Visual cortical thickness increases with prolonged artificial vision restoration

The Argus II retinal prosthesis restores visual perception to late blind individuals. It has been shown that structural changes occur in the brain due to late-onset blindness, including cortical thinning in visual cortical regions. Following vision restoration, it is not yet known whether visual regions are reinvigorated and regain a normal cortical thickness or retain the diminished thickness from blindness. We evaluated the cortical thicknesses of 10 Argus II participants, 10 blind participants, and 13 sighted participants. The Argus II patients on average had a thicker left cuneus cortex and lateral occipital cortex relative to the blind patients. The duration of the Argus II use significantly partially correlated with thicker visual cortical regions in the left hemisphere. Furthermore, in the 2 case studies (scanned before and after implantation), the patient with longer device use (44.5 months) had an increase in the cortical thickness of visual regions, whereas the shorter-using patient did not (6.5 months). Overall, the Argus II participants' cortical thickness was on average significantly rejuvenated in 2 higher visual regions, and participants using the implant for a longer duration had thicker visual regions. This research raises the possibility of structural plasticity reversing visual cortical atrophy in vision restoration participants.

Perovskite Quantum Dot-Based Photovoltaic Biointerface for Photostimulation of Neurons

OBJECTIVE

A promising avenue for vision restoration against retinal degeneration is the use of semiconductor-based photovoltaic biointerfaces to substitute natural photoreceptors. Instead of silicon, perovskite has emerged as an exciting material for solar energy harvesting, and its nanocrystalline forms generally offer better stability than their bulk counterparts in addition to the distinct synthesis and fabrication steps.

METHODS

Herein, we synthesize tetramethylammonium lead iodide (TMAPbI3) perovskite quantum dots (QDs) as a novel photoactive material for photovoltaic biointerfaces. While the TMAPbI3 quantum dots and electrolyte interface induces Faradaic photocurrent under light illumination, the heterojunction with P3HT converts the charge-transfer process to a safe capacitive photocurrent with an improved ionic responsivity of 17.4 mA/W.

SIGNIFICANCE

The integration of the 18-nm quantum dot thickness shows good biocompatibility with primary cultures of hippocampal neurons and the photoresponse of the biointerface triggered photostimulation of the neurons. The rise of perovskite materials can stimulate novel forms of photovoltaic retina implants.

Short pulse epiretinal stimulation allows focal activation of retinal ganglion cells

Epiretinal implants suffer from a lack of spatial resolution, which is greatly influenced by the undesired co-activation of distal cells with their axons passing close to targeted somas. Short current pulses in the range of 50μs have been shown to preferentially activate somas, but the low specificity may limit practical applications. In this paper, we explored decreasing pulse durations down to 10μs for achieving focal activation, i.e., a large differentiation between axonal and somatic activation in epiretinal configuration. We determined thresholds for pulses ranging between 10 and 500μs in retinal ganglion cells of both wild-type and photoreceptor-degenerated mouse retina. Ex-vivo stimulation using biphasic rectangular pulses was performed using a custom-built modified Howland-type current-controlled stimulator and a microelectrode. We demonstrate reliable direct activation of retinal ganglion cells using 10μs pulses for both somatic and axonal electrode positions. Cells from wild-type and photoreceptor-degenerated retinas exhibited similar thresholds. Axonal thresholds were significantly higher for all pulse durations, with the ratio between axonal and somatic thresholds strongly increasing with decreasing pulse duration (1.32 and 4.39 for pulse durations of 500 and 10μs, respectively). Computational modeling points to somatic polarization as the underlying mechanism for lower somatic thresholds. Our results demonstrate focal activation with pulses in the range of 10μs as a potential strategy to avoid the long-standing problem of axonal co-activation in epiretinal implants.

Wireless and Opto-Stimulated Flexible Implants: Artificial Retina Constructed by Ferroelectric BiFeO3-BaTiO3/P(VDF-TrFE) Composites

The degeneration of retinal photoreceptors is one of the primary causes of blindness, and the implantation of retinal prostheses offers hope for vision restoration in individuals who are completely blind. Flexible bioelectronic devices present a promising avenue for the next generation of retinal prostheses owing to their soft mechanical properties and tissue friendliness. In this study, we developed flexible composite films of ferroelectric BiFeO3-BaTiO3 (BFO-BTO) particles synthesized by the hydrothermal method and ferroelectric poly(vinyldene difluoride-trifluoroethylene) (P(VDF-TrFE)) polymer and investigated their applications in artificial retinas. Owing to the coupling of the photothermal effect of BFO-BTO particles and the pyroelectric effect of the P(VDF-TrFE) polymer, the composite films demonstrate a strong photoelectric response (a maximum peak-to-peak photovoltage > 80 V under blue light of 100 mW/cm2) in a wide wavelength range of light (from visible to infrared) with the inherent flexibility and ease of preparation, making it an attractive candidate for artificial retinal applications. Experimental results showed that blind rats implanted with artificial retinas of the composites display light-responsive behavior, showcasing the effectiveness of vision restoration. This study demonstrates a novel approach for employing ferroelectric materials in vision restoration and offers insights into future artificial retina design.

Honeycomb-Patterned Graphene Microelectrodes: A Promising Approach for Safe and Effective Retinal Stimulation Based on Electro-Thermo-Mechanical Modeling and Simulation

The main objective of the present study is to use graphene as electrode neural interface material to design novel microelectrodes topology for retinal prosthesis and investigate device operation safety based on the computational framework. The study's first part establishes the electrode material selection based on electrochemical impedance and the equivalent circuit model. The second part of the study is modeling at the microelectrode-tissue level to investigate the potential distribution, generated resistive heat dissipation, and thermally induced stress in the tissue due to electrical stimulation. The formulation of Joule heating and thermal expansion between microelectrode-tissue-interface employing finite element method modeling is based on the three coupled equations, specifically Ohm's law, Navier's equation, and Fourier equation. Electrochemical simulation results of electrode material reveal that single-layer and few-layer graphene-based microelectrode has a specific impedance in the range of 0.02- [Formula: see text], comparable to platinum counterparts. The microelectrode of [Formula: see text] size can stimulate retinal tissue with a threshold current in the range of 8.7- [Formula: see text]. Such stimulation with the observed microelectrode size indicates that both microelectrodes and retinal tissue stay structurally intact, and the device is thermally and mechanically stable, functioning within the safety limit. The results reveal the viability of high-density graphene-based microelectrodes for improved interface as stimulating electrodes to acquire higher visual acuity. Furthermore, the novel microelectrodes design configuration in the honeycomb pattern gives the retinal tissue non-invasive heating and minimal stress upon electrical stimulation. Thus, it paves the path to designing a graphene-based microelectrode array for retinal prosthesis for further in vitro or in vivo studies.

PRPF31-retinitis pigmentosa: Challenges and opportunities for clinical translation

Mutations in pre-mRNA processing factor 31 cause autosomal dominant retinitis pigmentosa (PRPF31-RP), for which there is currently no efficient treatment, making this disease a prime target for the development of novel therapeutic strategies. PRPF31-RP exhibits incomplete penetrance due to haploinsufficiency, in which reduced levels of gene expression from the mutated allele result in disease. A variety of model systems have been used in the investigation of disease etiology and therapy development. In this review, we discuss recent advances in both in vivo and in vitro model systems, evaluating their advantages and limitations in the context of therapy development for PRPF31-RP. Additionally, we describe the latest approaches for treatment, including AAV-mediated gene augmentation, genome editing, and late-stage therapies such as optogenetics, cell transplantation, and retinal prostheses.

Eye-Mimicked Neural Network Composed of Photosensitive Neural Spheroids with Human Opsin Proteins

An in vitro model, composed of the short-wavelength human opsins and rhodopsins, is created. Two types of photosensitive neural spheroids are transfected for selective reaction under bluish-purple and green lights. These are employed to two devices with intact neuron and neural-spheroid to study the interaction. By photostimulation, the photosensitive spheroid initiated photoactivation, and the signal generated from its body is transmitted to adjacent neural networks. Specifically, the signal traveled through the axon bundle in narrow gap from photosensitive spheroid to intact spheroid as an eye-to-brain model including optic nerve. The whole process with photosensitive spheroid is monitored by calcium ion detecting fluorescence images. The results of this study can be applied to examine vision restoration and novel photosensitive biological systems with spectral sensitivity.

Bioengineering strategies for restoring vision

Late-stage retinal degenerative disease involving photoreceptor loss can be treated by optogenetic therapy, cell transplantation and retinal prostheses. These approaches aim to restore light sensitivity to the retina as well as visual perception by integrating neuronal responses for transmission to the cortex. In age-related macular degeneration, some cell-based therapies also aim to restore photoreceptor-supporting tissue to prevent complete photoreceptor loss. In the earlier stages of degeneration, gene-replacement therapy could attenuate retinal-disease progression and reverse loss of function. And gene-editing strategies aim to correct the underlying genetic defects. In this Review, we highlight the most promising gene therapies, cell therapies and retinal prostheses for the treatment of retinal disease, discuss the benefits and drawbacks of each treatment strategy and the factors influencing whether functional tissue is reconstructed and repaired or replaced with an electronic device, and summarize upcoming technologies for enhancing the restoration of vision.

Semiconducting electrodes for neural interfacing: a review

In the past 50 years, the advent of electronic technology to directly interface with neural tissue has transformed the fields of medicine and biology. Devices that restore or even replace impaired bodily functions, such as deep brain stimulators and cochlear implants, have ushered in a new treatment era for previously intractable conditions. Meanwhile, electrodes for recording and stimulating neural activity have allowed researchers to unravel the vast complexities of the human nervous system. Recent advances in semiconducting materials have allowed effective interfaces between electrodes and neuronal tissue through novel devices and structures. Often these are unattainable using conventional metallic electrodes. These have translated into advances in research and treatment. The development of semiconducting materials opens new avenues in neural interfacing. This review considers this emerging class of electrodes and how it can facilitate electrical, optical, and chemical sensing and modulation with high spatial and temporal precision. Semiconducting electrodes have advanced electrically based neural interfacing technologies owing to their unique electrochemical and photo-electrochemical attributes. Key operation modalities, namely sensing and stimulation in electrical, biochemical, and optical domains, are discussed, highlighting their contrast to metallic electrodes from the application and characterization perspective.

Neurostimulators for high-resolution artificial retina: ASIC design challenges and solutions

Objective.Neurostimulator is one of the most important part in artificial retina design. In this paper, we discuss the main challenges in the design of application-specific integrated circuit for high-resolution artificial retina and suggest corresponding solutions.Approach. Problems in the design of the neurostimulator for the existing artificial retina have not been solved yet are analyzed and solutions are presented. For verification of the solutions, mathematical proof, MATLAB and Ansys simulations are used.Main results. The drawbacks of resorting to a high-voltage complementary metal oxide semiconductor (CMOS) process to deal with the large voltage compliance demanded by the stimulator output stage are pointed out, and an alternative approach based on a circuit that switches the voltage of the common reference electrode is proposed to overcome. The necessity of an active discharge circuit to remove the residual charge of electrodes caused by an unbalanced stimulus is investigated. We present a circuit analysis showing that the use of a passive discharge circuit is sufficient to suppress problematic direct current in most situations. Finally, possible restrictions on input and output (I/O) count are investigated by estimating the resistive-capacitive delay caused by the interconnection between the I/O pad and the microelectrode array.Significance. The results of this paper clarified the problems currently faced by neurostimulator design for the artificial retina. Through the solutions presented in this study, circuits with more competitiveness in power and area consumption can be designed.

Sight restoration reverses blindness-induced cross-modal functional connectivity changes between the visual and somatosensory cortex at rest

Resting-state functional connectivity (rsFC) has been used to assess the effect of vision loss on brain plasticity. With the emergence of vision restoration therapies, rsFC analysis provides a means to assess the functional changes following sight restoration. Our study demonstrates a partial reversal of blindness-induced rsFC changes in Argus II retinal prosthesis patients compared to those with severe retinitis pigmentosa (RP). For 10 healthy control (HC), 10 RP, and 7 Argus II subjects, four runs of resting-state functional magnetic resonance imaging (fMRI) per subject were included in our study. rsFC maps were created with the primary visual cortex (V1) as the seed. The rsFC group contrast maps for RP > HC, Argus II > RP, and Argus II > HC revealed regions in the post-central gyrus (PostCG) with significant reduction, significant enhancement, and no significant changes in rsFC to V1 for the three contrasts, respectively. These findings were also confirmed by the respective V1-PostCG ROI-ROI analyses between test groups. Finally, the extent of significant rsFC to V1 in the PostCG region was 5,961 in HC, 0 in RP, and 842 mm3 in Argus II groups. Our results showed a reduction of visual-somatosensory rsFC following blindness, consistent with previous findings. This connectivity was enhanced following sight recovery with Argus II, representing a reversal of changes in cross-modal functional plasticity as manifested during rest, despite the rudimentary vision obtained by Argus II patients. Future investigation with a larger number of test subjects into this rare condition can further unveil the profound ability of our brain to reorganize in response to vision restoration.

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

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

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.

Flexible ultrasound-induced retinal stimulating piezo-arrays for biomimetic visual prostheses

Electronic visual prostheses, or biomimetic eyes, have shown the feasibility of restoring functional vision in the blind through electrical pulses to initiate neural responses artificially. However, existing visual prostheses predominantly use wired connections or electromagnetic waves for powering and data telemetry, which raises safety concerns or couples inefficiently to miniaturized implant units. Here, we present a flexible ultrasound-induced retinal stimulating piezo-array that can offer an alternative wireless artificial retinal prosthesis approach for evoking visual percepts in blind individuals. The device integrates a two-dimensional piezo-array with 32-pixel stimulating electrodes in a flexible printed circuit board. Each piezo-element can be ultrasonically and individually activated, thus, spatially reconfigurable electronic patterns can be dynamically applied via programmable ultrasound beamlines. As a proof of concept, we demonstrate the ultrasound-induced pattern reconstruction in ex vivo murine retinal tissue, showing the potential of this approach to restore functional, life-enhancing vision in people living with blindness.

POLYRETINA restores light responses in vivo in blind Göttingen minipigs

Retinal prostheses hold the potential for artificial vision in blind people affected by incurable diseases of the outer retinal layer. Available technologies provide only a small field of view: a significant limitation for totally blind people. To overcome this problem, we recently proposed a large and high-density photovoltaic epiretinal device, known as POLYRETINA. Here, we report the in vivo assessment of POLYRETINA. First, we characterise a model of chemically-induced blindness in Göttingen minipigs. Then, we develop and test a minimally invasive injection procedure to insert the large epiretinal implant into the eye. Last, we show that POLYRETINA restores light-evoked cortical responses in blind animals at safe irradiance levels. These results indicate that POLYRETINA holds the potential for artificial vision in totally blind patients affected by retinitis pigmentosa.

Visual-tactile shape perception in the visually restored with artificial vision

Retinal prostheses partially restore vision to late blind patients with retinitis pigmentosa through electrical stimulation of still-viable retinal ganglion cells. We investigated whether the late blind can perform visual–tactile shape matching following the partial restoration of vision via retinal prostheses after decades of blindness.

We tested for visual–visual, tactile–tactile, and visual–tactile two-dimensional shape matching with six Argus II retinal prosthesis patients, ten sighted controls, and eight sighted controls with simulated ultra-low vision. In the Argus II patients, the visual–visual shape matching performance was significantly greater than chance. Although the visual–tactile shape matching performance of the Argus II patients was not significantly greater than chance, it was significantly higher with longer duration of prosthesis use. The sighted controls using natural vision and the sighted controls with simulated ultra-low vision both performed the visual–visual and visual–tactile shape matching tasks significantly more accurately than the Argus II patients. The tactile–tactile matching was not significantly different between the Argus II patients and sighted controls with or without simulated ultra-low vision.

These results show that experienced retinal prosthesis patients can match shapes across the senses and integrate artificial vision with somatosensation. The correlation of retinal prosthesis patients’ crossmodal shape matching performance with the duration of device use supports the value of experience to crossmodal shape learning. These crossmodal shape matching results in Argus II patients are the first step toward understanding crossmodal perception after artificial visual restoration.

New Era of Electroceuticals: Clinically Driven Smart Implantable Electronic Devices Moving towards Precision Therapy

In the name of electroceuticals, bioelectronic devices have transformed and become essential for dealing with all physiological responses. This significant advancement is attributable to its interdisciplinary nature from engineering and sciences and also the progress in micro and nanotechnologies. Undoubtedly, in the future, bioelectronics would lead in such a way that diagnosing and treating patients' diseases is more efficient. In this context, we have reviewed the current advancement of implantable medical electronics (electroceuticals) with their immense potential advantages. Specifically, the article discusses pacemakers, neural stimulation, artificial retinae, and vagus nerve stimulation, their micro/nanoscale features, and material aspects as value addition. Over the past years, most researchers have only focused on the electroceuticals metamorphically transforming from a concept to a device stage to positively impact the therapeutic outcomes. Herein, the article discusses the smart implants' development challenges and opportunities, electromagnetic field effects, and their potential consequences, which will be useful for developing a reliable and qualified smart electroceutical implant for targeted clinical use. Finally, this review article highlights the importance of wirelessly supplying the necessary power and wirelessly triggering functional electronic circuits with ultra-low power consumption and multi-functional advantages such as monitoring and treating the disease in real-time.

Real-Time Optimization of Retinal Ganglion Cell Spatial Activity in Response to Epiretinal Stimulation

Retinal prostheses aim to improve visual perception in patients blinded by photoreceptor degeneration. However, shape and letter perception with these devices is currently limited due to low spatial resolution. Previous research has shown the retinal ganglion cell (RGC) spatial activity and phosphene shapes can vary due to the complexity of retina structure and electrode-retina interactions. Visual percepts elicited by single electrodes differ in size and shapes for different electrodes within the same subject, resulting in interference between phosphenes and an unclear image. Prior work has shown that better patient outcomes correlate with spatially separate phosphenes. In this study we use calcium imaging, in vitro retina, neural networks (NN), and an optimization algorithm to demonstrate a method to iteratively search for optimal stimulation parameters that create focal RGC activation. Our findings indicate that we can converge to stimulation parameters that result in focal RGC activation by sampling less than 1/3 of the parameter space. A similar process implemented clinically can reduce time required for optimizing implant operation and enable personalized fitting of retinal prostheses.

Biodegradable scaffolds facilitate epiretinal transplantation of hiPSC-Derived retinal neurons in nonhuman primates

Transplantation of stem cell-derived retinal neurons is a promising regenerative therapy for optic neuropathy. However, significant anatomic differences compromise its efficacy in large animal models. The present study describes the procedure and outcomes of human-induced pluripotent stem cell (hiPSC)-derived retinal sheet transplantation in primate models using biodegradable materials. Stem cell-derived retinal organoids were seeded on polylactic-coglycolic acid (PLGA) scaffolds and directed toward a retinal ganglion cell (RGC) fate. The seeded tissues showed active proliferation, typical neuronal morphology, and electrical excitability. The cellular scaffolds were then epiretinally transplanted onto the inner surface of rhesus monkey retinas. With sufficient graft-host contact provided by the scaffold, the transplanted tissues survived for up to 1 year without tumorigenesis. Histological examinations indicated survival, further maturation, and migration. Moreover, green fluorescent protein-labeled axonal projections toward the host optic nerve were observed. Cryopreserved organoids were also able to survive and migrate after transplantation. Our results suggest the potential efficacy of RGC replacement therapy in the repair of optic neuropathy for the restoration of visual function. STATEMENT OF SIGNIFICANCE: In the present study, we generated a human retinal sheet by seeding hiPSC-retinal organoid-derived RGCs on a biodegradable PLGA scaffold. We transplanted this retinal sheet onto the inner surface of the rhesus monkey retina. With scaffold support, donor cells survive, migrate and project their axons into the host optic nerve. Furthermore, an effective cryopreservation strategy for retinal organoids was developed, and the thawed organoids were also observed to survive and show cell migration after transplantation.

Neuromodulation using electroosmosis

Objective.Our laboratory has proposed chemical stimulation of retinal neurons using exogenous glutamate as a biomimetic strategy for treating vision loss caused by photoreceptor (PR) degenerative diseases. Although our previousin-vitrostudies using pneumatic actuation indicate that chemical retinal stimulation is achievable, an actuation technology that is amenable to microfabrication, as needed for anin-vivoimplantable device, has yet to be realized. In this study, we sought to evaluate electroosmotic flow (EOF) as a mechanism for delivering small quantities of glutamate to the retina. EOF has great potential for miniaturization.Approach.An EOF device to dispense small quantities of glutamate was constructed and its ability to drive retinal output tested in anin-vitropreparation of PR degenerate rat retina.Main results.We built and tested an EOF microfluidic system, with 3D printed and off-the-shelf components, capable of injecting small volumes of glutamate in a pulsatile fashion when a low voltage control signal was applied. With this device, we produced excitatory and inhibitory spike rate responses in PR degenerate rat retinae. Glutamate evoked spike rate responses were also observed to be voltage-dependent and localized to the site of injection.Significance.The EOF device performed similarly to a previously tested conventional pneumatic microinjector as a means of chemically stimulating the retina while eliminating the moving plunger of the pneumatic microinjector that would be difficult to miniaturize and parallelize. Although not implantable, the prototype device presented here as a proof of concept indicates that a retinal prosthetic based on EOF-driven chemical stimulation is a viable and worthwhile goal. EOF should have similar advantages for controlled dispensing of charged neurochemicals at any neural interface.

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.

Using Interleaved Stimulation to Measure the Size and Selectivity of the Sustained Phase-Locked Neural Response to Cochlear Implant Stimulation

We measured the sustained neural response to electrical stimulation by a cochlear implant (CI). To do so, we interleaved two stimuli with frequencies F1 and F2 Hz and recorded a neural distortion response (NDR) at F2-F1 Hz. We show that, because any one time point contains only the F1 or F2 stimulus, the instantaneous nonlinearities typical of electrical artefact should not produce distortion at this frequency. However, if the stimulus is smoothed, such as by charge integration at the nerve membrane, subsequent (neural) nonlinearities can produce a component at F2-F1 Hz. We stimulated a single CI electrode with interleaved sinusoids or interleaved amplitude-modulated pulse trains such that F2 = 1.5F1, and found no evidence for an NDR when F2-F1 was between 90 and 120 Hz. However, interleaved amplitude-modulated pulse trains with F2-F1~40 Hz revealed a substantial NDR with a group delay of about 45 ms, consistent with a thalamic and/or cortical response. The NDR could be measured even from recording electrodes adjacent to the implant and at the highest pulse rates (> 4000 pps) used clinically. We then measured the selectivity of this sustained response by presenting F1 and F2 to different electrodes and at different between-electrode distances. This revealed a broad tuning that, we argue, reflects the overlap between the excitation elicited by the two electrodes. Our results also provide a glimpse of the neural nonlinearity in the auditory system, unaffected by the biomechanical cochlear nonlinearities that accompany acoustic stimulation. Several potential clinical applications of our findings are discussed.

Multisensory perception in Argus II retinal prosthesis patients: Leveraging auditory-visual mappings to enhance prosthesis outcomes

Crossmodal mappings associate features (such as spatial location) between audition and vision, thereby aiding sensory binding and perceptual accuracy. Previously, it has been unclear whether patients with artificial vision will develop crossmodal mappings despite the low spatial and temporal resolution of their visual perception (particularly in light of the remodeling of the retina and visual cortex that takes place during decades of vision loss). To address this question, we studied crossmodal mappings psychophysically in Retinitis Pigmentosa patients with partial visual restoration by means of Argus II retinal prostheses, which incorporate an electrode array implanted on the retinal surface that stimulates still-viable ganglion cells with a video stream from a head-mounted camera. We found that Argus II patients (N = 10) exhibit significant crossmodal mappings between auditory location and visual location, and between auditory pitch and visual elevation, equivalent to those of age-matched sighted controls (N = 10). Furthermore, Argus II patients (N = 6) were able to use crossmodal mappings to locate a visual target more quickly with auditory cueing than without. Overall, restored artificial vision was shown to interact with audition via crossmodal mappings, which implies that the reorganization during blindness and the limitations of artificial vision did not prevent the relearning of crossmodal mappings. In particular, cueing based on crossmodal mappings was shown to improve visual search with a retinal prosthesis. This result represents a key first step toward leveraging crossmodal interactions for improved patient visual functionality.

Spatial and temporal resolution of optogenetically recovered vision in ChR2-transduced mouse retina

OBJECTIVE

Retinal ganglion cells (RGCs) represent an attractive target in vision restoration strategies, because they undergo little degeneration compared to other retinal neurons. Here we investigated the temporal and spatial resolution in adult photoreceptor-degenerated (rd10) mouse retinas, where RGCs have been transduced with the optogenetic actuator channelrhodopsin-2 (ChR2).

APPROACH

The RGC spiking activity was recorded continuously with a CMOS-based microelectrode array during a variety of photostimulation protocols. The temporal resolution was assessed through Gaussian white noise stimuli and evaluated using a linear-nonlinear-Poisson model. Spatial sensitivity was assessed upon photostimulation with single rectangular pulses stepped across the retina and upon stimulation with alternating gratings of different spatial frequencies. Spatial sensitivity was estimated using logistic regression or by evaluating the spiking activity of independent RGCs.

MAIN RESULTS

The temporal resolution after photostimulation displayed an about ten times faster kinetics as compared to physiological filters in wild-type RGCs. The optimal spatial resolution estimated using the logistic regression model was 10 µm and 87 µm based on the population response. These values correspond to an equivalent acuity of 1.7 or 0.2 cycles per degree, which is better than expected from the size of RGCs' optogenetic receptive fields.

SIGNIFICANCE

The high temporal and spatial resolution obtained by photostimulation of optogenetically transduced RGCs indicate that high acuity vision restoration may be obtained by photostimulation of appropriately modified RGCs in photoreceptor-degenerated retinas.

Update on Gene Therapy Clinical Trials for Choroideremia and Potential Experimental Therapies

Background and objectives: Choroideremia (CHM) is an X-linked recessive chorioretinal dystrophy caused by mutations involving the CHM gene. Gene therapy has entered late-phase clinical trials, although there have been variable results. This review gives a summary on the outcomes of phase I/II CHM gene therapy trials and describes other potential experimental therapies. Materials and Methods: A Medline (National Library of Medicine, Bethesda, MD, USA) search was performed to identify all articles describing gene therapy treatments available for CHM. Results: Five phase I/II clinical trials that reported subretinal injection of adeno-associated virus Rab escort protein 1 (AAV2.REP1) vector in CHM patients were included. The Oxford study (NCT01461213) included 14 patients; a median gain of 5.5 ± 6.8 SD (-6 min, 18 max) early treatment diabetic retinopathy study (ETDRS) letters was reported. The Tubingen study (NCT02671539) included six patients; only one patient had an improvement of 17 ETDRS letters. The Alberta study (NCT02077361) enrolled six patients, and it reported a minimal vision change, except for one patient who gained 15 ETDRS letters. Six patients were enrolled in the Miami trial (NCT02553135), which reported a median gain of 2 ± 4 SD (-1 min, 10 max) ETDRS letters. The Philadelphia study (NCT02341807) included 10 patients; best corrected visual acuity (BCVA) returned to baseline in all by one-year follow-up, but one patient had -17 ETDRS letters from baseline. Overall, 40 patients were enrolled in trials, and 34 had 2 years of follow-up, with a median gain of 1.5 ± 7.2 SD (-14 min, 18 max) in ETDRS letters. Conclusions: The primary endpoint, BCVA following gene therapy in CHM, showed a marginal improvement with variability between trials. Optimizing surgical technique and pre-, peri-, and post-operative management with immunosuppressants to minimize any adverse ocular inflammatory events could lead to reduced incidence of complications. The ideal therapeutic window needs to be addressed to ensure that the necessary cell types are adequately transduced, minimizing viral toxicity, to prolong long-term transgenic potential. Long-term efficacy will be addressed by ongoing studies.

Toward Closed-Loop Electrical Stimulation of Neuronal Systems: A Review

Biological neuronal cells communicate using neurochemistry and electrical signals. The same phenomena also allow us to probe and manipulate neuronal systems and communicate with them. Neuronal system malfunctions cause a multitude of symptoms and functional deficiencies that can be assessed and sometimes alleviated by electrical stimulation. Our working hypothesis is that real-time closed-loop full-duplex measurement and stimulation paradigms can provide more in-depth insight into neuronal networks and enhance our capability to control diseases of the nervous system. In this study, we review extracellular electrical stimulation methods used in in vivo, in vitro, and in silico neuroscience research and in the clinic (excluding methods mainly aimed at neuronal growth and other similar effects) and highlight the potential of closed-loop measurement and stimulation systems. A multitude of electrical stimulation and measurement-based methods are widely used in research and the clinic. Closed-loop methods have been proposed, and some are used in the clinic. However, closed-loop systems utilizing more complex measurement analysis and adaptive stimulation systems, such as artificial intelligence systems connected to biological neuronal systems, do not yet exist. Our review promotes the research and development of intelligent paradigms aimed at meaningful communications between neuronal and information and communications technology systems, "dialogical paradigms," which have the potential to take neuroscience and clinical methods to a new level.

1225-Channel Neuromorphic Retinal-Prosthesis SoC With Localized Temperature-Regulation

A 1225-Channel Neuromorphic Retinal Prosthesis (RP) SoC is presented. Existing RP SoCs directly convert light intensity to electrical stimulus, which limit the adoption of delicate stimulus patterns to increase visual acuity. Moreover, a conventional centralized image processor leads to the local hot spot that poses a risk to the nearby retinal cells. To solve these issues, the proposed SoC adopts a distributed Neuromorphic Image Processor (NMIP) located within each pixel that extracts the outline of the incoming image, which reduces current dispersion and stimulus power compared with light-intensity proportional stimulus pattern. A spike-based asynchronous digital operation results in the power consumption of 56.3 nW/Ch without local temperature hot spot. At every 5×5 pixels, the localized (49-point) temperature-regulation circuit limits the temperature increase of neighboring retinal cells to less than 1 °C, and the overall power consumption of the SoC to be less than that of the human eye. The 1225-channel SoC fabricated in 0.18 μm 1P6M CMOS occupies 15mm² while consuming 2.7 mW, and is successfully verified with image reconstruction demonstration.

Restriction of eye motility in patients with RETINA IMPLANT Alpha AMS

PURPOSE

To evaluate the motility of the eye in patients with the RETINA IMPLANT Alpha AMS.

METHODS

Eye motility was determined in eight gaze directions in ten blind retinitis pigmentosa patients, who had received the RETINA IMPLANT Alpha AMS, before implantation of the subretinal implant and at six time-points up to one year after.

RESULTS

The analysis of eye motility showed a restriction in the upgaze and gaze to the temporal side directly after surgery in eight of the nine patients included. The degree of motility restriction decreased continuously with recovery during the observation time. One year after surgery, eye motility was still restricted in the majority of patients, especially in the upgaze to the temporal side at 20° (five of seven patients).

CONCLUSION

Retinal implants with intraorbital parts (e.g. connecting cables) caused restriction in the temporal and superior viewing directions in the majority of patients. Although this restriction might be cosmetically visible, this limitation in eye motility has no effects on the monocular vision and the implant's efficacy for daily use.

Development and in vitro validation of flexible intraretinal probes

The efforts to improve the treatment efficacy in blind patients with retinal degenerative diseases would greatly benefit from retinal activity feedback, which is lacking in current retinal implants. While the door for a bidirectional communication device that stimulates and records intraretinally has been opened by the recent use of silicon-based penetrating probes, the biological impact induced by the insertion of such rigid devices is still unknown. Here, we developed for the first time, flexible intraretinal probes and validated in vitro the acute biological insertion impact in mouse retinae compared to standard silicon-based probes. Our results show that probes based on flexible materials, such as polyimide and parylene-C, in combination with a narrow shank design 50 µm wide and 7 µm thick, and the use of insertion speeds as high as 187.5 µm/s will successfully penetrate the retina, reduce the footprint of the insertion to roughly 2 times the cross-section of the probe, and induce low dead cell counts, while keeping the vitality of the tissue and recording the neural activity at different depths.

Sensitization of ON-bipolar cells with ambient light activatable multi-characteristic opsin rescues vision in mice

Gene therapy-based treatment such as optogenetics offers a potentially powerful way to bypass damaged photoreceptors in retinal degenerative diseases and use the remaining retinal cells for functionalization to achieve photosensitivity. However, current approaches of optogenetic treatment rely on opsins that require high intensity light for activation thus adding to the challenge for use as part of a wearable device. Here, we report AAV2 assisted delivery of highly photosensitive multi-characteristic opsin (MCO1) into ON-bipolar cells of mice with retinal degeneration to allow activation by ambient light. Rigorous characterization of delivery efficacy by different doses of AAV2 carrying MCO1 (vMCO1) into targeted cells showed durable expression over 6 months after delivery as measured by reporter expression. The enduring MCO1 expression was correlated with the significantly improved behavioral outcome, that was longitudinally measured by visual water-maze and optomotor assays. The pro/anti-inflammatory cytokine levels in plasma and vitreous humor of the vMCO1-injected group did not change significantly from baseline or control group. Furthermore, biodistribution studies at various time points after injection in animal groups injected with different doses of vMCO1 showed non-detectable vector copies in non-targeted tissues. Immunohistochemistry of vMCO1 transfected retinal tissues showed bipolar specific expression of MCO1 and the absence of immune/inflammatory response. Furthermore, ocular imaging using SD-OCT showed no change in the structural architecture of vMCO1-injected eyes. Induction of ambient light responsiveness to remaining healthy bipolar cells in subjects with retinal degeneration will allow the retinal circuitry to gain visual acuity without requiring an active stimulation device.

Blind patients in end-stage inherited retinal degeneration: multimodal imaging of candidates for artificial retinal prosthesis

PURPOSE

To characterize the imaging features of blind patients with end-stage inherited retinal degeneration (IRD) and to assess possible morpho-functional correlations.

METHODS

In this observational cross-sectional study, we reviewed the clinical data and multimodal imaging of 40 eyes of 21 blind (light perception or less) institutional patients affected by end-stage IRD screened for Alpha AMS (Retina Implant AG, Reutlingen, Germany) retinal prosthesis eligibility. Analysis was carried out using spectral-domain optical coherence tomography (SD-OCT), fluorescein angiography and fundus autofluorescence.

RESULTS

Among patients with IRD-related low vision, the extrapolated prevalence of the blind was roughly 10%, median age 60.4 years with a disease duration of 40.4 years, showing epiretinal membranes (80%), hyperreflective intraretinal nodules (90%) and the absence of the ellipsoid zone (77.5%) on SD-OCT examination. Cystoid macular oedema was present in 52.5% of eyes, the majority of which being of the microcystoid subtype (42.5%), while 37.5% of eyes also lacked outer and inner retinal layer segmentation. Disease duration was found to be predictive of disrupted retinal layers (P = 0.029) and microcystoid macular oedema (P = 0.035), which was also more frequent in eyes without light perception (P = 0.013).

CONCLUSIONS

Eyes without vision due to end-stage IRD have a typical imaging pattern, predominantly characterized by epiretinal membranes, hyperreflective intraretinal nodules and the absence of the ellipsoid zone. Furthermore, microcystoid macular oedema and retinal layer disruption may be considered as signs of longstanding disease.

Light-Responsive Inorganic Biomaterials for Biomedical Applications

Light-responsive inorganic biomaterials are an emerging class of materials used for developing noninvasive, noncontact, precise, and controllable medical devices in a wide range of biomedical applications, including photothermal therapy, photodynamic therapy, drug delivery, and regenerative medicine. Herein, a range of biomaterials is discussed, including carbon-based nanomaterials, gold nanoparticles, graphite carbon nitride, transition metal dichalcogenides, and up-conversion nanoparticles that are used in the design of light-responsive medical devices. The importance of these light-responsive biomaterials is explored to design light-guided nanovehicle, modulate cellular behavior, as well as regulate extracellular microenvironments. Additionally, future perspectives on the clinical use of light-responsive biomaterials are highlighted.

Flexible and Transparent Metal Oxide/Metal Grid Hybrid Interfaces for Electrophysiology and Optogenetics

Flexible and transparent microelectrodes and interconnects provide the unique capability for a wide range of emerging biological applications, including simultaneous optical and electrical interrogation of biological systems. For practical biointerfacing, it is important to further improve the optical, electrical, electrochemical, and mechanical properties of the transparent conductive materials. Here, high-performance microelectrodes and interconnects with high optical transmittance (59-81%), superior electrochemical impedance (5.4-18.4 Ω cm2), and excellent sheet resistance (5.6-14.1 Ω sq-1), using indium tin oxide (ITO) and metal grid (MG) hybrid structures are demonstrated. Notably, the hybrid structures retain the superior mechanical properties of flexible MG other than brittle ITO with no changes in sheet resistance even after 5000 bending cycles against a small radius at 5 mm. The capabilities of the ITO/MG microelectrodes and interconnects are highlighted by high-fidelity electrical recordings of transgenic mouse hearts during co-localized programmed optogenetic stimulation. In vivo histological analysis reveals that the ITO/MG structures are fully biocompatible. Those results demonstrate the great potential of ITO/MG interfaces for broad fundamental and translational physiological studies.

The effect of waveform asymmetry on perception with epiretinal prostheses

Objective

Retinal prosthetic implants have helped improve vision in patients blinded by photoreceptor degeneration. Retinal implant users report improvements in light perception and performing visual tasks, but their ability to perceive shapes and letters is limited due to the low precision of retinal activation, which is exacerbated by axonal stimulation and high perceptual thresholds. A previous in vitro study in our lab used calcium imaging to measure the spatial activity of mouse retinal ganglion cells (RGCs) in response to electrical stimulation. Based on this study, symmetric anodic-first (SA) stimulation effectively avoided axonal activation and asymmetric anodic-first stimulation (AA) with duration ratios (ratio of the anodic to cathodic phase) greater than 10 reduced RGC activation thresholds significantly. Applying these novel stimulation strategies in clinic may increase perception precision and improve the overall patient outcomes.

Approach

We combined human subject testing and computational modeling to further examine the effect of SA and AA stimuli on perception shapes and thresholds for epiretinal stimulation of RGCs.

Main results

Threshold measurement in three Argus II participants indicated that AA stimulation could increase perception probabilities compared to a standard symmetric cathodic-first (SC) pulse, and this effect can be intensified by addition of an interphae gap (IPG). Our in silico RGC model predicts lower thresholds with AA and asymmetric cathodic-first (AC) stimuli compared to a SC pulse. This effect was more pronounced at shorter pulse widths. The most effective pulse for threshold reduction with short pulse durations (≤0.12 ms) was AA stimulation with small duration ratios (≤5) and long IPGs (≥2 ms). For the 0.5 ms pulse duration, SC stimulation with IPGs longer than 0.5 ms, or asymmetric stimuli with large duration ratios (≥20) were most effective in threshold reduction. Phosphene shape analysis did not reveal a significant change in percept elongation with SA stimulation. However, there was a significant increase in percept size (P < 0.01) with AA stimulation compared to the standard pulse in one participant.

Significane

Including asymmetric waveform capability will provide more flexible options for optimization and personalized fitting of retinal implants.

Graphene Oxide-Based Nanomaterials: An Insight into Retinal Prosthesis

Retinal prosthesis has recently emerged as a treatment strategy for retinopathies, providing excellent assistance in the treatment of age-related macular degeneration (AMD) and retinitis pigmentosa. The potential application of graphene oxide (GO), a highly biocompatible nanomaterial with superior physicochemical properties, in the fabrication of electrodes for retinal prosthesis, is reviewed in this article. This review integrates insights from biological medicine and nanotechnology, with electronic and electrical engineering technological breakthroughs, and aims to highlight innovative objectives in developing biomedical applications of retinal prosthesis.

Stimulation Strategies for Improving the Resolution of Retinal Prostheses

Electrical stimulation using implantable devices with arrays of stimulating electrodes is an emerging therapy for neurological diseases. The performance of these devices depends greatly on their ability to activate populations of neurons with high spatiotemporal resolution. To study electrical stimulation of populations of neurons, retina serves as a useful model because the neural network is arranged in a planar array that is easy to access. Moreover, retinal prostheses are under development to restore vision by replacing the function of damaged light sensitive photoreceptors, which makes retinal research directly relevant for curing blindness. Here we provide a progress review on stimulation strategies developed in recent years to improve the resolution of electrical stimulation in retinal prostheses. We focus on studies performed with explanted retinas, in which electrophysiological techniques are the most advanced. We summarize achievements in improving the spatial and temporal resolution of electrical stimulation of the retina and methods to selectively stimulate neurons with different visual functions. Future directions for retinal prostheses development are also discussed, which could provide insights for other types of neuromodulatory devices in which high-resolution electrical stimulation is required.

Photovoltaic Restoration of Central Vision in Atrophic Age-Related Macular Degeneration

PURPOSE

Loss of photoreceptors in atrophic age-related macular degeneration results in severe visual impairment, although some peripheral vision is retained. To restore central vision without compromising the residual peripheral field, we developed a wireless photovoltaic retinal implant (PRIMA; Pixium Vision, Paris, France) in which pixels convert images projected from video glasses using near-infrared light into electric current to stimulate the nearby inner retinal neurons.

DESIGN

We carried out a first-in-human clinical trial to test the safety and efficacy of the prosthesis in patients with geographic atrophy (ClinicalTrials.gov identifier, NCT03333954).

PARTICIPANTS

Five patients with geographic atrophy zone of at least 3 optic disc diameters, no foveal light perception, and best-corrected visual acuity of 20/400 to 20/1000 in the worse-seeing study eye.

METHODS

The 2-mm wide, 30-μm thick chip, containing 378 pixels (each 100 μm in diameter), was implanted subretinally in the area of atrophy (absolute scotoma).

MAIN OUTCOME MEASURES

Anatomic outcomes were assessed with fundus photography and OCT for up to 12 months of follow-up. Prosthetic vision was assessed by mapping light perception, bar orientation, letter recognition, and Landolt C acuity.

RESULTS

In all patients, the prosthesis was implanted successfully under the macula, although in 2 patients, it was implanted in unintended locations: within the choroid and off center by 2 mm. All 5 patients could perceive white-yellow prosthetic visual patterns with adjustable brightness in the previous scotomata. The 3 with optimal placement of the implant demonstrated prosthetic acuity of 20/460 to 20/550, and the patient with the off-center implant demonstrated 20/800 acuity. Residual natural acuity did not decrease after implantation in any patient.

CONCLUSIONS

Implantation of the PRIMA did not decrease the residual natural acuity, and it restored visual sensitivity in the former scotoma in each of the 5 patients. In 3 patients with the proper placement of the chip, prosthetic visual acuity was only 10% to 30% less than the level expected from the pixel pitch (20/420). Therefore, the use of optical or electronic magnification in the glasses as well as smaller pixels in future implants may improve visual acuity even further.

Characteristics of prosthetic vision in rats with subretinal flat and pillar electrode arrays

Objective

Retinal prostheses aim to restore sight by electrically stimulating the surviving retinal neurons. In clinical trials of the current retinal implants, prosthetic visual acuity does not exceed 20/550. However, to provide meaningful restoration of central vision in patients blinded by age-related macular degeneration (AMD), prosthetic acuity should be at least 20/200, necessitating a pixel pitch of about 50 μm or lower. With such small pixels, stimulation thresholds are high due to limited penetration of electric field into tissue. Here, we address this challenge with our latest photovoltaic arrays and evaluate their performance in vivo.

Approach

We fabricated photovoltaic arrays with 55 and 40 μm pixels (a) in flat geometry, and (b) with active electrodes on 10 μm tall pillars. The arrays were implanted subretinally into rats with degenerate retina. Stimulation thresholds and grating acuity were evaluated using measurements of the visually evoked potentials (VEP).

Main results

With 55 μm pixels, we measured grating acuity of 48 ± 11 μm, which matches the linear pixel pitch of the hexagonal array. This geometrically corresponds to a visual acuity of 20/192 in a human eye, matching the threshold of legal blindness in the US (20/200). With pillar electrodes, the irradiance threshold was nearly halved, and duration threshold reduced by more than three-fold, compared to flat pixels. With 40 μm pixels, VEP was too low for reliable measurements of the grating acuity, even with pillar electrodes.

Significance

While being helpful for treating a complete loss of sight, current prosthetic technologies are insufficient for addressing the leading cause of untreatable visual impairment—AMD. Subretinal photovoltaic arrays may provide sufficient visual acuity for restoration of central vision in patients blinded by AMD.

Chronically Implantable Package Based on Alumina Ceramics and Titanium with High-density Feedthroughs for Medical Implants

Implantable package to hermetically encapsulate electronics inside human body is critical for active implant devices such as neuroprothesestextbf. To meet the demanding package requirement for smaller size and higher feedthrough density, we propose a high-density (100+ feedthroughs for 10 mm diameter) ceramic/metal composite package with helium leakage rate on the 10^-10 Pa m³/s, at the same time possessing the best cytotoxicity level of Grade 0, which enable the chronic implant in human. Pure alumina substrate co-sintered with platinum (Pt) paste filled in micrometer holes have demonstrated extremely good hermetical seal and biocompatibility, then its braze joint with a titanium(Ti) ring was achieved, followed by the laser welding with a Ti cap. Standard helium leakage rate and cytotoxicity experiments have shown each component and joint interface are qualified for 100-year chronic implant, which is significant for various active implant instruments.

Changes in microchip position after implantation of a subretinal vision prosthesis in humans

PURPOSE

Retinal prosthetic devices have been developed to partially restore very low vision in legally blind patients with end-stage hereditary retinal dystrophies. Subretinal implants, unlike epiretinal implants, are not fixated by a tack. The aim of this study was to assess and analyse possible changes over time in the subretinal position of the RETINA IMPLANT Alpha IMS and Alpha AMS (ClinicalTrials.gov NCT01024803).

METHODS

Imaging studies were performed on fundus photographs using GIMP (Version 2.8.14). Postoperative photographs of the implanted eye were scaled and aligned. Landmarks were chosen and distances between landmarks were measured to then calculate the displacement of the microchip using a transformation matrix for rotational and translational movements. Analyses were performed using MATLAB 8.6 (The MathWorks Inc., Natick, MA).

RESULTS

Of the 27 datasets with the Alpha IMS device, 12 (44%) remained stable without displacement of the microchip relative to the optic disc and the major blood vessels, whereas in 15 (56%), displacement occurred. The mean ± SD displacement in those 15 eyes was 0.66 ± 0.35 mm (range, 0.24-1.67 mm). Of the eight datasets with the Alpha AMS device, 1 (13%) remained stable without displacement of the microchip relative to the optic disc and the major blood vessels, whereas in 7 (87%), displacement occurred. The mean ± SD displacement in those seven eyes was 0.66 ± 0.26 mm (range, 0.32-0.97 mm). Calculated from all eyes (including those in which no displacement occurred), the mean displacement was 0.36 mm in the IMS cohort, and 0.58 mm in the AMS cohort, however, the difference was not statistically significant (p = 0.17).

CONCLUSIONS

We have shown that the position of the subretinal implant changes in the majority of the cases after implantation. While the overall mean displacement of the chip was not significantly different in either of the cohorts, the maximum displacement was smaller in the Alpha AMS cohort.

Design of an Integrated Subretinal Implant using Cellular Neural Networks for Binary Image Generation in a 130 nm BiCMOS Process

Blindness caused by the eye diseases Retinitis-Pigmentosa and Age-Related-Macular-Degeneration leads to a degeneration of the photoreceptor layer while postsynaptic cells mostly stay intact. In this Paper a new concept for retinal implants is proposed. Instead of converting the incident light to a gray-scale picture with corresponding continuous-value stimulation levels, we here suggest to produce a binary image picture that only highlight edges in order to stimulate the retina solely at points which belong to an edge. An integrated test circuit is designed with a 130 nm BiCMOS process by using cellular neural networks for binary image generation. The circuit yields a simulated maximum rated power consumption of 2.61 mW for a 1000 information processing cells.

Micro/Nano Technologies for High-Density Retinal Implant

During the past decades, there have been leaps in the development of micro/nano retinal implant technologies, which is one of the emerging applications in neural interfaces to restore vision. However, higher feedthroughs within a limited space are needed for more complex electronic systems and precise neural modulations. Active implantable medical electronics are required to have good electrical and mechanical properties, such as being small, light, and biocompatible, and with low power consumption and minimal immunological reactions during long-term implantation. For this purpose, high-density implantable packaging and flexible microelectrode arrays (fMEAs) as well as high-performance coating materials for retinal stimulation are crucial to achieve high resolution. In this review, we mainly focus on the considerations of the high-feedthrough encapsulation of implantable biomedical components to prolong working life, and fMEAs for different implant sites to deliver electrical stimulation to targeted retinal neuron cells. In addition, the functional electrode materials to achieve superior stimulation efficiency are also reviewed. The existing challenge and future research directions of micro/nano technologies for retinal implant are briefly discussed at the end of the review.

Photochemistry of Organic Retinal Prostheses

Organic devices are attracting considerable attention as prostheses for the recovery of retinal light sensitivity lost to retinal degenerative disease. The biotic/abiotic interface created when light-sensitive polymers and living tissues are placed in contact allows excitation of a response in blind laboratory rats exposed to visual stimuli. Although polymer retinal prostheses have proved to be efficient, their working mechanism is far from being fully understood. In this review article, we discuss the results of the studies conducted on these kinds of polymer devices and compare them with the data found in the literature for inorganic retinal prostheses, where the working mechanisms are better comprehended. This comparison, which tries to set some reference values and figures of merit, is intended for use as a starting point to determine the direction for further investigation.

Mechanical Stimulation of the Retina: Therapeutic Feasibility and Cellular Mechanism

Retinal prostheses that seek to restore vision by artificially stimulating retinal neurons with electrical current are an emerging treatment for photoreceptor degenerative diseases but face difficulties achieving naturalistic vision with high spatial resolution. Here, we report the unexpected discovery of a technique for mechanically stimulating retinal neurons with the potential to bypass the limitations of electrical stimulation. We found that pulsatile injections of standard Ames medium solution into explanted retinas of wild type rats under certain injection conditions (pulse-width > 50ms at 0.69 kPa pressure) elicit spatially localized retinal responses similar to light-evoked responses. The same injections made into photoreceptor degenerated retinas of transgenic S334ter-3 rats also elicit robust neural responses. We investigated the cellular mechanism causing these responses, by repeating the injections after treating the retinas with a pharmacological blocker of the transient receptor potential vanilloid (TRPV) channel group, a common mechanoreceptor found on retinal neurons, and observed a significant reduction in retinal ganglion cell spike rate response amplitudes. Together, these data reveal that therapeutic mechanical stimulation of the retina, occurring in part through TRPV channel activation, is feasible and this little explored neurostimulation paradigm could be useful in stimulating photoreceptor degenerated retinas for vision restoration.

Toward a Bidirectional Communication Between Retinal Cells and a Prosthetic Device - A Proof of Concept

Background: Significant progress toward the recovery of useful vision in blind patients with severe degenerative retinal diseases caused by photoreceptor death has been achieved with the development of visual prostheses that stimulate the retina electrically. However, currently used prostheses do not provide feedback about the retinal activity before and upon stimulation and do not adjust to changes during the remodeling processes in the retina. Both features are desirable to improve the efficiency of the electrical stimulation (ES) therapy offered by these devices. Accordingly, devices that not only enable ES but at the same time provide information about the retinal activity are beneficial. Given the above, a bidirectional communication strategy, in which inner retinal cells are stimulated and the output neurons of the retina, the ganglion cells, are recorded using penetrating microelectrode arrays (MEAs) is proposed.

Methods: Custom-made penetrating MEAs with four silicon-based shanks, each one with three or four iridium oxide electrodes specifically designed to match retinal dimensions were used to record the activity of light-adapted wildtype mice retinas and degenerated retinas from rd10 mice in vitro. In addition, responses to high potassium concentration and to light stimulation in wildtype retinas were examined. Furthermore, voltage-controlled ES was performed.

Results: The spiking activity of retinal ganglion cells (RGCs) was recorded at different depths of penetration inside the retina. Physiological responses during an increase of the extracellular potassium concentration and phasic and tonic responses during light stimulation were captured. Moreover, pathologic rhythmic activity was recorded from degenerated retinas. Finally, ES of the inner retina and simultaneous recording of the activity of RGCs was accomplished.

Conclusion: The access to different layers of the retina with penetrating electrodes while recording at the same time the spiking activity of RGCs broadens the use and the field of action of multi-shank and multi-site penetrating MEAs for retinal applications. It enables a bidirectional strategy to stimulate inner retinal cells electrically and to record from the spiking RGCs simultaneously (BiMEA). This opens the possibility of a feedback loop system to acknowledge the success of ES carried out by retinal prostheses.

Investigation of Injection Depth for Subretinal Delivery of Exogenous Glutamate to Restore Vision via Biomimetic Chemical Neuromodulation

Chemical neuromodulation of the retina using native neurotransmitters to biomimetically activate target retinal neurons through chemical synapses is a promising biomimetic alternative to electrical stimulation for restoring vision in blindness caused by photoreceptor degenerative diseases. Recent research has shown that subretinal chemical stimulation could be advantageous for treating photoreceptor degenerative diseases but many of the parameters for achieving efficacious chemical neuromodulation are yet to be explored. In this paper, we investigated how the depth at which neurotransmitter is injected subretinally affects the success rate, spike rate characteristics (i.e., amplitude, response latency, and time width), and spatial resolution of chemical stimulation in wild-type Long Evans and photoreceptor degenerated S334ter-3 transgenic rat retinas in vitro. We compared the responses to injections of glutamate at the subretinal surface and two subsurface depths near the outer and inner plexiform layers and found that while injections at all depths elicited robust retinal ganglion cell responses, they differed significantly in terms of the spike rate characteristics and spatial resolutions across injection depths. Shallow subsurface injections near the outer plexiform layer evoked the highest spike rate amplitudes and had the highest spatial resolution and success rates, while deep subsurface injections near the inner plexiform layer elicited the shortest latencies and narrowest time widths. Our results suggest that surface injections are suboptimal for subretinal chemical neuromodulation, while shallow subsurface and deep subsurface injections may optimize high spatial and high temporal resolution, respectively. These findings have great significance for the design and development of a potential neurotransmitter-based subretinal prosthesis.