| What could an eye implant do?
Let's
talk now about the eye implant you are developing. Firstly, what do you hope to
achieve with it?
Well, there are numerous conditions that
cause blindness. Some of the more prevalent ones involve the retina itself,
killing the photoreceptors the things that are capable of receiving light and
changing that into a response in the back of our head to say, 'Oh, there's
light.' But if there is any nice thing about a disease, it is that this disease
kills those photoreceptors only. There are basically 10 different layers
of the retina. In retinitis pigmentosa and a couple of other related diseases,
the nerves that are not the photoreceptor nerves basically stay alive. And when
you stimulate them with electricity, they actually do whatever they used to do
when you saw light. We wanted to implant some electronics (which we eventually
shrunk into a silicon chip) within or around the eye, to stimulate the nerves
of the retina and give some approximated vision back to some of these patients
who still have the capability of seeing but no longer have the mechanism that
starts it off.
But
surely that won't suit people who have always been blind none of it works.
It depends on how they went blind. The
optic nerves of people with glaucoma, for example, are essentially dead. The
retina itself becomes part of the optic nerve, and so those people would only
be treated by a device called a cortical stimulator: a rather risky prospect in
which you actually put implants in the brain to stimulate the nerves. (People
who are blind don't have an awful lot to lose in eye surgery, so the risks are
relatively low with stimulating the retina cells.)
How much sight might be restored and how can we know?
How
much sight do you think you could restore? Can you give some examples of what
people might be able to see?
I think that a patient fitted with this is
going to have to relearn how to see, just as cochlear implant patients have to
relearn how to hear. And it's not going to be the way you and I see; it's not
going to be 20/20 vision. Think of being at a sporting event where you can
certainly see the numbers on the scoreboard, and where on some of the larger
scoreboards that show pictures as well rudimentary images, animations, that
sort of thing I guess you could make out faces if you had enough training. We
may be able to get people to read; we may be able to get people to recognise at
least that there is an object there, a person perhaps, movement, that sort of
thing. But we are a long way off from being able to convey real images. Even
so, it would be wonderful to be able to get past an obstacle without ramming into
it. That is a big plus.
Light and dark perception is something that
we are almost certain we are going to be able to convey. A lot of blind people
suffer from horrible sleeping disorders because they lose synchrony with the 24-hour
day. They don't know there is sunlight there, so they don't know when to wake
up or when to go to sleep, and they shift into and out of synchronisation with
us. Some of our studies have shown that the device we have is capable of at
least evoking a physiological response in the brain that says, 'Yes, there is
light there.' And because that is in the absence of any other light source, it
has to result from our device.
So
far your tests have been on sheep. How do you know what they are seeing?
The animals can't tell us what they see,
but we can measure the electrical activity in their brains. When we stimulate
the retina, that activity travels down the optic nerve to the centre of the
brain, where it splits off and is processed in a number of ways before going to
the vision centres of the brain, the visual cortex. If we can find where the
visual cortex is on an animal (it's fairly well defined) we can put some
recording electrodes immediately above that portion of the brain and when we
stimulate it, some event is going to result if the animal is realising that it
'sees' something. And when we deliver numerous repetitive stimulations, the
animal will come up with some sort of electrical pattern in its brain to tell
you, ah! it sees something.
But to know what people are actually seeing
how big the light is, how bright it is, that sort of thing, which is called
psychophysics we are going to have to get some humans to tell us.
How can an eye implant become a beneficial reality and when?
You
say the device itself is a silicon chip. How big is it?
The chip can be extremely small. We are
constrained more by cost than anything else, because it was an inexpensive
process we happened to make a fairly large chip, about 6 millimetres in size.
Beforehand, we built a similar circuit about half a metre by half a metre that
had all of the components you can go down to Dick Smith Electronics and buy
the components there. We were able to shrink that to something substantially
smaller, which we could put in or around the eye region in such a way that you
probably wouldn't be able to tell by looking at a person fitted with this thing
that they have it.
What
obstacles have to be overcome before this can be implanted in a human eye?
There are some technical things.
Engineering-wise, we have to make sure that this device is sealed. If any
piece of electronics a radio, say gets into salt water or even around salt
water, eventually it will stop working. The body is made mostly of salt water,
so putting electronics in the body is a very difficult problem. And the signals
that this chip is able to deliver have to be able to get out from the little
implanted capsule to the electrodes that stimulate the nerves. That is a
particularly difficult prospect, but we are making good progress on it.
There are also some medical aspects. We have serious problems with being able to fit substantial
things within the eye. I have heard the retina likened to wet tissue paper. It
is extremely delicate. So we have to develop techniques of surgery. We have
made some good progress, actually implanting a few devices within the eye of an
animal, and it seems to be a reasonable prospect to go into longer-term tests.
Probably one of the trickiest prospects is
to convey the world image in a very pixelised version. By way of analogy,
although cochlear implants have been around for 10 or 15 years, there is
still a huge amount of activity going on, to figure out how you get sound that
goes into a microphone into something that can actually stimulate people to
hear. A similar thing is going to be happening with vision.
Using the retina itself we are, in fact, at
an advantage, because it is all mapped what you see on one side is actually
on the other side of your retina. So we know where we stimulate and where we
see. But there is still a long way to go to stimulate what we see: does it get bigger, does it get smaller, does it hurt,
that sort of thing.
What
is holding up the testing in humans that you need for that?
Patients overseas have
been anaesthetised on the operating table and tested. But we felt that we could not yet say,
'If we get these results, then we can actually put a implant in someone's eye.'
Other studies have been extremely preliminary, and we have been reluctant to
use humans for things that would not benefit anybody. We want to be ready to
start implanting things for real, not just for testing.
An edited transcript of the full interview can be found at http://www.science.org.au/scientists/gs.htm.
Focus questions
- What do you think Suaning meant when he said that people would need to ‘relearn how to see' once they were fitted with visual implants?
- What are the similarities and differences between the visual implant being developed by Suaning and the cochlear implant used to treat deafness?
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