- •Visual Prosthetics
- •Preface
- •Acknowledgments
- •Contents
- •Contributors
- •1.1 The Visual System as an Engineering Compromise
- •1.2 An Overview of Human Visual System Architecture
- •1.2.1 Architecture and Basic Function of the Eye
- •1.2.2 Layout of the Retino-Cortical Pathway
- •1.2.3 Layout of the Subcortical Pathways
- •1.3 An Overview of Human Visual Function
- •1.3.1 Roles of Central (Foveal) Vision
- •1.3.2 Roles of Peripheral Vision
- •1.3.3 Roles of Dark-Adapted Vision
- •1.3.4 A Few Remarks Regarding Visual Development
- •1.4 Prospects for Prosthetic Vision Restoration
- •References
- •2.1 Introduction
- •2.2 Retina
- •2.2.1 Anatomy
- •2.2.2 Physiology and Receptive Fields
- •2.4.1 Anatomy
- •2.4.2 Physiology and Receptive Fields
- •2.6 The Role of Spatiotemporal Edges in Early Vision
- •2.7 The Role of Corners in Early Vision
- •2.7.1 Overview
- •2.8 Effects of Fixational Eye Movements in Early Visual Physiology and Perception
- •2.8.1 Overview
- •2.8.2 Neural Adaptation and Visual Fading
- •2.8.3 Microsaccades in Visual Physiology and Perception
- •References
- •3.1 Introduction
- •3.2 Background
- •3.3 Retinal Disease and Its Diversity
- •3.4 Retinal Remodeling
- •3.5 Retinal Circuitry
- •3.6 Retinal Circuitry Revision
- •3.7 Implications for Bionic Rescue
- •3.8 Implications for Biological Rescue
- •3.9 Final Remarks
- •References
- •4.1 Introduction
- •4.4 What Are the Limits to This Cortical Plasticity?
- •4.5 Possible Mechanisms Behind Brain Plasticity
- •4.6 Modulation of Brain Plasticity: Recent Developments
- •4.7 Neuroplasticity and Other Neuroprostheses Efforts
- •4.8 A Look at What Is Ahead
- •References
- •5.1 Introduction
- •5.2 Vision Changes Experienced by RP Patients
- •5.2.1 Overview
- •5.2.2 Visual Field Loss in RP
- •5.2.3 Changes in Color Vision and Glare Sensitivity in RP
- •5.2.4 Vision Fluctuations in RP
- •5.3 Visual Changes in Patients with Advanced Macular Degeneration
- •5.3.1 Changes Due to Wet AMD or Choroidal Neovascularization
- •5.3.2 Changes Due to Dry AMD or Geographic Atrophy
- •5.4 Charles Bonnet Syndrome
- •5.4.1 Overview
- •5.4.2 Complexity of Visual Hallucinations in CBS
- •5.4.3 Predictors and Alleviating Factors for CBS
- •5.5 Filling-In Phenomena (Perceptual Completion)
- •5.6 Remapping of Primary Visual Cortex in Patients with Central Scotomas from Macular Disease
- •5.7 The Preferred Retinal Locus for Fixation
- •5.8 Photopsias
- •5.8.1 Photopsias in RP
- •5.8.2 Photopsias in AMD and Other Ocular Diseases
- •5.9 Concluding Remarks
- •References
- •6.1 Introduction
- •6.2 Electrode–Electrolyte Interface
- •6.3 Electrode Material
- •6.3.1 Electrode Characterization
- •6.4 Overview of Electrode Materials for Neural Stimulation
- •6.5 Overview of Extracellular Stimulation
- •6.6 Safe Stimulation of Tissue
- •6.6.1 Mechanisms of Neural Injury
- •6.6.2 Parameters for Safe Stimulation
- •6.6.3 Stimulation Induced Injury in the Retina
- •References
- •7.1 Introduction
- •7.2 Power and Data Transmission
- •7.2.1 Wireline Connection
- •7.2.2 Inductive Coils
- •7.2.3 Serial Optical Telemetry
- •7.2.4 Photodiode Array-Based Prostheses
- •7.2.5 Thermal Safety Considerations
- •7.2.6 Conclusions: Comparing the Different Approaches
- •7.3 Tissue Response to a Subretinal Implant
- •7.3.1 Flat Implants
- •7.3.2 Chamber Implants
- •7.3.3 Pillar Arrays
- •7.4 Damage to Retinal Tissue from Electrical Stimulation
- •7.4.1 Effect of Pulse Duration
- •7.4.2 Electrode Size
- •7.5 Concluding Remarks
- •References
- •8.1 Introduction
- •8.2 Quasistatic Numerical Methods: The Admittance Method
- •8.2.1 Layered Retinal Model
- •8.2.2 Equivalent Electric Circuit
- •8.3 Three-Dimensional Activation Function Calculation
- •8.4 Safety of Implant
- •8.5 Conclusion
- •References
- •9.1 Pathophysiology of Retinal Degeneration
- •9.2.1 Outer Plexiform Layer
- •9.2.2 Inner Plexiform Layer
- •9.2.2.1 Bipolar Cell Excitation of Retinal Ganglion Cells
- •9.2.2.2 Amacrine Cell Modulation of Signal Processing
- •9.2.2.3 Inhibitory Transmitters
- •9.2.2.4 Acetylcholine and Dopamine
- •9.2.2.5 Neuropeptides
- •9.2.2.6 Putative neurotransmitters for retinal prosthesis
- •9.3 Neurophysiological Changes in Retinal Degeneration
- •9.4 Rationale for a Neurotransmitter-Based Retinal Prosthesis
- •9.4.1 Limitations of Electrical Stimulation
- •9.5 Technical Considerations and Design Approaches
- •9.5.1 Operating Principles for a Neurotransmitter-Based Retinal Prosthesis
- •9.5.2 Establishing a Retinal Prosthesis/Synaptic Interface
- •9.5.2.1 The Proximity Requirement
- •9.5.2.2 Convective Delivery of Neurotransmitters Via Microfluidics
- •9.5.2.3 Functionalized Surfaces for Neurotransmitter Stimulation
- •9.5.2.4 Synaptic Requirements for l-Glutamate Mediated Neuronal Stimulation
- •9.6 Summary
- •References
- •10.1 Introduction
- •10.2 Pioneering Experiments
- •10.2.1 Stimulation with No Chromophores
- •10.2.2 Azo Chromophores
- •10.3 Current Research
- •10.3.1 Caged Neurotransmitters
- •10.3.2 Pore Blocker and Photoisomerization
- •10.3.3 The Channelrhodopsins
- •10.3.4 Melanopsin
- •10.4 Synthetic Chromophores and Artificial Sight
- •References
- •11.1 Background
- •11.2 Physical Structure of Intracortical Electrodes
- •11.3 Charge Injection Using Intracortical Electrodes
- •11.3.1 The Intracortical Electrode as a Transducer
- •11.3.2 Charge Injection Limits
- •11.4 Intracortical Electrode Coatings
- •11.5 Characterization of Intracortical Electrodes
- •11.5.1 Cyclic Voltammetry
- •11.5.2 Electrode Stimulation Voltage Waveforms
- •11.5.3 Non-ideal Access Resistance Behavior
- •11.5.4 Non-linear Electrode Polarization
- •11.5.5 Determining Electrode Safety
- •11.6 Contrasts of In Vitro and In Vivo Behavior
- •11.7 Alternative Coatings for Improving Intracortical Electrodes
- •11.7.1 SIROF
- •11.7.2 PEDOT
- •11.7.3 Carbon Nanotube Coatings
- •11.8 Conclusion
- •References
- •12.1 Introduction
- •12.2 Responses of RGCs to Electrical Stimulation in Normal Retina
- •12.2.1 Epiretinal Stimulation
- •12.2.1.1 Target of Stimulation
- •12.2.1.2 The Site of Spike Initiation in RGCs
- •12.2.1.3 Threshold vs. Stimulating Electrode Diameter
- •12.2.1.4 Spatial Extent of Activation
- •12.2.1.5 Selective Activation
- •12.2.1.6 Temporal Response Properties
- •12.2.2 Subretinal Stimulation
- •12.2.2.1 Target of Stimulation
- •12.2.2.2 Threshold vs. Polarity of Stimulation Pulse
- •12.2.2.3 Spatial Extent of Activation
- •12.2.2.4 Temporal Response Properties
- •12.2.2.5 Dynamics of the Retinal Response
- •12.4 Responses of RGCs to Electrical Stimulation in Degenerate Retina
- •12.4.1 Epiretinal Stimulation
- •12.4.2 Subretinal Stimulation
- •12.4.2.1 Response Properties of RGCs
- •12.4.2.2 Activation Thresholds of RGCs
- •12.5 Cortical Responses to Retinal Stimulation
- •12.5.1 Spatial Properties Revealed by Cortical Measurements
- •12.5.2 Local Field Potentials
- •12.5.3 Elicited Responses Are Focal
- •12.5.4 Cortical Measurements Reveal Electrode Interactions
- •12.5.5 Temporal Responsiveness in Cortex
- •12.6 Suggestions for Future Studies
- •References
- •13.1 Introduction
- •13.2 General Considerations for Acute Retinal Stimulation Experiments
- •13.3 Surgical Technique
- •13.4 Threshold Measurements
- •13.5 Spatial Resolution and Pattern Perception
- •13.6 Temporal Resolution
- •13.7 Subretinal Versus Epiretinal Stimulation
- •13.8 Less Invasive Stimulation Procedures
- •13.9 Conclusions and Outlook
- •References
- •14.1 Introduction
- •14.2 Overview of Chronic Retinal Implant Technologies
- •14.2.1 The Retinal Implant AG Microphotodiode Prosthesis
- •14.2.2 The Intelligent Retinal Implant System
- •14.2.3 Second Sight Medical Products, Inc. A16 System
- •14.3 Thresholds on Individual Electrodes
- •14.3.1 Single Pulse Thresholds Using the SSMP System
- •14.3.2 Pulse Train Integration and Temporal Sensitivity
- •14.4 Suprathreshold Brightness
- •14.4.1 Brightness Using the Retinal Implant AG System
- •14.4.2 Brightness Using the Intelligent Medical Implant System
- •14.4.3 Brightness Using the SSMP A16 System
- •14.5 Spatial Vision
- •14.5.1 Spatial Vision with the Retinal Implant AG System
- •14.5.2 Spatial Vision with the Intelligent Medical Implant System
- •14.5.3 Spatial Vision with the SSMP A16 System
- •14.6 Models to Guide Electrical Stimulation Protocols
- •14.7 Conclusions
- •References
- •15.1 Background
- •15.2 Cortical Surface Stimulation
- •15.3 Intracortical Microstimulation
- •15.4 Optic Nerve Stimulation
- •15.5 What Is Known and What Needs to Be Done
- •15.6 Current Research Efforts
- •15.6.1 Optic Nerve Stimulation
- •15.6.2 Cortical Surface Stimulation
- •15.6.3 Intracortical Stimulation of Visual Cortex
- •15.6.4 CORTIVIS Program
- •15.6.5 Lateral Geniculate Stimulation
- •15.7 Microelectrode Arrays and Stimulation Hardware
- •15.7.1 Miniature Cameras
- •15.7.2 Animal Models
- •15.7.3 Image Processing and Phosphene Mapping
- •15.8 Conclusion
- •References
- •16.1 Introduction
- •16.2 Simulation Techniques and Basic Parameters
- •16.2.1 Gaze Tracking and Image Stabilization
- •16.2.2 Filter Engine Parameters
- •16.2.2.1 Raster Spatial Properties
- •16.2.2.2 Dot Spatial Properties
- •16.2.2.3 Temporal Properties
- •16.2.2.4 Dynamic Background Noise
- •16.2.2.5 Input Filtering/Windowing, Image Enhancement
- •16.3 Optotype Resolution and Reading
- •16.3.1 Visual Acuity
- •16.3.2 Reading
- •16.4 Face and Object Recognition
- •16.5 Visually Guided Behavior
- •16.5.1 Hand–Eye Coordination
- •16.5.2 Wayfinding
- •16.6 Visual Tracking
- •16.7 Computational Simulations
- •16.8 Conclusion
- •References
- •17.1 Introduction
- •17.2 Situating Image Analysis
- •17.3 The Experimental Framework
- •17.4 Tracking a Low-Resolution Target
- •17.5 Discussion
- •17.6 Conclusion
- •References
- •18.1 Introduction
- •18.2 Representation of Visual Space on the Visual Cortex
- •18.3 Cortical Stimulation Studies
- •18.4 Variability in Occipital Cortex
- •18.5 Phosphene Map Estimation
- •18.6 Psychophysical Studies with the Estimated Maps
- •References
- •19.1 Importance of Mapping
- •19.3 The Computer Era: Refining the Pointing Method of Phosphene Mapping
- •19.4 Verbal Mapping
- •19.5 Mapping Studies Using Subject Drawings
- •19.6 Recent Simulation Studies Using Phosphene Mapping
- •19.6.1 Tactile Simulations at Shanghai Jiao Tong University
- •19.6.2 Simulations in Our Laboratory
- •19.7 Concluding Remarks on Phosphene Mapping Techniques
- •References
- •20.1 Introduction
- •20.2 Principles for Assessment of Prosthetic Vision
- •20.2.1 Experimental Design
- •20.2.2 The Importance of Pre-operative Testing
- •20.2.3 Post-operative Assessment
- •20.2.4.1 Potential Approaches
- •20.2.4.2 Avoidance of Bias
- •20.2.4.3 Criteria for Sound Testing
- •20.2.4.4 Forced Choice Procedures
- •20.2.4.5 Response Time
- •20.2.4.6 Task (Perceptual) Learning
- •20.2.4.7 Establishing Criteria for Meaningful Change
- •20.2.4.8 Light Level
- •20.3 Vision Assessment in Prosthesis Recipients: Overview
- •20.3.1 Visual Function Assessment: Overview
- •20.3.2 Visual Performance Assessment: Overview
- •20.3.2.1 Measured Visual Performance
- •20.3.2.2 Self-Reported Visual Performance
- •20.4 Visual Function Assessment
- •20.4.1 Candidate Measures
- •20.4.1.1 Contrast Sensitivity (Contrast Detection)
- •20.4.1.2 Contrast Discrimination
- •20.4.1.3 Motion Perception
- •20.4.1.4 Depth Perception
- •20.4.2 Tests Used in Prosthesis Trials
- •20.4.3 Tests that Have Been Designed for Use with Prostheses
- •20.4.4 Vision Tests for Very Low Vision
- •20.5 Visual Performance Assessment
- •20.5.1 Measured Performance
- •20.5.2 Self-Reported Performance (Questionnaires)
- •20.6 Summary
- •References
- •21.1 Concepts of Functional Vision and Rehabilitation
- •21.1.1 Application to Orientation and Mobility
- •21.1.2 Application for Activities of Daily Living
- •21.1.3 Patient Lifestyle and Expectations
- •21.1.4 Congenital and Adventitious Vision Loss
- •21.2 Evaluation and Intervention with Prosthetic Vision
- •21.2.1 Evaluation
- •21.2.2 Intervention
- •21.3 Measuring Functional Outcomes
- •21.4 The Future
- •References
- •Author Index
- •Subject Index
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2.7.2 Corner Perception and the Redundancy-Reducing
Hypothesis
The information transmitted by our visual system is constrained by physical limitations, such as the relatively small number of axons available in the optic nerve. To some extent, our visual system overcomes these limitations by extracting, emphasizing, and processing non-redundant visual features. In 1961, Barlow proposed that the brain recodes visual data “so that their redundancy is reduced but comparatively little information is lost.” This idea is known as the “Redundancy-Reducing Hypothesis” [14, 15]. The redundancy-reducing hypothesis has been invoked as an explanation for why neurons at the early levels of the visual system are suited to perform “edge-detection,” or “contour-extraction.” However, redundancy reduction is not necessarily constrained to edges, but rather should theoretically apply to any feature in the visual scene [177]. Just as edges are a less redundant feature than diffuse light, Fred Attneave proposed in the 1950s that “points of maximum curvature” (i.e., discontinuities in edges, such as curves, angles and corners – any point at which straight-lines are deflected) are even less redundant than edges themselves, and thus contain more information [12]. If points of high curvature are less redundant than points of low curvature, then sharp corners should also be less redundant than shallow corners. This hypothesis is consistent with experiments showing that sharp corners are perceptually more salient and generate stronger physiological responses than shallow corners [206, 208, 210].
2.8 Effects of Fixational Eye Movements in Early Visual Physiology and Perception
2.8.1 Overview
As we read a page of text, our eyes rapidly flick from left to right in small hops, bringing each word sequentially into focus. When we look at a person’s face, our eyes similarly dart here and there, resting momentarily on one eye, the other eye, mouth and other features. But these large eye movements, called saccades (Fig. 2.19a), are just a small part of the daily workout our eye muscles get. Our eyes never stop moving: even when they are apparently fixated on something, they still jump and jiggle imperceptibly in ways that turn out to be essential for seeing. The tiny eye motions that we produce whenever we fixate our gaze are called fixational eye movements (Fig. 2.19b) [139]. If these miniature motions are halted during fixation, all stationary objects simply fade from view.
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Fig. 2.19 Fixational eye movements and visual fading. (a) An observer views a picture (left) while eye positions are monitored (right). The eyes jump, seem to fixate or rest momentarily, producing a small dot on the trace, then jump to a new region of interest. The large jumps in eye position illustrated here are called saccades. However, even during fixation, or “rest” times, eyes are never still, but continuously produce fixational eye movements: drifts, tremor, and microsaccades. From [228]. (b) Cartoon representation of fixational eye movements in humans and primates. Microsaccades (straight and fast movements), drifts (curvy slow movements) and tremor (oscillations superimposed on drifts) transport the visual image across the retinal photoreceptor mosaic. From [135]. (c) Troxler fading. In 1804 Swiss philosopher Ignaz Paul Vital Troxler discovered that deliberately fixating on something causes surrounding stationary images to fade away. To elicit this experience, stare at the central dot while paying attention to the surrounding pale ring. The ring soon vanishes, and the central dot appears set against a while background. Move your eyes, and it pops back into view. Modified from [139]. (d) This drawing illustrates the suction cup technique, used by Yarbus [228] and others. This technique was very popular in early retinal stabilization studies for its simplicity, but it is now considered old-fashioned, and other, less invasive stabilization techniques are preferred. The target image is directly attached to the eyeball by means of a contact lens assembly. The target is viewed through a powerful lens. The assembly is firmly attached to the eye by a suction device. Modified from [139]
2.8.2 Neural Adaptation and Visual Fading
That the eyes move constantly has been known for centuries. In 1860 Hermann von Helmholtz pointed out that keeping one’s eyes motionless was a difficult proposition and suggested that “wandering of the gaze” prevented the retina from becoming tired.
Animal nervous systems may have evolved to detect changes in the environment, because spotting differences promotes survival. Motion in the visual field
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may indicate that a predator is approaching or that prey is escaping. Such changes prompt visual neurons to respond with neural impulses. Unchanging objects do not generally pose a threat, so animal brains – and visual systems – did not evolve to notice them. Frogs are an extreme case, as they produce no spontaneous eye movements in the absence of head movements. For a resting frog, such lack of eye movements results in the visual fading of all stationary objects. Jerome Lettvin and colleagues stated that a frog “will starve to death surrounded by food if it is not moving.” Thus a fly sitting still on the wall will be invisible to a resting frog, but once the fly is aloft, the frog will immediately detect it and capture it with its tongue.
Frogs cannot see unmoving objects because an unchanging stimulus leads to “neural adaptation.” That is, under constant stimulation, visual neurons adjust their gain as to gradually stop responding. Neural adaptation saves energy but also limits sensory perception. Human neurons also adapt to sameness. However, the human visual system does much better than a frog’s at detecting unmoving objects, because human eyes create their own motion, even during visual fixation. Fixational eye movements shift the visual scene across the retina, prodding visual neurons into action and counteracting neural adaptation. They thus prevent stationary objects from fading away.
The goal of oculomotor fixational mechanisms may not be retinal stabilization, but rather controlled image motion adjusted so as to overcome adaptation in an optimal fashion for visual processing [198].
In 1804, Troxler reported that precisely fixating the gaze on an object of interest causes stationary images in the surrounding region gradually to fade away. Thus, even a small reduction in the rate and size of fixational eye movements greatly impairs vision, even outside of the laboratory and for observers with healthy eyes and brains (Fig. 2.19c).
Eliminating all eye movements, however, can only be achieved in a laboratory. In the early 1950s, some research teams achieved this stilling effect with a tiny custom slide projector, mounted directly onto a contact lens that attached directly to the observer’s eye with a suction device (Fig. 2.19d). In this setup, a person views the projected image through this lens, which moves with the eye. Using such a retinal stabilization technique, the image shifts every time the eye shifts. Thus it remains still with respect to the eye, causing the visual neurons to adapt and the image to fade away. Nowadays, researchers create this same result by measuring eye movements with a camera pointed at the eye. They transmit the eye-position data to a projection system that moves the image with the eye, thereby stabilizing the image on the retina.
Around the same time, three different types of fixational eye movements were characterized. Microsaccades are small, involuntary saccades that are produced when the subjects attempt to fixate their gaze on a visual target. They are the largest and fastest of the fixational eye movements, carrying an image across dozens to several hundreds of photoreceptors. Drifts are slow meandering motions that occur between the fast, linear microsaccades. Tremor is a tiny, very fast oscillation superimposed on drifts. Tremor is the smallest type of fixational eye movement, its motion no bigger than the size of one photoreceptor. See Martinez-Conde et al. [136, 139, 141] for some recent reviews of fixational eye movement parameters in humans, primates, and other vertebrates.
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2.8.3 Microsaccades in Visual Physiology and Perception
Starting in the late 1990s, fixational eye movement research has focused on microsaccades. Physiological experiments found that microsaccades increase the firing of neurons in the visual cortex and lateral geniculate nucleus, by moving the images of stationary stimuli in and out of neuronal receptive fields. Firing rate increases following microsaccades were clustered in bursts of spikes, whereas individual spikes tended to occur in the periods between microsaccades. Moreover, bursts of spikes were better correlated with previous microsaccades than either single spikes or instantaneous firing rate. Bursts highly correlated with previous microsaccades had large spike numbers and short inter-spike intervals [137, 138]. Because microsaccades are related to maintaining visibility and counteracting fading (see further below), bursts that indicate previous microsaccades accurately must encompass the neural code for visibility. In area V1, optimal burst sizes following microsaccades tended to be three spikes or more. These bursts may be an important clue to the neural code or “language” that our brain uses to represent the visibility of the world [137]. The neural codes by which neurons, or neuronal populations, encode and transmit visual information are not only critical to our understanding of normal visual processing, but also to the development and refinement of neural prostheses.
Microsaccades could enhance spatial summation by synchronizing the activity of nearby neurons [137]. By generating bursts of spikes, microsaccades may also enhance temporal summation of responses from neurons with neighboring RFs [137]. Moreover, microsaccades may help disambiguate latency and brightness in visual perception, allowing us to use latency in our visual discriminations [137]. Changes in contrast can be encoded as changes in the latency of neuronal responses [2, 3, 77]. Since the brain knows when a microsaccade is generated, differential latencies in visual responses could be used by the brain to indicate differences in contrast and salience.
Despite several decades of debate (see [139] for a review), a direct link between microsaccade production and visual perception has only recently been demonstrated. Martinez-Conde et al. [140] found that increased microsaccade production during fixation resulted in enhanced visibility for visual targets. Conversely, decreased microsaccade production led to periods of visual fading. These results established a potential causal relationship between microsaccades and target visibility during fixation, and corroborated predictions from previous physiological studies in which microsaccades were found to increase the spiking rates in visual neurons [137, 138]. Microsaccade production has been subsequently linked to perceptual transitions in various other visual phenomena, such as binocular rivalry [215], filling-in of artificial scotomas [207], and illusory motion (perceived speed as well as subjective direction [108, 209]).
Fewer studies have addressed the neural and perceptual consequences of drifts and tremor. However, all fixational eye movements may contribute significantly to visual perception, depending on stimulation conditions. For example, receptive fields in the periphery may be so large that only microsaccades are large and fast
