DSpace Angular :: Browsing by Author "Petoe, Matthew"

Browsing by Author "Petoe, Matthew"

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Are long stimulus pulse durations the answer to improving spatial resolution in retinal prostheses?
(Annals of Translational Medicine, 2016-11) Petoe, Matthew; Shivdasani, Mohit
Retinal prostheses can provide artificial vision to patients with degenerate retinae by electrically stimulating the remaining inner retinal neurons. The evoked perception is generally adequate for light localization, but of limited spatial resolution owing to the indiscriminate activation of multiple retinal cell types, leading to distortions in the perceived image. Here we present a perspective on a recent work by Weitz and colleagues who demonstrate a focal confinement of retinal ganglion cell (RGC) activation when using extended pulse durations in the stimulation waveform. Using real-time calcium imaging, they provide evidence that long pulse durations selectively stimulate inner retinal neurons, whilst avoiding unwanted axonal activations. The application of this stimulation technique may provide enhanced spatial resolution for retinal prosthesis users. These experiments provide a robust analysis of the effects of increasing pulse duration and introduce the potential for alternative stimulation paradigms in retinal prostheses.
Cortical auditory evoked potential time-frequency growth functions for fully objective hearing threshold estimation
(Elsevier, Inc., 2018-12) Mao, Darren; Innes-Brown, Hamish; Petoe, Matthew; Wong, Yan; McKay, Colette
Cortical auditory evoked potential (CAEPs) thresholds have been shown to correlate well with behaviourally determined hearing thresholds. Growth functions of CAEPs show promise as an alternative to single level detection for objective hearing threshold estimation; however, the accuracy and clinical relevance of this method is not well examined. In this study, we used temporal and spectral CAEP features to generate feature growth functions. Spectral features may be more robust than traditional peak-picking methods where CAEP morphology is variable, such as in children or hearing device users. Behavioural hearing thresholds were obtained and CAEPs were recorded in response to a 1 kHz puretone from twenty adults with no hearing loss. Four features, peak-to-peak amplitude, root-mean-square, peak spectral power and peak phase-locking value (PLV) were extracted from the CAEPs. Functions relating each feature with stimulus level were used to calculate objective hearing threshold estimates. We assessed the performance of each feature by calculating the difference between the objective estimate and the behaviourally-determined threshold. We compared the accuracy of the estimates using each feature and found that the peak PLV feature performed best, with a mean threshold error of 2.7 dB and standard deviation of 5.9 dB across subjects from behavioural threshold. We also examined the relation between recording time, data quality and threshold estimate errors, and found that on average for a single threshold, 12.7 minutes of recording was needed for a 95% confidence that the threshold estimate was within 20 dB of the behavioural threshold, using the peak-to-peak amplitude feature, while 14 minutes is needed for the peak PLV feature. These results show that the PLV of CAEPs can be used to find a clinically relevant hearing threshold estimate. Its potential stability in differing morphology may be an advantage in testing infants or cochlear implant users.
Determining the Contribution of Retinotopic Discrimination to Localization Performance With a Suprachoroidal Retinal Prosthesis
(IOVS, 2017-06) Petoe, Matthew; McCarthy, Chris; Shivdasani, Mohit; Sinclair, Nicholas; Scott, Adele; Ayton, Lauren; Barnes, Nick; Bionic Vision Australia Consortium
Purpose: With a retinal prosthesis connected to a head-mounted camera, subjects can perform low vision tasks using a combination of electrode discrimination and head-directed localization. The objective of the present study was to investigate the contribution of retinotopic electrode discrimination (perception corresponding to the arrangement of the implanted electrodes with respect to their position beneath the retina) to visual performance for three recipients of a 24-channel suprachoroidal retinal implant. Proficiency in retinotopic discrimination may allow good performance with smaller head movements, and identification of this ability would be useful for targeted rehabilitation. Methods: Three participants with retinitis pigmentosa performed localization and grating acuity assessments using a suprachoroidal retinal prosthesis. We compared retinotopic and nonretinotopic electrode mapping and hypothesized that participants with measurable acuity in a normal retinotopic condition would be negatively impacted by the nonretinotopic condition. We also expected that participants without measurable acuity would preferentially use head movement over retinotopic information. Results: Only one participant was able to complete the grating acuity task. In the localization task, this participant exhibited significantly greater head movements and significantly lower localization scores when using the nonretinotopic electrode mapping. There was no significant difference in localization performance or head movement for the remaining two subjects when comparing retinotopic to nonretinotopic electrode mapping. Conclusions: Successful discrimination of retinotopic information is possible with a suprachoroidal retinal prosthesis. Head movement behavior during a localization task can be modified using a nonretinotopic mapping. Behavioral comparisons using retinotopic and nonretinotopic electrode mapping may be able to highlight deficiencies in retinotopic discrimination, with a view to address these deficiencies in a rehabilitation environment. (ClinicalTrials.gov number, NCT01603576).
Fully objective hearing threshold estimation in cochlear implant users using phase-locking value growth functions
(Elsevier B.V., 2019-03) Mao, Darren; Innes-Brown, Hamish; Petoe, Matthew; Wong, Yan; McKay, Colette
Cochlear implant users require fitting of electrical threshold and comfort levels for optimal access to sound. In this study, we used single-channel cortical auditory evoked responses (CAEPs) obtained from 20 participants using a Nucleus device. A fully objective method to estimate threshold levels was developed, using growth function fitting and the peak phase-locking value feature. Results demonstrated that growth function fitting is a viable method for estimating threshold levels in cochlear implant users, with a strong correlation (r=0.979, p<0.001) with behavioral thresholds. Additionally, we compared the threshold estimates using CAEPs acquired from a standard montage (Cz to mastoid) against using a montage of recording channels near the cochlear implant, simulating recording from the device itself. The correlation between estimated and behavioural thresholds remained strong (r=0.966, p<0.001), however the recording time needed to be increased to produce a similar estimate accuracy. Finally, a method for estimating comfort levels was investigated, and showed that the comfort level estimates were mildly correlated with behavioral comfort levels (r=0.50, p=0.024).
Gaze compensation as a technique for improving hand-eye coordination in prosthetic vision
(ARVO, 2018-01) Titchener, Samuel; Shivdasani, Mohit; Fallon, James; Petoe, Matthew
Purpose: Shifting the region-of-interest within the input image to compensate for gaze shifts (“gaze compensation”) may improve hand–eye coordination in visual prostheses that incorporate an external camera. The present study investigated the effects of eye movement on hand-eye coordination under simulated prosthetic vision (SPV), and measured the coordination benefits of gaze compensation. Methods: Seven healthy-sighted subjects performed a target localization-pointing task under SPV. Three conditions were tested, modeling: retinally stabilized phosphenes (uncompensated); gaze compensation; and no phosphene movement (center-fixed). The error in pointing was quantified for each condition. Results: Gaze compensation yielded a significantly smaller pointing error than the uncompensated condition for six of seven subjects, and a similar or smaller pointing error than the center-fixed condition for all subjects (two-way ANOVA, P < 0.05). Pointing error eccentricity and gaze eccentricity were moderately correlated in the uncompensated condition (azimuth: R2 = 0.47; elevation: R2 = 0.51) but not in the gaze-compensated condition (azimuth: R2 = 0.01; elevation: R2 = 0.00). Increased variability in gaze at the time of pointing was correlated with greater reduction in pointing error in the center-fixed condition compared with the uncompensated condition (R2 = 0.64). Conclusions: Eccentric eye position impedes hand–eye coordination in SPV. While limiting eye eccentricity in uncompensated viewing can reduce errors, gaze compensation is effective in improving coordination for subjects unable to maintain fixation. Translational Relevance: The results highlight the present necessity for suppressing eye movement and support the use of gaze compensation to improve hand–eye coordination and localization performance in prosthetic vision.
Harmonization of Outcomes and Vision Endpoints in Vision Restoration Trials: Recommendations from the International HOVER Taskforce
(ARVO, 2020-07) Ayton, Lauren; Rizzo, Joseph; Bailey, Ian; Colenbrander, August; Dagnelie, Gislin; Geruschat, Duane; Hessburg, Philip; McCarthy, Chris; Petoe, Matthew; Rubin, Gary; Troyk, Philip; HOVER International Task Force
Translational research in vision prosthetics, gene therapy, optogenetics, stem cell and other forms of transplantation, and sensory substitution is creating new therapeutic options for patients with neural forms of blindness. The technical challenges faced by each of these disciplines differ considerably, but they all face the same challenge of how to assess vision in patients with ultra-low vision (ULV), who will be the earliest subjects to receive new therapies. Historically, there were few tests to assess vision in ULV patients. In the 1990s, the field of visual prosthetics expanded rapidly, and this activity led to a heightened need to develop better tests to quantify end points for clinical studies. Each group tended to develop novel tests, which made it difficult to compare outcomes across groups. The common lack of validation of the tests and the variable use of controls added to the challenge of interpreting the outcomes of these clinical studies. In 2014, at the bi-annual International “Eye and the Chip” meeting of experts in the field of visual prosthetics, a group of interested leaders agreed to work cooperatively to develop the International Harmonization of Outcomes and Vision Endpoints in Vision Restoration Trials (HOVER) Taskforce. Under this banner, more than 80 specialists across seven topic areas joined an effort to formulate guidelines for performing and reporting psychophysical tests in humans who participate in clinical trials for visual restoration. This document provides the complete version of the consensus opinions from the HOVER taskforce, which, together with its rules of governance, will be posted on the website of the Henry Ford Department of Ophthalmology (www.artificialvision.org). Research groups or companies that choose to follow these guidelines are encouraged to include a specific statement to that effect in their communications to the public. The Executive Committee of the HOVER Taskforce will maintain a list of all human psychophysical research in the relevant fields of research on the same website to provide an overview of methods and outcomes of all clinical work being performed in an attempt to restore vision to the blind. This website will also specify which scientific publications contain the statement of certification. The website will be updated every 2 years and continue to exist as a living document of worldwide efforts to restore vision to the blind. The HOVER consensus document has been written by over 80 of the world's experts in vision restoration and low vision and provides recommendations on the measurement and reporting of patient outcomes in vision restoration trials.
Head and Gaze Behavior in Retinitis Pigmentosa
(ARVO, 2019-05) Titchener, Samuel; Ayton, Lauren; Abbott, Carla; Fallon, James; Shivdasani, Mohit; Caruso, Emily; Sivarajah, Pyrawy; Petoe, Matthew
Purpose: Peripheral visual field loss (PVFL) due to retinitis pigmentosa (RP) decreases saccades to areas of visual defect, leading to a habitually confined range of eye movement. We investigated the relative contributions of head and eye movement in RP patients and normal-sighted controls to determine whether this reduced eye movement is offset by increased head movement. Methods: Eye-head coordination was examined in 18 early-moderate RP patients, 4 late-stage RP patients, and 19 normal-sighted controls. Three metrics were extracted: the extent of eye, head, and total gaze (eye+head) movement while viewing a naturalistic scene; head gain, the ratio of head movement to total gaze movement during smooth pursuit; and the customary oculomotor range (COMR), the orbital range within which the eye is preferentially maintained during a pro-saccade task. Results: The late-stage RP group had minimal gaze movement and could not discern the naturalistic scene. Variance in head position in early-moderate RP was significantly greater than in controls, whereas variance in total gaze was similar. Head gain was greater in early-moderate RP than in controls, whereas COMR was smaller. Across groups, visual field extent was negatively correlated with head gain and positively correlated with COMR. Accounting for age effects, these results demonstrate increased head movement at the expense of eye movement in participants with PVFL. Conclusions: RP is associated with an increased propensity for head movement during gaze shifts, and the magnitude of this effect is dependent on the severity of visual field loss.
Identification of Characters and Localization of Images Using Direct Multiple-Electrode Stimulation With a Suprachoroidal Retinal Prosthesis
(IOVS, 2017-08) Shivdasani, Mohit; Sinclair, Nicholas; Gillespie, Lisa; Petoe, Matthew; Titchener, Samuel; Fallon, James; Perera, Thushara; Pardinas-Diaz, Darien; Barnes, Nick; Blamey, Peter; Bionic Vision Australia Consortium
Purpose: Retinal prostheses provide vision to blind patients by eliciting phosphenes through electrical stimulation. This study explored whether character identification and image localization could be achieved through direct multiple-electrode stimulation with a suprachoroidal retinal prosthesis. Methods: Two of three retinitis pigmentosa patients implanted with a suprachoroidal electrode array were tested on three psychophysical tasks. Electrode patterns were stimulated to elicit perception of simple characters, following which percept localization was tested using either static or dynamic images. Eye tracking was used to assess the association between accuracy and eye movements. Results: In the character identification task, accuracy ranged from 2.7% to 93.3%, depending on the patient and character. In the static image localization task, accuracy decreased from near perfect to <20% with decreasing contrast (patient 1). Patient 2 scored up to 70% at 100% contrast. In the dynamic image localization task, patient 1 recognized the trajectory of the image up to speeds of 64 deg/s, whereas patient 2 scored just above chance. The degree of eye movement in both patients was related to accuracy and, to some extent, stimulus direction. Conclusions: The ability to identify characters and localize percepts demonstrates the capacity of the suprachoroidal device to provide meaningful information to blind patients. The variation in scores across all tasks highlights the importance of using spatial cues from phosphenes, which becomes more difficult at low contrast. The use of spatial information from multiple electrodes and eye-movement compensation is expected to improve performance outcomes during real-world prosthesis use in a camera-based system. (ClinicalTrials.gov number, NCT01603576.).
Interobserver Agreement of Electrode to Retina Distance Measurements in a Second-Generation (44-Channel) Suprachoroidal Retinal Prosthesis
(Translational Vision Science & Technology, 2022-09) Abbott, Carla; Baglin, Elizabeth; Kolic, Maria; McGuinness, Myra; Titchener, Samuel; Young, Kiera; Yeoh, Jonathan; Luu, Chi; Ayton, Lauren; Petoe, Matthew; Allen, Penelope
Purpose: The electrode to retina (ER) distance is an important contributory factor to the safety and efficacy of a suprachoroidal retinal prosthesis. Measuring ER distance may be performed by different observers during multisite studies. The aim of this study was to assess the interobserver agreement in measuring ER distance. Methods: Three independent, trained observers measured ER distance from the center of each suprachoroidal electrode to the inner retinal pigment epithelium in spectral-domain optical coherence tomography (SD-OCT) B-scans. A total of 121 ER distance measurements from 77 B-scans collected over 5 months from one subject implanted with a second-generation 44-channel suprachoroidal retinal prosthesis (NCT03406416) were made by each observer. Results: ER distance ranged from 208 to 509 µm. Pearson's correlation coefficient (ρ) showed agreement of 0.99 (95% confidence interval [CI] = 0.98–0.99) in measuring ER for each pairwise comparison. The mean difference in ER distance between observers ranged from 2.4 to 6.4 µm with pairwise limits of agreement (95% CI) of ±20 µm (5.5% of mean). Intraclass correlation coefficient (ICC) showed agreement of 0.98 (95% CI = 0.97–0.99) between observers. Conclusions: There is high agreement in measuring ER distances for suprachoroidal retinal prostheses using our systematic approach between multiple, trained observers, supporting the use of a single observer for each image. Translational Relevance: High interobserver agreement outcomes indicate that multiple, trained observers can be used to take ER measurements across different images in suprachoroidal retinal prosthesis studies. This improves multisite study efficiency and gives confidence in interpreting results relating to the safety and efficacy of suprachoroidal retinal prostheses.
Multisensory attention training for treatment of tinnitus
(Scientific Reports, 2016-05) Spiegel, Daniel; Linford, Tania; Thompson, Ben; Petoe, Matthew; Kobayashi, Kei; Stinear, Cathy; Searchfield, Grant
Tinnitus is the conscious perception of sound with no physical sound source. Some models of tinnitus pathophysiology suggest that networks associated with attention, memory, distress and multisensory experience are involved in tinnitus perception. The aim of this study was to evaluate whether a multisensory attention training paradigm which used audio, visual, and somatosensory stimulation would reduce tinnitus. Eighteen participants with predominantly unilateral chronic tinnitus were randomized between two groups receiving 20 daily sessions of either integration (attempting to reduce salience to tinnitus by binding with multisensory stimuli) or attention diversion (multisensory stimuli opposite side to tinnitus) training. The training resulted in small but statistically significant reductions in Tinnitus Functional Index and Tinnitus Severity Numeric Scale scores and improved attentional abilities. No statistically significant improvements in tinnitus were found between the training groups. This study demonstrated that a short period of multisensory attention training reduced unilateral tinnitus, but directing attention toward or away from the tinnitus side did not differentiate this effect.
Oculomotor Responses to Dynamic Stimuli in a 44-Channel Suprachoroidal Retinal Prosthesis
(tvst, 2020-12) Titchener, Samuel; Kvansakul, Jessica; Shivdasani, Mohit; Nayagam, David; Epp, Stephanie; Williams, Chris; Barnes, Nick; Kentler, William; Kolic, Maria; Balin, Elizabeth; Ayton, Lauren; Abbott, Carla; Luu, Chi; Allen, Penelope; Petoe, Matthew
PURPOSE: To investigate oculomotor behavior in response to dynamic stimuli in retinal implant recipients. METHODS: Three suprachoroidal retinal implant recipients performed a four-alternative forced-choice motion discrimination task over six sessions longitudinally. Stimuli were a single white bar ("moving bar") or a series of white bars ("moving grating") sweeping left, right, up, or down across a 42″ monitor. Performance was compared with normal video processing and scrambled video processing (randomized image-to-electrode mapping to disrupt spatiotemporal structure). Eye and head movement was monitored throughout the task. RESULTS: Two subjects had diminished performance with scrambling, suggesting retinotopic discrimination was used in the normal condition and made smooth pursuit eye movements congruent to the moving bar stimulus direction. These two subjects also made stimulus-related eye movements resembling optokinetic reflex (OKR) for moving grating stimuli, but the movement was incongruent with stimulus direction. The third subject was less adept at the task, appeared primarily reliant on head position cues (head movements were congruent to stimulus direction), and did not exhibit retinotopic discrimination and associated eye movements. CONCLUSIONS: Our observation of smooth pursuit indicates residual functionality of cortical direction-selective circuits and implies a more naturalistic perception of motion than expected. A distorted OKR implies improper functionality of retinal direction-selective circuits, possibly due to retinal remodeling or the non-selective nature of the electrical stimulation. TRANSLATIONAL RELEVANCE: Retinal implant users can make naturalistic eye movements in response to moving stimuli, highlighting the potential for eye tracker feedback to improve perceptual localization and image stabilization in camera-based visual prostheses.
Proportional recovery after stroke depends on corticomotor integrity
(to American Neurological Association, 2015-11-17) Byblow, Winston; Stinear, Cathy; Barber, Alan; Petoe, Matthew; Ackerley, Suzanne
OBJECTIVE: For most patients the resolution of upper limb impairment during the first six months after stroke is 70% of the maximum possible. We sought to identify candidate mechanisms of this proportional recovery. We hypothesized that the proportional resolution of upper limb impairment depends on ipsilesional corticomotor pathway function, is mirrored by the proportional recovery of excitability in this pathway, and is unaffected by upper limb therapy dose. METHOD: Upper limb impairment was measured in 93 patients at 2, 6, 12 and 26 weeks after first-ever ischaemic stroke. Motor evoked potentials and motor threshold were recorded from extensor carpi radialis using transcranial magnetic stimulation, and fractional anisotropy in the posterior limbs of the internal capsules was determined with diffusion-weighted MRI. RESULTS: Initial impairment score, the presence of motor evoked potentials and fractional anisotropy asymmetry were the only predictors of impairment resolution, indicating a key role for corticomotor tract function. By 12 weeks, upper limb impairment resolved by 70% in patients with motor evoked potentials regardless of their initial impairment, and ipsilesional rest motor threshold also resolved by 70%. The resolution of impairment was insensitive to upper limb therapy dose. INTERPRETATION: These findings indicate that upper limb impairment resolves by 70% of the maximum possible regardless of initial impairment, but only for patients with intact corticomotor function. Impairment resolution seems to reflect spontaneous neurobiological processes that involve the ipsilesional corticomotor pathway. A better understanding of these mechanisms could lead to interventions that increase the resolution of impairment above 70%. This article is protected by copyright. All rights reserved.
A Second-Generation (44-Channel) Suprachoroidal Retinal Prosthesis: Long-Term Observation of the Electrode–Tissue Interface
(Translational Vision Science & Technology, 2022-06) Titchener, Samuel; Nayagam, David; Kvansakul, Jessica; Kolic, Maria; Baglin, Elizabeth; Abbott, Carla; McGuinness, Myra; Ayton, Lauren; Luu, Chi; Greenstein, Steven; Kentler, William; Shivdasani, Mohit; Allen, Penelope; Petoe, Matthew
Purpose: To report the long-term observations of the electrode–tissue interface and perceptual stability in humans after chronic stimulation with a 44-channel suprachoroidal retinal implant. Methods: Four subjects (S1–4) with end-stage retinitis pigmentosa received the implant unilaterally (NCT03406416). Electrode impedances, electrode–retina distance (measured using optical coherence tomography imaging), and perceptual thresholds were monitored up to 181 weeks after implantation as the subjects used the prosthesis in the laboratory and in daily life. Stimulation charge density was limited to 32 µC/cm2 per phase. Results: Electrode impedances were stable longitudinally. The electrode–retina distances increased after surgery and then stabilized, and were well-described by an asymptotic exponential model. The stabilization of electrode–retina distances was variable between subjects, stabilizing after 45 weeks for S1, 63 weeks for S2, and 24 weeks for S3 (linear regression; Pgradient > 0.05). For S4, a statistically significant increase in electrode–retina distance persisted (P < 0.05), but by the study end point the rate of increase was clinically insignificant (exponential model: 0.33 µm/wk). Perceptual electrical thresholds were stable in one subject, decreased over time in two subjects (linear model; P < 0.05), and increased slightly in one subject but remained within the predefined charge limits (P = 0.02). Conclusions: Chronic stimulation with the suprachoroidal retinal prosthesis over 3 years resulted in stable impedances, small individual changes in perceptual electrical thresholds, and no clinically significant increase in electrode–retina distances after a period of settling after surgery. Translational Relevance: Chronic stimulation with the 44-channel suprachoroidal retinal implant with a charge density of up to 32 µC/cm2 per phase is suitable for long-term use in humans.
Sensory augmentation to aid training with retinal prostheses
(IOP Publishing, 2020-07) Kvansakul, Jessica; Hamilton, Lachlan; Ayton, Lauren; McCarthy, Chris; Petoe, Matthew
OBJECTIVE: Retinal prosthesis recipients require rehabilitative training to learn the non-intuitive nature of prosthetic 'phosphene vision'. This study investigated whether the addition of auditory cues, using The vOICe sensory substitution device (SSD), could improve functional performance with simulated phosphene vision. APPROACH: Forty normally sighted subjects completed two visual tasks under three conditions. The phosphene condition converted the image to simulated phosphenes displayed on a virtual reality headset. The SSD condition provided auditory information via stereo headphones, translating the image into sound. Horizontal information was encoded as stereo timing differences between ears, vertical information as pitch, and pixel intensity as audio intensity. The third condition combined phosphenes and SSD. Tasks comprised light localisation from the Basic Assessment of Light and Motion (BaLM) and the Tumbling-E from the Freiburg Acuity and Contrast Test (FrACT). To examine learning effects, twenty of the forty subjects received SSD training prior to assessment. MAIN RESULTS: Combining phosphenes with auditory SSD provided better light localisation accuracy than either phosphenes or SSD alone, suggesting a compound benefit of integrating modalities. Although response times for SSD-only were significantly longer than all other conditions, combined condition response times were as fast as phosphene-only, highlighting that audio-visual integration provided both response time and accuracy benefits. Prior SSD training provided a benefit to localisation accuracy and speed in SSD-only (as expected) and Combined conditions compared to untrained SSD-only. Integration of the two modalities did not improve spatial resolution task performance, with resolution limited to that of the higher resolution modality (SSD). SIGNIFICANCE: Combining phosphene (visual) and SSD (auditory) modalities was effective even without SSD training and led to an improvement in light localisation accuracy and response times. Spatial resolution performance was dominated by auditory SSD. The results suggest there may be a benefit to including auditory cues when training vision prosthesis recipients.
An update on retinal prostheses
(Elsevier B.V., 2019-12) Ayton, Lauren; Barnes, Nick; Dagnelie, Gislin; Fujikado, Takashi; Goetz, Georges; Hornig, Ralf; Jones, Bryan; Muqit, Mahiul; Rathbun, Daniel; Stingl, Katarina; Weiland, James; Petoe, Matthew
Retinal prostheses are designed to restore a basic sense of sight to people with profound vision loss. They require a relatively intact posterior visual pathway (optic nerve, lateral geniculate nucleus and visual cortex). Retinal implants are options for people with severe stages of retinal degenerative disease such as retinitis pigmentosa and age-related macular degeneration. There have now been three regulatory-approved retinal prostheses. Over five hundred patients have been implanted globally over the past 15 years. Devices generally provide an improved ability to localize high-contrast objects, navigate, and perform basic orientation tasks. Adverse events have included conjunctival erosion, retinal detachment, loss of light perception, and the need for revision surgery, but are rare. There are also specific device risks, including overstimulation (which could cause damage to the retina) or delamination of implanted components, but these are very unlikely. Current challenges include how to improve visual acuity, enlarge the field-of-view, and reduce a complex visual scene to its most salient components through image processing. This review encompasses the work of over 40 individual research groups who have built devices, developed stimulation strategies, or investigated the basic physiology underpinning retinal prostheses. Current technologies are summarized, along with future challenges that face the field.
Vision function testing for a suprachoroidal retinal prosthesis: effects of image filtering
(IOP Publishing, 2016-04) Barnes, Nick; Scott, Adele; Lieby, Paulette; Petoe, Matthew; McCarthy, Chris; Stacey, Ashley; Ayton, Lauren; Sinclair, Nicholas; Shivdasani, Mohit; Lovell, Nigel; McDermott, Hugh; Walker, Janine; BVA Consortium
OBJECTIVE: One strategy to improve the effectiveness of prosthetic vision devices is to process incoming images to ensure that key information can be perceived by the user. This paper presents the first comprehensive results of vision function testing for a suprachoroidal retinal prosthetic device utilizing of 20 stimulating electrodes. Further, we investigate whether using image filtering can improve results on a light localization task for implanted participants compared to minimal vision processing. No controlled implanted participant studies have yet investigated whether vision processing methods that are not task-specific can lead to improved results. APPROACH: Three participants with profound vision loss from retinitis pigmentosa were implanted with a suprachoroidal retinal prosthesis. All three completed multiple trials of a light localization test, and one participant completed multiple trials of acuity tests. The visual representations used were: Lanczos2 (a high quality Nyquist bandlimited downsampling filter); minimal vision processing (MVP); wide view regional averaging filtering (WV); scrambled; and, system off. MAIN RESULTS: Using Lanczos2, all three participants successfully completed a light localization task and obtained a significantly higher percentage of correct responses than using MVP ([Formula: see text]) or with system off ([Formula: see text]). Further, in a preliminary result using Lanczos2, one participant successfully completed grating acuity and Landolt C tasks, and showed significantly better performance ([Formula: see text]) compared to WV, scrambled and system off on the grating acuity task. SIGNIFICANCE: Participants successfully completed vision tasks using a 20 electrode suprachoroidal retinal prosthesis. Vision processing with a Nyquist bandlimited image filter has shown an advantage for a light localization task. This result suggests that this and targeted, more advanced vision processing schemes may become important components of retinal prostheses to enhance performance. ClinicalTrials.gov Identifier: NCT01503576.

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