highest risk category (Class III), and they are therefore required to go through a rigorous regulatory approval process before progressing to market. The successful development of these devices is achieved through close collaboration across disciplines including engineers, scientists and a surgical/clinical team, and the adherence to clear design principles. Preclinical studies form one of several key components in the development pathway from concept to product release of neural stimulators. Importantly, these studies provide iterative feedback in order to optimise the final design of the device. Key components of any preclinical evaluation include: in vitro studies that are focussed on device reliability and include accelerated testing under highly controlled environments; in vivo studies using animal models of the disease or injury in order to assess efficacy and, given an appropriate animal model, the safety of the technology under both passive and electrically active conditions; and human cadaver and ex vivo studies designed to ensure the device's form factor conforms to human anatomy, to optimise the surgical approach and to develop any specialist surgical tooling required.

SIGNIFICANCE

The pipeline from concept to commercialisation of these devices is long and expensive; careful attention to both device design and its preclinical evaluation will have significant impact on the duration and cost associated with taking a device through to commercialisation. Carefully controlled in vitro and in vivo studies together with ex vivo and human cadaver trials are key components of a thorough preclinical evaluation of any new neural stimulator.

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.

A Review of Implant Communication Technology in WBAN: Progress and Challenges

Over the past six decades, there has been tremendous progress made in the field of medical implant communications. A comprehensive review of the progress, current state of the art, and future direction is presented in this paper. Implanted medical devices (IMDs) are designed mainly for the purpose of diagnostic, therapeutic, and assistive applications in heathcare, active living, and sports technology. The primary target of IMDs' design revolves around reliable communications, sustainable power sources, and a high degree of miniaturization while maintaining biocompatibility to surrounding tissues adhering to the human safety limits set by appropriate guidelines. The role of the Internet of Things and intelligent data analysis in implant device networks as future research is presented in this paper. Finally, in addition to reviewing the state of the art, a novel intuitive lower bound on implant size is presented.

Modeling the Improved Visual Acuity Using Photodiode Based Retinal Implants Featuring Fractal Electrodes

Electronically restoring vision to patients blinded by severe retinal degenerations is rapidly becoming a realizable feat through retinal implants. Upon receiving an implant, previously blind patients can now detect light, locate objects, and determine object motion direction. However, the restored visual acuity (VA) is still significantly below the legal blindness level (VA < 20/200). The goal of this research is to optimize the inner electrode geometry in photovoltaic subretinal implants in order to restore vision to a VA better than blindness level. We simulated neural stimulation by 20 μm subretinal photovoltaic implants featuring square or fractal inner electrodes by: (1) calculating the voltage generated on the inner electrode based on the amount of light entering the photodiode, (2) mapping how this voltage spreads throughout the extracellular space surrounding retinal bipolar neurons, and (3) determining if these extracellular voltages are sufficient for neural stimulation. By optimizing the fractal inner electrode geometry, we show that all neighboring neurons can be stimulated using an irradiance of 12 mW/mm², while the optimized square only stimulates ~10% of these neurons at an equivalent irradiance. The 20 μm fractal electrode can thus theoretically restore VA up to 20/80, if other limiting factors common to retinal degenerations, such as glia scarring and rewiring of retinal circuits, could be reduced. For the optimized square to stimulate all neighboring neurons, the irradiance has to be increased by almost 300%, which is very near the maximum permissible exposure safety limit. This demonstration that fractal electrodes can stimulate targeted neurons for long periods using safe irradiance levels highlights the possibility for restoring vision to a VA better than the blindness level using photodiode-based retinal implants.

Fractal Electrodes as a Generic Interface for Stimulating Neurons

The prospect of replacing damaged body parts with artificial implants is being transformed from science fiction to science fact through the increasing application of electronics to interface with human neurons in the limbs, the brain, and the retina. We propose bio-inspired electronics which adopt the fractal geometry of the neurons they interface with. Our focus is on retinal implants, although performance improvements will be generic to many neuronal types. The key component is a multifunctional electrode; light passes through this electrode into a photodiode which charges the electrode. Its electric field then stimulates the neurons. A fractal electrode might increase both light transmission and neuron proximity compared to conventional Euclidean electrodes. These advantages are negated if the fractal’s field is less effective at stimulating neurons. We present simulations demonstrating how an interplay of fractal properties generates enhanced stimulation; the electrode voltage necessary to stimulate all neighboring neurons is over 50% less for fractal than Euclidean electrodes. This smaller voltage can be achieved by a single diode compared to three diodes required for the Euclidean electrode’s higher voltage. This will allow patients, for the first time, to see with the visual acuity necessary for navigating rooms and streets.

Wireless Power Transfer Strategies for Implantable Bioelectronics

Neural implants have emerged over the last decade as highly effective solutions for the treatment of dysfunctions and disorders of the nervous system. These implants establish a direct, often bidirectional, interface to the nervous system, both sensing neural signals and providing therapeutic treatments. As a result of the technological progress and successful clinical demonstrations, completely implantable solutions have become a reality and are now commercially available for the treatment of various functional disorders. Central to this development is the wireless power transfer (WPT) that has enabled implantable medical devices (IMDs) to function for extended durations in mobile subjects. In this review, we present the theory, link design, and challenges, along with their probable solutions for the traditional near-field resonant inductively coupled WPT, capacitively coupled short-ranged WPT, and more recently developed ultrasonic, mid-field, and far-field coupled WPT technologies for implantable applications. A comparison of various power transfer methods based on their power budgets and WPT range follows. Power requirements of specific implants like cochlear, retinal, cortical, and peripheral are also considered and currently available IMD solutions are discussed. Patient's safety concerns with respect to electrical, biological, physical, electromagnetic interference, and cyber security from an implanted neurotech device are also explored in this review. Finally, we discuss and anticipate future developments that will enhance the capabilities of current-day wirelessly powered implants and make them more efficient and integrable with other electronic components in IMDs.

Advances in Retinal Prosthetic Research: A Systematic Review of Engineering and Clinical Characteristics of Current Prosthetic Initiatives

PURPOSE

To date, reviews of retinal prostheses have focused primarily on devices undergoing human trials in the Western Hemisphere and fail to capture significant advances in materials and engineering research in countries such as Japan and Korea, as well as projects in early stages of development. To address these gaps, this systematic review examines worldwide advances in retinal prosthetic research, evaluates engineering characteristics and clinical progress of contemporary device initiatives, and identifies potential directions for future research in the field of retinal prosthetics.

METHODS

A literature search using PubMed, Google Scholar, and IEEExplore was conducted following the PRISMA Guidelines for Systematic Review. Inclusion criteria were peer-reviewed papers demonstrating progress in human or animal trials and papers discussing the prosthetic engineering design. For each initiative, a description of the device, its engineering considerations, and recent clinical results were provided.

RESULTS

Ten prosthetic initiatives met our inclusion criteria and were organized by stimulation location. Of these initiatives, four have recently completed human trials, three are undergoing multi- or single-center human trials, and three are undergoing preclinical animal testing. Only the Argus II (FDA 2013, CE 2011) has obtained FDA approval for use in the United States; the Alpha-IMS (CE 2013) has achieved the highest visual acuity using a Landolt-C test to date and is the only device presently undergoing a multicenter clinical trial.

CONCLUSION

Several distinct approaches to retinal stimulation have been successful in eliciting visual precepts in animals and/or humans. However, many clinical needs are still not met and engineering challenges must be addressed before a retinal prosthesis with the capability to fully and safely restore functional vision can be realized.

[Artificial organs]

Research has been fighting against organ failure and shortage of donations by supplying artificial organs for many years. With the raise of new technologies, tissue engineering and regenerative medicine, many organs can benefit of an artificial equivalent: thanks to retinal implants some blind people can visualize stimuli, an artificial heart can be proposed in case of cardiac failure while awaiting for a heart transplant, artificial larynx enables laryngectomy patients to an almost normal life, while the diabetic can get a glycemic self-regulation controlled by smartphones with an artificial device. Dialysis devices become portable, as well as the oxygenation systems for terminal respiratory failure. Bright prospects are being explored or might emerge in a near future. However, the retrospective assessment of putative side effects is not yet sufficient. Finally, the cost of these new devices is significant even if the advent of three dimensional printers may reduce it.

Towards high-resolution retinal prostheses with direct optical addressing and inductive telemetry

OBJECTIVE

Despite considerable advances in retinal prostheses over the last two decades, the resolution of restored vision has remained severely limited, well below the 20/200 acuity threshold of blindness. Towards drastic improvements in spatial resolution, we present a scalable architecture for retinal prostheses in which each stimulation electrode is directly activated by incident light and powered by a common voltage pulse transferred over a single wireless inductive link.

APPROACH

The hybrid optical addressability and electronic powering scheme provides separate spatial and temporal control over stimulation, and further provides optoelectronic gain for substantially lower light intensity thresholds than other optically addressed retinal prostheses using passive microphotodiode arrays. The architecture permits the use of high-density electrode arrays with ultra-high photosensitive silicon nanowires, obviating the need for excessive wiring and high-throughput data telemetry. Instead, the single inductive link drives the entire array of electrodes through two wires and provides external control over waveform parameters for common voltage stimulation.

MAIN RESULTS

A complete system comprising inductive telemetry link, stimulation pulse demodulator, charge-balancing series capacitor, and nanowire-based electrode device is integrated and validated ex vivo on rat retina tissue.

SIGNIFICANCE

Measurements demonstrate control over retinal neural activity both by light and electrical bias, validating the feasibility of the proposed architecture and its system components as an important first step towards a high-resolution optically addressed retinal prosthesis.

Development of high impedance measurement system for water leakage detection in implantable neuroprosthetic devices

There has been a push for a greater number of channels in implantable neuroprosthetic devices; but, that number has largely been limited by current hermetic packaging technology. Microfabricated packaging is becoming reality, but a standard testing system is needed to prepare these devices for clinical trials. Impedance measurements of electrodes built into the packaging layers may give an early warning of device failure and predict device lifetime. Because the impedance magnitudes of such devices can be on the order of gigaohms, a versatile system was designed to accommodate ultra-high impedances and allow future integrated circuit implementation in current neural prosthetic technologies. Here we present the circuitry, control software, and preliminary testing results of our designed system.

On Using Residual Voltage to Estimate Electrode Model Parameters for Damage Detection

Current technology has enabled a significant increase in the number of electrodes for electrical stimulation. For large arrays of electrodes, it becomes increasingly difficult to monitor and detect failures at the stimulation site. In this paper, we propose the idea that the residual voltage from a biphasic electrical stimulation pulse can serve to recognize damage at the electrode-tissue interface. We use a simple switch circuit approach to estimate the relaxation time constant of the electrode model, which essentially models the residual voltage in biphasic electrical stimulation, and compare it with standard electrode characterization techniques. Out of 15 electrodes in a polyimide-based SIROF array, our approach highlights 3 damaged electrodes, consistent with measurements made using cyclic voltammetry and electrode impedance spectroscopy.

An Inductive Power and Data Telemetry Subsystem With Fast Transient Low Dropout Regulator for Biomedical Implants

This paper presents a capacitorless low-dropout (LDO) regulator with fast transient response and data reverse telemetry circuit for fully implantable wireless transmission applications. We propose a novel hybrid feedback structure using high-frequency compensation technology to achieve a rapid transient response for the LDO regulator. To reduce the size of the implant and transmit neural recordings through the same coil without interfering with power transmission, the load-shift-key (LSK) modulation technique is adopted for back data telemetry. The proposed implantable chip, fabricated using commercial 0.18 μm complementary metal oxide semiconductor technology, yielded an output power of 15 mW. Under 1.15 V operation voltage, the maximum overshoot and undershoot voltages were less than 45 mV and 55 mV, respectively, for a 15 mA full-load current whose rising and falling time were less than 100 ns. The proposed LSK transceiver uses a digitized demodulator to improve bandwidth efficiency for low carrier frequency operation.

A Battery-Less, Implantable Neuro-Electronic Interface for Studying the Mechanisms of Deep Brain Stimulation in Rat Models

Although deep brain stimulation (DBS) has been a promising alternative for treating several neural disorders, the mechanisms underlying the DBS remain not fully understood. As rat models provide the advantage of recording and stimulating different disease-related regions simultaneously, this paper proposes a battery-less, implantable neuro-electronic interface suitable for studying DBS mechanisms with a freely-moving rat. The neuro-electronic interface mainly consists of a microsystem able to interact with eight different brain regions bi-directionally and simultaneously. To minimize the size of the implant, the microsystem receives power and transmits data through a single coil. In addition, particular attention is paid to the capability of recording neural activities right after each stimulation, so as to acquire information on how stimulations modulate neural activities. The microsystem has been fabricated with the standard 0.18 μm CMOS technology. The chip area is 7.74 mm (2) , and the microsystem is able to operate with a single supply voltage of 1 V. The wireless interface allows a maximum power of 10 mW to be transmitted together with either uplink or downlink data at a rate of 2 Mbps or 100 kbps, respectively. The input referred noise of recording amplifiers is 1.16 μVrms, and the stimulation voltage is tunable from 1.5 V to 4.5 V with 5-bit resolution. After the electrical functionality of the microsystem is tested, the capability of the microsystem to interface with rat brain is further examined and compared with conventional instruments. All experimental results are presented and discussed in this paper.

Implantable neurotechnologies: electrical stimulation and applications

Neural stimulation using injected electrical charge is widely used both in functional therapies and as an experimental tool for neuroscience applications. Electrical pulses can induce excitation of targeted neural pathways that aid in the treatment of neural disorders or dysfunction of the central and peripheral nervous system. In this review, we summarize the recent trends in the field of electrical stimulation for therapeutic interventions of nervous system disorders, such as for the restoration of brain, eye, ear, spinal cord, nerve and muscle function. Neural prosthetic applications are discussed, and functional electrical stimulation parameters for treating such disorders are reviewed. Important considerations for implantable packaging and enhancing device reliability are also discussed. Neural stimulators are expected to play a profound role in implantable neural devices that treat disorders and help restore functions in injured or disabled nervous system.

Imparting electroactivity to polycaprolactone fibers with heparin-doped polypyrrole: Modulation of hemocompatibility and inflammatory responses

Hemocompatibility, anti-inflammation and anti-thrombogenicity of acellular synthetic vascular grafts remains a challenge in biomaterials design. Using electrospun polycaprolactone (PCL) fibers as a template, a coating of polypyrrole (PPy) was successfully polymerized onto the fiber surface. The fibers coated with heparin-doped PPy (PPy-HEP) demonstrated better electroactivity, lower surface resistivity (9-10-fold) and better anti-coagulation response (non-observable plasma recalcification after 30min vs. recalcification at 8-9min) as compared to fibers coated with pristine PPy. Red blood cell compatibility, measured by% hemolysis, was greatly improved on PPy-HEP-coated PCL in comparison to uncoated PCL (3.9±2.1% vs. 22.1±4.1%). PPy-HEP-coated PCL fibers also exhibited higher stiffness values (6.8±0.9MPa vs. 4.2±0.8MPa) as compared to PCL fibers, but similar tensile strengths. It was also observed that the application of a low alternating current led to a 4-fold reduction of platelet activation (as quantitated by CD62p expression) for the PPy-HEP-coated fibers as compared to non-stimulated conditions. In parallel, a reduction in the leukocyte adhesion to both pristine PPy-coated and PPy-HEP-coated fibers was observable with AC stimulation. Overall, a new strategy involving the use of hemocompatible conducting polymers and electrical stimulation to control thrombogenicity and inflammatory responses for synthetic vascular graft designs was demonstrated.

Development, manufacturing and application of double-sided flexible implantable microelectrodes

Many neuroprosthetic applications require the use of very small, flexible multi-channel microelectrodes (e.g. polyimide-based film-like electrodes) to fit anatomical constraints. By arranging the electrode contacts on both sides of the polyimide film, selectivity can be further increased without increasing size. In this work, two approaches to create such double-sided electrodes are described and compared: sandwich electrodes prepared by precisely gluing two single-sided structures together, and monolithic electrodes created using a new double-sided photolithography process. Both methods were successfully applied to manufacture double-sided electrodes for stimulation of the vestibular system. In a case study, the electrodes were implanted in the semicircular canals of three guinea pigs and proven to provide electrical stimulation of the vestibular nerve. For both the monolithic electrodes and the sandwich electrodes, long-term stability and functionality was observed over a period of more than 12 months. Comparing the two types of electrodes with respect to the manufacturing process, it can be concluded that monolithic electrodes are the preferred solution for very thin electrodes (<20 μm), while sandwich electrode technology is especially suitable for thicker electrodes (40-50 μm).

Visual prostheses: the enabling technology to give sight to the blind

Millions of patients are either slowly losing their vision or are already blind due to retinal degenerative diseases such as retinitis pigmentosa (RP) and age-related macular degeneration (AMD) or because of accidents or injuries. Employment of artificial means to treat extreme vision impairment has come closer to reality during the past few decades. Currently, many research groups work towards effective solutions to restore a rudimentary sense of vision to the blind. Aside from the efforts being put on replacing damaged parts of the retina by engineered living tissues or microfabricated photoreceptor arrays, implantable electronic microsystems, referred to as visual prostheses, are also sought as promising solutions to restore vision. From a functional point of view, visual prostheses receive image information from the outside world and deliver them to the natural visual system, enabling the subject to receive a meaningful perception of the image. This paper provides an overview of technical design aspects and clinical test results of visual prostheses, highlights past and recent progress in realizing chronic high-resolution visual implants as well as some technical challenges confronted when trying to enhance the functional quality of such devices.

A 13.56-mbps pulse delay modulation based transceiver for simultaneous near-field data and power transmission

A fully-integrated near-field wireless transceiver has been presented for simultaneous data and power transmission across inductive links, which operates based on pulse delay modulation (PDM) technique. PDM is a low-power carrier-less modulation scheme that offers wide bandwidth along with robustness against strong power carrier interference, which makes it suitable for implantable neuroprosthetic devices, such as retinal implants. To transmit each bit, a pattern of narrow pulses are generated at the same frequency of the power carrier across the transmitter (Tx) data coil with specific time delays to initiate decaying ringing across the tuned receiver (Rx) data coil. This ringing shifts the zero-crossing times of the undesired power carrier interference on the Rx data coil, resulting in a phase shift between the signals across Rx power and data coils, from which the data bit stream can be recovered. A PDM transceiver prototype was fabricated in a 0.35- μm standard CMOS process, occupying 1.6 mm(2). The transceiver achieved a measured 13.56 Mbps data rate with a raw bit error rate (BER) of 4.3×10(-7) at 10 mm distance between figure-8 data coils, despite a signal-to-interference ratio (SIR) of -18.5 dB across the Rx data coil. At the same time, a class-D power amplifier, operating at 13.56 MHz, delivered 42 mW of regulated power across a separate pair of high-Q power coils, aligned with the data coils. The PDM data Tx and Rx power consumptions were 960 pJ/bit and 162 pJ/bit, respectively, at 1.8 V supply voltage.

A nonparametric stochastic optimizer for TDMA-based neuronal signaling

This paper considers neurons as a physical communication medium for intrabody networks of nano/micro-scale machines and formulates a noisy multiobjective optimization problem for a Time Division Multiple Access (TDMA) communication protocol atop the physical layer. The problem is to find the Pareto-optimal TDMA configurations that maximize communication performance (e.g., latency) by multiplexing a given neuronal network to parallelize signal transmissions while maximizing communication robustness (i.e., unlikeliness of signal interference) against noise in neuronal signaling. Using a nonparametric significance test, the proposed stochastic optimizer is designed to statistically determine the superior-inferior relationship between given two solution candidates and seek the optimal trade-offs among communication performance and robustness objectives. Simulation results show that the proposed optimizer efficiently obtains quality TDMA configurations in noisy environments and outperforms existing noise-aware stochastic optimizers.

Development of an implantable flexible probe for simultaneous near-infrared spectroscopy and electrocorticography

A combination of near-infrared spectroscopy (NIRS) and electrocorticography (ECoG) provides beneficial information on cortical activity from different aspects. Integration of such multimodal measurement capability into a single apparatus and the direct measurement of cortical activity during chronic subdural implantation may be a powerful means for clinical diagnosis and neuroscience. However, an optical fiber-based NIRS probe cannot be miniaturized for implantation into the brain, and the light-scattering effect of ECoG electrodes in NIRS measurements is unknown. We describe here the development of a flexible probe, small enough for chronic subdural implantation, for simultaneous NIRS and ECoG. Two light-emitting diodes of different wavelengths and two photodiodes were mounted on a polyimide-based flexible substrate, and ECoG electrodes were formed with a design minimizing artifacts in NIRS recording. The fabricated probe measured ECoGs at sufficient spatial resolution and submicromolar changes in hemoglobin concentrations in in vivo experiments with acute implantation into a rat. Comparison of measured changes in hemoglobin concentrations for different source-detector distances reveals the reliability of the measured values and the practicality of the simulation model. The proposed intracranial multimodality probe may provide beneficial evidence for pre- and intrasurgical assessment of neurosurgery and reveal the interaction of electrophysiology and hemodynamics at high spatial resolution without artifacts due to scalp blood flow.

A review and update on the current status of retinal prostheses (bionic eye)

INTRODUCTION/BACKGROUND

The Argus® II is the first retinal prosthesis approved for the treatment of patients blind from retinitis pigmentosa (RP), receiving CE (Conformité Européenne) marking in March 2011 and FDA approval in February 2013. Alpha-IMS followed closely and obtained CE marking in July 2013. Other devices are being developed, some of which are currently in clinical trials.

SOURCES OF DATA

A systematic literature search was conducted on PubMED, Google Scholar and IEEExplore.

AREAS OF AGREEMENT

Retinal prostheses play a part in restoring vision in blind RP patients providing stable, safe and long-term retinal stimulation.

AREAS OF CONTROVERSY

Objective improvement in visual function does not always translate into consistent improvement in the patient's quality of life. Controversy exists over the use of an external image-capturing device versus internally placed photodiode devices.

GROWING POINTS

The alpha-IMS, a photovoltaic-based retinal prosthesis recently obtained its CE marking in July 2013.

AREAS TIMELY FOR DEVELOPING RESEARCH

Improvement in retinal prosthetic vision depends on: (i) improving visual resolution, (ii) improving the visual field, (iii) developing an accurate neural code for image processing and (iv) improving the biocompatibility of the device to ensure longevity.

ASIC design and data communications for the Boston retinal prosthesis

We report on the design and testing of a custom application-specific integrated circuit (ASIC) that has been developed as a key component of the Boston retinal prosthesis. This device has been designed for patients who are blind due to age-related macular degeneration or retinitis pigmentosa. Key safety and communication features of the low-power ASIC are described, as are the highly configurable neural stimulation current waveforms that are delivered to its greater than 256 output electrodes. The ASIC was created using an 0.18 micron Si fabrication process utilizing standard 1.8 volt CMOS transistors as well as 20 volt lightly doped drain FETs. The communication system receives frequency-shift keyed inputs at 6.78 MHz from an implanted secondary coil, and transmits data back to the control unit through a lower-bandwidth channel that employs load-shift keying. The design's safety is ensured by on-board electrode voltage monitoring, stimulus charge limits, error checking of data transmitted to the implant, and comprehensive self-test and performance monitoring features. Each stimulus cycle is initiated by a transmitted word with a full 32-bit error check code. Taken together, these features allow researchers to safely and wirelessly tailor retinal stimulation and vision recovery for each patient.

A system verification platform for high-density epiretinal prostheses

Retinal prostheses have restored light perception to people worldwide who have poor or no vision as a consequence of retinal degeneration. To advance the quality of visual stimulation for retinal implant recipients, a higher number of stimulation channels is expected in the next generation retinal prostheses, which poses a great challenge to system design and verification. This paper presents a system verification platform dedicated to the development of retinal prostheses. The system includes primary processing, dual-band power and data telemetry, a high-density stimulator array, and two methods for output verification. End-to-end system validation and individual functional block characterization can be achieved with this platform through visual inspection and software analysis. Custom-built software running on the computers also provides a good way for testing new features before they are realized by the ICs. Real-time visual feedbacks through the video displays make it easy to monitor and debug the system. The characterization of the wireless telemetry and the demonstration of the visual display are reported in this paper using a 256-channel retinal prosthetic IC as an example.

A high frequency active voltage doubler in standard CMOS using offset-controlled comparators for inductive power transmission

In this paper, we present a fully integrated active voltage doubler in CMOS technology using offset-controlled high speed comparators for extending the range of inductive power transmission to implantable microelectronic devices (IMD) and radio-frequency identification (RFID) tags. This active voltage doubler provides considerably higher power conversion efficiency (PCE) and lower dropout voltage compared to its passive counterpart and requires lower input voltage than active rectifiers, leading to reliable and efficient operation with weakly coupled inductive links. The offset-controlled functions in the comparators compensate for turn-on and turn-off delays to not only maximize the forward charging current to the load but also minimize the back current, optimizing PCE in the high frequency (HF) band. We fabricated the active voltage doubler in a 0.5-μm 3M2P std . CMOS process, occupying 0.144 mm(2) of chip area. With 1.46 V peak AC input at 13.56 MHz, the active voltage doubler provides 2.4 V DC output across a 1 kΩ load, achieving the highest PCE = 79% ever reported at this frequency. In addition, the built-in start-up circuit ensures a reliable operation at lower voltages.

Responses to pulsatile subretinal electric stimulation: effects of amplitude and duration

In working to improve the quality of visual percepts elicited by retinal prosthetics, considerable effort has been made to understand how retinal neurons respond to electric stimulation. Whereas responses arising from direct activation of retinal ganglion cells have been well studied, responses arising through indirect activation (e.g., secondary to activation of bipolar cells) are not as well understood. Here, we used cell-attached, patch-clamp recordings to measure the responses of rabbit ganglion cells in vitro to a wide range of stimulus-pulse parameters (amplitudes: 0-100 μA; durations: 0.1-50 ms), applied to a 400-μm-diameter, subretinal-stimulating electrode. The indirect responses generally consisted of multiple action potentials that were clustered into bursts, although the latency and number of spikes within a burst were highly variable. When different parameter pairs representing identical charge levels were compared, the shortest pulse durations generally elicited the most spikes. In addition, latencies were shortest, and jitter was lowest for short pulses. These findings suggest that short pulses are optimum for activation of presynaptic neurons, and therefore, short pulses are more effective for both direct as well as indirect activation.

Advancements in fabrication process of microelectrode array for a retinal prosthesis using Liquid Crystal Polymer (LCP)

Liquid Crystal Polymer (LCP) has been considered as an alternative biomaterial for implantable biomedical devices primarily for its low moisture absorption rate compared with conventional polymers such as polyimide, parylene and silicone elastomers. A novel retinal prosthetic device based on monolithic encapsulation of LCP is being developed in which entire neural stimulation circuitries are integrated into a thin and eye-conformable structure. Micromachining techniques for fabrication of a LCP retinal electrode array have been previously reported. In this research, however, for being used as a part of the LCP-based retinal implant, we developed advanced fabrication process of LCP retinal electrode through new approaches such as electroplating and laser-machining in order to achieve higher mechanical robustness, long-term reliability and flexibility. Thickened metal tracks could contribute to higher mechanical strength as well as higher long-term reliability when combined with laser-ablation process by allowing high-pressure lamination. Laser-thinning technique could improve the flexibility of LCP electrode.

A Figure-of-Merit for Designing High-Performance Inductive Power Transmission Links

Power transfer efficiency (PTE) and power delivered to the load (PDL) are two key inductive link design parameters that relate to the power source and driver specs, power loss, transmission range, robustness against misalignment, variations in loading, and interference with other devices. Designers need to strike a delicate balance between these two because designing the link to achieve high PTE will degrade the PDL and vice versa. We are proposing a new figure-of-merit (FoM), which can help designers to find out whether a two-, three-, or four-coil link is appropriate for their particular application and guide them through an iterative design procedure to reach optimal coil geometries based on how they weigh the PTE versus PDL for that application. Three design examples at three different power levels have been presented based on the proposed FoM for implantable microelectronic devices, handheld mobile devices, and electric vehicles. The new FoM suggests that the two-coil links are suitable when the coils are strongly coupled, and a large PDL is needed. Three-coil links are the best when the coils are loosely coupled, the coupling distance varies considerably, and large PDL is necessary. Finally, four-coil links are optimal when the PTE is paramount, the coils are loosely coupled, and their relative distance and alignment are stable. Measurement results support the accuracy of the theoretical design procedure and conclusions.

Photochemical restoration of visual responses in blind mice

Retinitis pigmentosa (RP) and age-related macular degeneration (AMD) are degenerative blinding diseases caused by the death of rods and cones, leaving the remainder of the visual system intact but largely unable to respond to light. Here, we show that AAQ, a synthetic small molecule photoswitch, can restore light sensitivity to the retina and behavioral responses in vivo in mouse models of RP, without exogenous gene delivery. Brief application of AAQ bestows prolonged light sensitivity on multiple types of retinal neurons, resulting in synaptically amplified responses and center-surround antagonism in arrays of retinal ganglion cells (RGCs). Intraocular injection of AAQ restores the pupillary light reflex and locomotory light avoidance behavior in mice lacking retinal photoreceptors, indicating reconstitution of light signaling to brain circuits. AAQ and related photoswitch molecules present a potential drug strategy for restoring retinal function in degenerative blinding diseases.

Efficient universal computing architectures for decoding neural activity

The ability to decode neural activity into meaningful control signals for prosthetic devices is critical to the development of clinically useful brain– machine interfaces (BMIs). Such systems require input from tens to hundreds of brain-implanted recording electrodes in order to deliver robust and accurate performance; in serving that primary function they should also minimize power dissipation in order to avoid damaging neural tissue; and they should transmit data wirelessly in order to minimize the risk of infection associated with chronic, transcutaneous implants. Electronic architectures for brain– machine interfaces must therefore minimize size and power consumption, while maximizing the ability to compress data to be transmitted over limited-bandwidth wireless channels. Here we present a system of extremely low computational complexity, designed for real-time decoding of neural signals, and suited for highly scalable implantable systems. Our programmable architecture is an explicit implementation of a universal computing machine emulating the dynamics of a network of integrate-and-fire neurons; it requires no arithmetic operations except for counting, and decodes neural signals using only computationally inexpensive logic operations. The simplicity of this architecture does not compromise its ability to compress raw neural data by factors greater than . We describe a set of decoding algorithms based on this computational architecture, one designed to operate within an implanted system, minimizing its power consumption and data transmission bandwidth; and a complementary set of algorithms for learning, programming the decoder, and postprocessing the decoded output, designed to operate in an external, nonimplanted unit. The implementation of the implantable portion is estimated to require fewer than 5000 operations per second. A proof-of-concept, 32-channel field-programmable gate array (FPGA) implementation of this portion is consequently energy efficient. We validate the performance of our overall system by decoding electrophysiologic data from a behaving rodent.

Development of the boston retinal prosthesis

A small, hermetic, wirelessly-controlled retinal prosthesis was developed for pre-clinical studies in Yucatan mini-pigs. The device was implanted on the outside of the eye in the orbit, and it received both power and data wirelessly from external sources. The prosthesis drove a sub-retinal thin-film array of sputtered iridium oxide stimulating electrodes. The implanted device included a hermetic titanium case containing the 16-channel stimulator chip and discrete circuit components. Feedthroughs in the hermetic case connected the chip to secondary power- and data-receiving coils, which coupled to corresponding external power and data coils driven by a power amplifier. Power was delivered by a 500 KHz carrier, and data were delivered by frequency shift keying. Stimulation pulse strength, duration and frequency were programmed wirelessly from an external computer system. Through an 'outbound' telemetry channel, electrode impedances were monitored by an on-board analog to digital converter that sampled the output voltage waveforms. The final assembly was tested in vitro in physiological saline and in vivo in two mini-pigs for up to three months by measuring stimulus artifacts generated by the implant's current drivers.

An overview of the recent wideband transcutaneous wireless communication techniques

Neuroprosthetic devices such as cochlear and retinal implants need to deliver a large volume of data from external sensors into the body, while invasive brain-computer interfaces need to deliver sizeable amounts of data from the central nervous system to target devices outside of the body. Nonetheless, the skin should remain intact. This paper reviews some of the latest techniques to establish wideband wireless communication links across the skin.

Standard ERG equipment can be used to monitor functionality of retinal implants

Identifying whether or not a retinal implant has malfunctioned after implantation is crucial for safety and efficacy testing in preclinical animal studies and clinical testing in human volunteers. Technical failure can lead to charge injection to areas other than the retina leading to a misjudgment of safety considerations or psychophysical results. This study assessed the feasibility of using standard ERG recordings for the detection of failure of a subretinal implant in-situ using a porcine model. Corneally recorded potentials were compared before and after introduction of damage to the implant leading to failure to deliver charges to the retina. The recorded signal decreased by up to 173% following induced damage to the implant. This shows that standard ERG equipment can be used to monitor if a malfunction occurred in animal testing and can also be applicable in clinical trials.

Analysis of dual band power and data telemetry for biomedical implants

Inductive coupling is commonly used for wireless power and data transfer in biomedical telemetry systems. To increase data bandwidth while maintaining power transfer efficiency, a multiband telemetry system transmitting power and data using different frequencies has been adopted. However, the power link and data link interact with each other, complicating the operation of both power and data transmission. In this paper, we demonstrate that to achieve high performance data transmission, the cross-coupling between the power coils and data coils have to be taken into consideration. Design equations have been derived and shown that the signal to noise (interference) ratio could be significantly reduced and the resulting data transmission could fail if only the data link coupling is optimized without considering the cross-coupling between the power link and the data link. Design examples have been constructed to demonstrate that there could be more than 30 dB difference in the signal to noise ratio. The analysis has been verified with simulation and measurement results.

Overview of the boston retinal prosthesis: challenges and opportunities to restore useful vision to the blind

A small, hermetic, wirelessly-controlled retinal prosthesis was developed for pre-clinical studies in Yucatan mini-pigs. The device was implanted on the outside of the eye in the orbit, and it received both power and data wirelessly from external sources. The prosthesis drove a sub-retinal thin-film array of sputtered iridium oxide stimulating electrodes. The implanted device included a hermetic titanium case containing the 16-channel stimulator chip and discrete circuit components. Feedthroughs in the hermetic case connected the chip to secondary power- and data-receiving coils, which coupled to corresponding external power and data coils driven by a power amplifier. Power was delivered by a 500 KHz carrier, and data were delivered by frequency shift keying. Stimulation pulse strength, duration and frequency were programmed wirelessly from an external computer system. Through an 'outbound' telemetry channel, electrode impedances were monitored by an on-board analog to digital converter that sampled the output voltage waveforms. The final assembly was tested in vitro in physiological saline and in vivo in two mini-pigs for up to three months by measuring stimulus artifacts generated by the implant's current drivers.

Biomaterials-based electronics: polymers and interfaces for biology and medicine

Advanced polymeric biomaterials continue to serve as a cornerstone for new medical technologies and therapies. The vast majority of these materials, both natural and synthetic, interact with biological matter in the absence of direct electronic communication. However, biological systems have evolved to synthesize and utilize naturally-derived materials for the generation and modulation of electrical potentials, voltage gradients, and ion flows. Bioelectric phenomena can be translated into potent signaling cues for intra- and inter-cellular communication. These cues can serve as a gateway to link synthetic devices with biological systems. This progress report will provide an update on advances in the application of electronically active biomaterials for use in organic electronics and bio-interfaces. Specific focus will be granted to covering technologies where natural and synthetic biological materials serve as integral components such as thin film electronics, in vitro cell culture models, and implantable medical devices. Future perspectives and emerging challenges will also be highlighted.

Wirelessly powered stimulator and recorder for neuronal interfaces

Functional Electrical Stimulation (FES) is widely adopted in neuro-engineering to partially alleviate diseased functions in the brain, retina and cochlea. We present a 32-channel wirelessly powered constant current stimulator and low power recording amplifier for FES based applications. The biphasic stimulator utilizes innovative techniques for matched positive/ negative currents and thus improves charge balance. Electrode discharging scheme is added for stimulation artifact suppression. An improved low power amplifier is incorporated for evoked response measurements. Electrical performance is characterized using simulated electrode-electrolyte impedance. Closed-loop stimulation and recording experiments have been performed. Stimulation current magnitudes of 2 μA-200 μA and up to 400 Hz rate have been realized. Theory and limitation of discharging scheme is explored while suppressing artifacts down to 3 ms. Alternate anodic-first and cathodic-first stimulation pulses are adopted for enhanced charge balancing. The low power amplifier exhibits gain of 1200 and bandwidth 350 Hz-1.02 KHz. A multiplexer/ demultiplexer is used to share the front-end among 32 electrodes. The inductively coupled wireless energy harvester works at 125 KHz-135 KHz that can remotely deliver 1.4 mW at 1cm distance to an equivalent of 10K load. The system can accommodate multielectrodes with impedance up to 100 K Ω. The entire hybrid analog-digital system consumes 360 μW quiescent power. Miniaturization makes it suitable for in-vivo applications.

A blister-test apparatus for studies on the adhesion of materials used for neural electrodes

A blister test apparatus has been developed, which allows a quantitative adhesion analysis of thin-film metallizations on polymers manufactured in cleanroom conditions suitable for micromachining of neural electrode arrays. The device is capable of pressurizing metallic membranes at wafer level, monitoring the pressure and the height of the developing blister while detecting the moment of delamination, allowing the calculation of the adhesion energy between metal film and polymer. The machine is designed for quantitative long-term studies of materials used in neural microelectrode arrays.