Andrea Appleton 2016-04-19 04:49:08
Anthony Andreottola has received the “bionic eye.” Alongside him is Lion Gislin Dagnelie, associate director of the Lions Vision Research and Rehabilitation Center. THE BIONIC EYE is a REALITY Thanks in part to Lions, about 150 people, once blind, are benefiting from an ingenious device. Anthony Andreottola, 55, has been blind for more than a decade. The mental health therapist has retinitis pigmentosa (RP), an inherited eye disease that slowly deteriorates the light-sensing cells of the retina. Most of the time, Andreottola gets around reasonably well with a cane. But last winter was one of the harshest on record in Boston, where he lives. More than nine feet of snow fell. “I had a miserable winter, the worst in my life,” Andreottola says. “Even relying on Uber or taxis, I couldn’t get where I needed to go. They were leaving me in places where I couldn’t navigate with a cane.” So when Andreottola’s ophthalmologist mentioned the “bionic eye,” a new technology specifically for people with RP, he was intrigued. The device, officially dubbed the Argus II, consists of an electrode array that is surgically implanted in the eye. In concert with external components, the array stimulates the retina with electrical pulses. The visual gains that result are modest, by the standards of the sighted. But, like the roughly 150 people who’d undergone the procedure before him, Andreottola thought it sounded worth it. “Basically my realistic hopes are that I can use it to navigate downtown Boston without getting hit by a bus,” he said in October, a few weeks before his surgery. “Anything more than that is extra.” About 100,000 patients in the United States have RP. Only those in the late stages—about 10,000 people—stand to benefit from the Argus II. “It’s a rare disease but it's also the disease from hell,” says Gislin Dagnelie, associate director of the Lions Vision Research and Rehabilitation Center, a division of the Johns Hopkins Wilmer Eye Institute in Baltimore. Night blindness is one of the early symptoms, followed by a slow narrowing of the visual field. Tunnel vision eventually gives way to blindness. “These patients find out when they're in their teens, their 20s, that they’re going to be blind. And they're going to be blind little by little. Every time they adjust to a new level of vision loss, it gets worse.” Dagnelie, who is also an associate professor of ophthalmology at Johns Hopkins, has worked for decades on developing the bionic eye. His early work on the project was supported by the Lions Vision Research Foundation, which created a $4 million endowment fund in 1994 to finance the research center he helps head. While raising the endowment, the foundation paid the center $200,000 a year for pilot projects. “I'm always really happy to see the support that we get from the Lions,” Dagnelie says. He became a member of the Suburban Lions Club in 2013. Dagnelie and his colleagues began testing how electrical currents affected the vision of RP patients in the early 1990s. Robert Greenberg, co-founder of Second Sight, the company based in Sylmar, California, that makes the Argus II, was in medical school when those experiments began. He recalls an early example. “I’d never been in an operating room at the time so I was very excited,” he says. A surgeon held a probe over the eye of a patient under local anesthesia and applied an electrical current. “The patient said, ‘I see a spot of light,’” Greenberg says. “With the second wire, the patient saw two spots. From then on, I was hooked.” At the time, Greenberg estimated it would take about a million dollars and a year to build a product. The FDA approved the Argus II for consumer use in 2013, nearly 25 years and $200 million later. “I didn’t really understand what the challenges were going into it,” Greenberg laughs. ‘Basically my realistic hopes are that I can use it to navigate downtown Boston without getting hit by a bus ... anything more than that is extra.’ About a dozen medical centers in the United States and a number in Europe currently perform the surgery to implant the device. (Retinal surgeon James Tahara Handa, a professor of ophthalmology at the Wilmer Eye Institute, performed Andreottola’s surgery and many others.) A pillsized implant embedded with an array of 60 electrodes is attached to the surface of the retina. Post-surgery, the patient dons a pair of glasses with a miniature video camera attached. The video camera sends video to a processor on the wearer’s belt, which reduces the image from normal resolution to a crude version the 60-pixel array can handle. The processor then sends that data to an antenna coil on the glasses, which beams it into the eye wirelessly. The signals go next to the electrode array, which emits pulses of electricity. The pulses stimulate the retina’s remaining healthy cells. These transmit the visual information to the brain much as they would in a healthy eye. The design of the retinal implant was inspired by the cochlear implant, which also uses an electrode array to transmit signals to the brain. Like early versions of the cochlear implant, the Argus II has major limitations. The most obvious is the vision itself. “The quality of the image is best described as moving shadows,” Dagnelie says. “It's gray, light and dark gray, and things are moving.” Details like facial features are impossible to make out. Getting the most out of the Argus II also requires a good deal of dedication. In the days after his surgery, Andreottola was hopeful but struggling to interpret the odd flashes of light the electrodes deliver. Gislin checks Andreottola’s vision with assistance from Michael Barry, a graduate student. “It’s hard to come up with words to describe what I see,” he says. “You know when you’re dancing in the nightclub and they put on the strobe lights and it looks like everything’s in slow motion? It’s kind of like that.” Early on, Andreottola had been able to avoid walking into a closed office door because he detected the shimmer of the glass panel, and he’d seen the shapes of cars and people and doorways. But images often seemed to vanish unexpectedly, and a given scene didn’t look consistently the same from one moment to the next. It can take a year of training to learn to get the most out of the Argus II. For instance, implant recipients must learn to move their heads regularly to refresh the image they see rather than moving their eyes. Otherwise the brain misinterprets the signals it’s receiving, and stationary objects appear to move. “Most of the patients who are successful with this are already successful blind people,” Dagnelie says. “So it's not like this is a fundamental change of their lives.” But the Argus II does give users a sense of their spatial environment, and that can make a big difference in daily life. They can generally see the white paint of a crosswalk, the crude shape of a chair in their path, the contrast of a white plate on a dark tablecloth. “I can avoid hitting things or walking into a wall,” says Nancy Tate, 69. Tate got the implant in 2007 as part of a clinical trial. “It gives me more mobility and I can pick up speed a little more than I otherwise would be able to with a cane.” At the moment, the procedure is limited to those with around $180,000 to spend or the tenacity to take on their insurance company. As yet, there is no national policy on coverage of the Argus II, though Dagnelie suspects one will take shape over the next couple of years. (Andreottola succeeded in getting coverage from his insurance company, but not without the intervention of the Commonwealth of Massachusetts Health Policy Commission. “It was quite the battle,” he says.) Meanwhile, researchers are continuing to improve the Argus II. “One of the nice things about it is that it’s software updatable,” Greenberg says. He is confident that future software updates will provide users with some color vision, among other improvements. Dagnelie, for his part, hopes the device will soon be able to record how the retina responds when it is electrically stimulated. With that feedback, researchers should be able to gain a better understanding of a particular patient’s retinal degeneration and tailor the processor’s signals to match. The “bionic eye” works thanks to a pair of glasses with an attached miniature video camera and a processor on the wearer’s belt. One glaring limitation of the technology is, of course, that it is designed for a tiny subset of the blind. That may soon change. “The vision for the company was always to treat all blindness,” Greenberg says. “We started with RP because of the nature of the disease.” Those in the late stages of RP have a more or less intact retina, but next to no vision. This made it a good candidate for early experimentation with electrical stimulation. Unlike, say, macular degeneration, which preserves some peripheral vision, patients with advanced RP had little to lose. Now that the device appears to be safe, researchers are expanding their horizons. A small study using the Argus II with age-related macular degeneration patients was launched this year. Because of its design, the Argus II will likely always be limited to those who have an intact retina that is attached to the back of the eye as well as a functioning optic nerve. This excludes patients who have had severe eye trauma or suffer from diseases affecting the optic nerve such as glaucoma. But Second Sight is working on developing a similar technology they hope will help virtually any blind person. The Orion I functions much like the Argus II, but bypasses the optic nerve and the eye entirely, connecting directly to the visual cortex of the brain. Animal trials are ongoing, and the company hopes to launch a human trial by late 2016. Greenberg may have greatly underestimated how long it would take to produce a bionic eye, but he continues to dream big. “The Six Million Dollar Man,” a TV show from the 1970s starring a man with a technologically-enhanced body including a bionic eye equipped with a zoom lens, is one source of inspiration. “My dream would be to get to a point where the vision is actually better than normal,” he says. “I think we can, but it’s going to take a lot of effort.” In the meantime, early adopters of the Argus II appear to be getting some slightly more modest benefits. “It hasn’t opened a new world to me, but it’s giving me a couple of peeks,” Andreottola says. “And if it keeps me from falling in one subway pit, then it’s worth a million dollars.” Andrea Appleton is a freelance journalist based in Baltimore.
Published by International Association of Lions Clubs . View All Articles.
This page can be found at http://digital.lionmagazine.org/article/The+Future+Has+Arrived/2423369/293797/article.html.