Artificial vision with wirelessly powered subretinal electronic implant alpha-IMS
Katarina Stingl, Karl Ulrich Bartz-Schmidt, Dorothea Besch, Angelika Braun, Anna Bruckmann, Florian Gekeler, Udo Greppmaier, Stephanie Hipp, Gernot Hörtdörfer, Christoph Kernstock, Assen Koitschev, Akos Kusnyerik, Helmut Sachs, Andreas Schatz, Krunoslav T Stingl, Tobias Peters, Barbara Wilhelm, Eberhart Zrenner, Katarina Stingl, Karl Ulrich Bartz-Schmidt, Dorothea Besch, Angelika Braun, Anna Bruckmann, Florian Gekeler, Udo Greppmaier, Stephanie Hipp, Gernot Hörtdörfer, Christoph Kernstock, Assen Koitschev, Akos Kusnyerik, Helmut Sachs, Andreas Schatz, Krunoslav T Stingl, Tobias Peters, Barbara Wilhelm, Eberhart Zrenner
Abstract
This study aims at substituting the essential functions of photoreceptors in patients who are blind owing to untreatable forms of hereditary retinal degenerations. A microelectronic neuroprosthetic device, powered via transdermal inductive transmission, carrying 1500 independent microphotodiode-amplifier-electrode elements on a 9 mm(2) chip, was subretinally implanted in nine blind patients. Light perception (8/9), light localization (7/9), motion detection (5/9, angular speed up to 35 deg s(-1)), grating acuity measurement (6/9, up to 3.3 cycles per degree) and visual acuity measurement with Landolt C-rings (2/9) up to Snellen visual acuity of 20/546 (corresponding to decimal 0.037° or corresponding to 1.43 logMAR (minimum angle of resolution)) were restored via the subretinal implant. Additionally, the identification, localization and discrimination of objects improved significantly (n = 8; p < 0.05 for each subtest) in repeated tests over a nine-month period. Three subjects were able to read letters spontaneously and one subject was able to read letters after training in an alternative-force choice test. Five subjects reported implant-mediated visual perceptions in daily life within a field of 15° of visual angle. Control tests were performed each time with the implant's power source switched off. These data show that subretinal implants can restore visual functions that are useful for daily life.
Figures
References
- Mathieson K, et al. 2012. Photovoltaic retinal prosthesis with high pixel density. Nat. Photonics 6, 391–39710.1038/nphoton.2012.104 ()
- Humayun MS, et al. 2012. Interim results from the international trial of second sight's visual prosthesis. Ophthalmology 119, 779–78810.1016/j.ophtha.2011.09.028 ()
- Ohta J, et al. 2007. Laboratory investigation of microelectronics-based stimulators for large-scale suprachoroidal transretinal stimulation (STS). J. Neural Eng. 4, S85–9110.1088/1741-2560/4/1/S10 ()
- Guenther T, Lovell NH, Suaning GJ. 2012. Bionic vision: system architectures: a review. Expert Rev. Med. Devices 9, 33–4810.1586/erd.11.58 ()
- Eickenscheidt M, Jenkner M, Thewes R, Fromherz P, Zeck G. 2012. Electrical stimulation of retinal neurons in epiretinal and subretinal configuration using a multicapacitor array. J. Neurophysiol. 107, 2742–275510.1152/jn.00909.2011 ()
- Stett A, Barth W, Weiss S, Haemmerle H, Zrenner E. 2000. Electrical multisite stimulation of the isolated chicken retina. Vision Res. 40, 1785–179510.1016/S0042-6989(00)00005-5 ()
- Fromherz P, Stett A. 1995. Silicon-neuron junction: capacitive stimulation of an individual neuron on a silicon chip. Phys. Rev. Lett. 75, 1670–167310.1103/PhysRevLett.75.1670 ()
- Schwahn H, Gekeler F, Kohler K, Kobuch K, Sachs HG, Schulmeyer F, Jakob W, Gabel VP, Zrenner E. 2001. Studies on the feasibility of a subretinal visual prosthesis: data from Yucatan micropig and rabbit. Graefe's Arch. Clin. Exp. Ophthalmol. 239, 961–96710.1007/s004170100368 ()
- Kohler K, Hartmann JA, Werts D, Zrenner E. 2001. Histological studies of retinal degeneration and biocompatibility of subretinal implants. Ophthalmologe 98, 364–36810.1007/s003470170142 ()
- Guenther E, Tröger B, Schlosshauer B, Zrenner E. 1999. Long-term survival of retinal cell cultures on retinal implant materials. Vision Res. 39, 3988–399410.1016/S0042-6989(99)00128-5 ()
- Zrenner E, et al. 2011. Subretinal electronic chips allow blind patients to read letters and combine them to words. Proc. R. Soc. B 278, 1489–149710.1098/rspb.2010.1747 ()
- Stingl K, et al. 2010. Subretinal electronic chips can restore useful visual functions in blind retinitis pigmentosa patients. Biomed. Tech. (Berl.) 55, (Suppl. 1)10.1515/BMT.2010.435 ()
- Gekeler F, et al. 2007. Compound subretinal prostheses with extra-ocular parts designed for human trials: successful long-term implantation in pigs. Graefes Arch. Clin. Exp. Ophthalmol. 245, 230–24110.1007/s00417-006-0339-x ()
- Besch D, Sachs H, Szurman P, Gülicher D, Wilke R, Reinert S, Zrenner E, Bartz-Schmidt KU, Gekeler F. 2008. Extraocular surgery for implantation of an active subretinal visual prosthesis with external connections: feasibility and outcome in seven patients. Br. J. Ophthalmol. 92, 1361–136810.1136/bjo.2007.131961 ()
- Sachs H, Bartz-Schmidt KU, Gabel VP, Zrenner E, Gekeler F. 2010. Subretinal implant: the intraocular implantation technique. Nova Acta Leopoldina NF III 379, 217–223
- Kusnyerik A, et al. 2012. Positioning of electronic subretinal implants in blind retinitis pigmentosa patients through multimodal assessment of retinal structures. Invest. Ophthalmol. Vis. Sci. 53, 3748–375510.1167/iovs.11-9409 ()
- Bach M, Wilke M, Wilhelm B, Zrenner E, Wilke R. 2010. Basic quantitative assessment of visual performance in patients with very low vision. Invest. Ophthalmol. Vis. Sci. 51, 1255–126010.1167/iovs.09-3512 ()
- Bach M. 1996. The Freiburg visual acuity test: automatic measurement of visual acuity. Optom. Vis. Sci. 73, 49–5310.1097/00006324-199601000-00008 ()
- Stingl K, et al. 2013. Safety, efficacy of subretinal visual implants in humans: methodological aspects. Clin. Exp. Opt. 96, 4–1310.1111/j.1444-0938.2012.00816.x ()
- Wilke R, Bach M, Wilhlem B, Durst W, Trauzettel-Klosinski S, Zrenner E. 2008. Testing visual functions in patients with visual prostheses. Artificial Sight. (
- Stingl K, et al. 2012. What can blind patients see in daily life with the subretinal alpha-IMS implant? Current overview from the clinical trial in Tübingen. Ophthalmologe 109, 136–14110.1007/s00347-011-2479-6 ()
- Drasdo N, Fowler C. 1974. Non-linear projection of the retinal image in a wide-angle schematic eye. Br. J. Ophthalmol. 58, 709–1410.1136/bjo.58.8.709 ()
- Hirsch J, Curcio CA. 1989. The spatial resolution capacity of human foveal retina. Vision Res. 29, 1095–110110.1016/0042-6989(89)90058-8 ()
- Trauzettel-Klosinski S. 2009. Rehabilitation of lesions in the visual pathways. Klin. Monbl. Augenheilkd. 226, 897–90710.1055/s-0028-1109874 ()
- Zrenner E. 2002. Will retinal implants restore vision? Science 295, 1022–102510.1126/science.1067996 ()
- Zrenner E. 2012. Artificial vision: solar cells for the blind. Nat. Photonics 6, 344–34510.1038/nphoton.2012.114 ()
- Rizzo JF, et al. 2001. Retinal prosthesis: an encouraging first decade with major challenges ahead. Ophthalmology 108, 13–1410.1016/S0161-6420(00)00430-9 ()
- Weiland JD, Cho AK, Humayun MS. 2011. Retinal prostheses: current clinical results and future needs. Ophthalmology 118, 2227–223710.1016/j.ophtha.2011.08.042 ()
- Stingl K, Greppmaier U, Wilhelm B, Zrenner E. 2010. Subretinal visual implants. Klin. Monbl. Augenheilkd. 227, 940–94510.1055/s-0029-1245830 ()
- Rizzo JF, 3rd, et al. 2011. Overview of the Boston retinal prosthesis: challenges and opportunities to restore useful vision to the blind’. Conf. Proc. IEEE Eng. Med. Biol. Soc. 2011, 7492–749510.1109/IEMBS.2011.6093610 ()
- Chow AY, Bittner AK, Pardue MT. 2010. The artificial silicon retina in retinitis pigmentosa patients (an American Ophthalmological Association thesis). Trans. Am. Ophthalmol. Soc. 108, 120–154
- Schmidt EM, Bak MJ, Hambrecht FT, Kufta CV, O'Rourke DK, Vallabhanath P. 1996. Feasibility of a visual prosthesis for the blind based on intracortical microstimulation of the visual cortex. Brain 119, 507–52210.1093/brain/119.2.507 ()
- Brelén ME, Vince V, Gérard B, Veraart C, Delbeke J. 2010. Measurement of evoked potentials after electrical stimulation of the human optic nerve. Invest. Ophthalmol. Vis. Sci. 51, 5351–535510.1167/iovs.09-4346 ()
Source: PubMed