Automatic Identification and Avoidance of Axon Bundle Activation for Epiretinal Prosthesis

ABSTRACTRetinal prostheses must be able to activate cells in a selective way in order to restore high-fidelity vision. However, inadvertent activation of far-away retinal ganglion cells (RGCs) through electrical stimulation of axon bundles can produce irregular and poorly controlled percepts, limiting artificial vision. Therefore, the problem of axon bundle activation can be defined as the axonal stimulation of RGCs with unknown soma and receptive field locations, typically outside the electrode array. Here, a new algorithm is presented that utilizes electrical recordings to determine the stimulation current amplitudes above which bundle activation occurs. The method exploits several spatiotemporal characteristics of electrically-evoked spikes to overcome the challenge of detecting small axonal spikes in extracellular recordings. The algorithm was validated using large-scale ex vivo stimulation and recording experiments in macaque retina, by comparing algorithmically and manually identified bundle activation thresholds. The algorithm could be used in a closed-loop manner by a future epiretinal prosthesis to reduce poorly controlled visual percepts associated with bundle activation. The method may also be applicable to other types of retinal implants and to cortical implants.ContributionsPT developed the algorithm and analyzed the data, with input from SMi and EJC. NB and NS helped with the analysis. SMa and LG performed dissections and collected the data. PT and VFH performed manual identification. PH, AS and AML developed and supported recording hardware and software. PT, EJC and SMi wrote the manuscript. NS and SMa edited it. EJC and SMi supervised the project.

A Three-Dimensional Microelectrode Array to Generate Virtual Electrodes for Epiretinal Prosthesis Based on a Modeling Study

Despite many advances in the development of retinal prostheses, clinical reports show that current retinal prosthesis subjects can only perceive prosthetic vision with poor visual acuity. A possible approach for improving visual acuity is to produce virtual electrodes (VEs) through electric field modulation. Generating controllable and localized VEs is a crucial factor in effectively improving the perceptive resolution of the retinal prostheses. In this paper, we aimed to design a microelectrode array (MEA) that can produce converged and controllable VEs by current steering stimulation strategies. Through computational modeling, we designed a three-dimensional concentric ring–disc MEA and evaluated its performance with different stimulation strategies. Our simulation results showed that electrode–retina distance (ERD) and inter-electrode distance (IED) can dramatically affect the distribution of electric field. Also the converged VEs could be produced when the parameters of the three-dimensional MEA were appropriately set. VE sites can be controlled by manipulating the proportion of current on each adjacent electrode in a current steering group (CSG). In addition, spatial localization of electrical stimulation can be greatly improved under quasi-monopolar (QMP) stimulation. This study may provide support for future application of VEs in epiretinal prosthesis for potentially increasing the visual acuity of prosthetic vision.

Endoscope-Assisted and Controlled Argus II Epiretinal Prosthesis Implantation in Late-Stage Retinitis Pigmentosa: A Report of 2 Cases

Several different approaches for restoring sight in subjects who are blind due to outer retinal degeneration are currently under investigation, including stem cell therapy, gene therapy, and visual prostheses. Although many different types of visual prostheses have shown promise, to date, the Argus II Epiretinal Prosthesis System, developed in a clinical setting over the course of 10 years, is the world’s first and only retinal prosthesis that has been approved by the United States Food and Drug Administration (FDA) and has been given the CE-Mark for sale within the European Economic Area (EEA). The incidence of serious adverse events from Argus II implantation decreased over time after minor changes in the implant design and improvements in the surgical steps used for the procedure had been made. In order to further decrease the scleral incision-related complications and enhance the assessment of the tack position and the contact between the array and the inner macular surface, we used an ophthalmic endoscope during the regular course of Argus II implantation surgery in 2 patients with late-stage retinitis pigmentosa in an attempt to improve the anatomical and functional outcomes.