[Vision restoration with implants in retinal degenerations].
ABSTRACT Up until now there has been no available treatment for diseases causing the permanent impairment of retinal photoreceptors. Currently the development of the retinal prostheses is the earliest to promise a result that can be implemented in the clinical treatment of these patients. Implants with different operating principles and in various stages of progress are presented in details, highlighting the characteristics, as well as the Hungarian aspects of the development. This survey intends to provide an overview on retinal prostheses, implantable in case of degenerative diseases of the retina, by reviewing and assessing the papers published in relevant journals and based on personal experience. Developments in microelectronics in recent years made it possible and proved to be feasible to replace the degenerated elements in the retina with electrical stimulation. Multiple comparable approaches are running simultaneously. Two types of these implants are directly stimulating the remaining living cells in the retina. Hitherto the finest resolution has been achieved with the subretinal implants. Although the epiretinal implant offer lower resolution, but requires shorter surgery for implantation. Retinal implants in certain retinal diseases are proved to be capable of generating vision-like experiences. A number of types of retinal implants can be expected to appear in clinical practice a few years after the successful conclusion of clinical trials.
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ABSTRACT: 1. To explore the feasibility of a visual prosthesis for the blind, human visual cortex has been stimulated during a series of surgical procedures on conscious volunteers undergoing other occipital lobe surgery.2. Area no. 17 seems the most effective locus for such stimulation, at least in sighted or recently hemianopic patients.3. Changes in electrode size and configuration, or in stimulus parameters, have little effect on subjective sensation.4. Thresholds do vary depending on parameters, but not electrode size, and these effects have been studied.5. Painful effects are associated with stimulation of the dura, but not of the calcarine artery and associated vessels.6. Stimulation of a single electrode usually produces one phosphene, whose size ranges from tiny punctate sensations like ;a star in the sky' up to a large coin at arm's length. Very large elongated phosphenes, like those seen by Brindley's second patient, have not been reported despite the number of patients, electrodes, and combinations of stimulus parameters tested. These large phosphenes may be an effect of prolonged blindness.7. Stimulation substantially above threshold may produce a second conjugate phosphene, inverted about the horizontal meridian.8. Stimulation of a single electrode may also produce multiple phosphenes with no differential threshold.9. Chromatic effects and/or phosphene flicker may, or may not occur. This can vary from point to point on the same patient.10. Phosphenes fade after 10-15 sec of continuous stimulation.11. All phosphenes move proportionately with voluntary eye movements, within the accuracy of our mapping techniques.12. Brightness modulation can easily be achieved by changing pulse amplitude.13. The position of phosphenes in the visual field corresponds only roughly with expectations based on classical maps showing the projection of the visual field onto the cortex.14. Patients can usually discriminate phosphenes produced by 1 mm(2) electrodes on 3 mm centres, although this seems to be close to the limit of resolution.15. Patterns of up to four phosphenes produced by four electrodes have been recognized. However, a variety of complex interactions have been reported.16. Multiple phosphenes are co-planar, although patients are unable to estimate their distance.17. Phosphenes appear immediately when stimulation is begun, and disappear immediately upon cessation of stimulation.18. Future work must concentrate on blind volunteers to explore possible differences in subjective sensation produced after prolonged blindness, and to explore more complex pattern presentation which requires substantial periods of time with any given patient.The Journal of Physiology 01/1975; 243(2):553-76. · 4.54 Impact Factor
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ABSTRACT: 1. An array of radio receivers, connected to electrodes in contact with the occipital pole of the right cerebral hemisphere, has been implanted into a 52-year-old blind patient. By giving appropriate radio signals, the patient can be caused to experience sensations of light (;phosphenes') in the left half of the visual field.2. The sensation caused by stimulation through a single electrode is commonly a single very small spot of white light at a constant position in the visual field; but for some electrodes it is two or several such spots, or a small cloud.3. For weak stimuli the map of the visual field on the cortex agrees roughly with the classical maps of Holmes and others derived from war wounds. With stronger stimuli, additional phosphenes appear; these follow a map that is roughly the classical map inverted about the horizontal meridian.4. The phosphenes produced by stimulation through electrodes 2.4 mm apart can be easily distinguished. By stimulation through several electrodes simultaneously, the patient can be caused to see predictable simple patterns.5. The effects of the duration and frequency of stimulating pulses on the threshold have been explored.6. For cortical phosphenes there is no sharp flicker fusion frequency, and probably no flicker fusion frequency at all.7. During voluntary eye movements, the phosphenes move with the eyes. During vestibular reflex eye movements they remain fixed in space.8. Phosphenes ordinarily cease immediately when stimulation ceases, but after strong stimulation they sometimes persist for up to 2 min.9. Our findings strongly suggest that it will be possible, by improving our prototype, to make a useful prosthesis.The Journal of Physiology 06/1968; 196(2):479-93. · 4.54 Impact Factor
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ABSTRACT: To evaluate the feasibility of bypassing damaged photoreceptors and electrically stimulating the remaining viable retinal layers to provide limited visual input to patients who are blind because of severe photoreceptor degeneration. In the operating room with the patient under local anesthesia, focal electrical stimulation of the retinal surface with brief biphasic pulses was performed using small probes inserted through the sclera. The procedure was performed in five subjects who had little or no light perception. Three subjects had retinitis pigmentosa, one had age-related macular degeneration, and one had unspecified retinal degeneration from birth. Stimulation elicited visual perception of a spot of light (phosphene). Subjects who previously had useful vision accurately localized the phosphenes according to the retinal area stimulated. Two subjects could track the movement of the stimulating electrode by reporting movement of the elicited phosphene, and could perceive two simultaneous phosphenes on independent stimulation with two electrodes. In a resolution test, one of the subjects with no light perception in his left eye resolved phosphenes at 1.75 degrees center-to-center distance (ie, 4/200 OS visual acuity). Local electrical stimulation of the retinal surface in patients blind from outer retinal disease results in focal light perception that seems to arise from the stimulated area. Such findings in an acute experiment warrant further research into the possibility of prolonged retinal stimulation, improved resolution, and ultimately, an intraocular visual prosthesis.Archives of Ophthalmology 02/1996; 114(1):40-6. · 4.49 Impact Factor