- •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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P.R. Troyk |
and this high charge capacity is obtained from a reversible Ir 3+/Ir 4+ valence transition that takes place within the film [8, 35] as depicted in Fig. 11.2. By restricting the redox reactions within the film, and utilizing a known high-charge capacity reaction, an increase in the injectable charge capacity and significantly improved safety and consistency of neural stimulation can be obtained. For cathodal-first stimulation pulses, the ability of AIROF to inject charge can be further be increased by applying a positive bias of 0.4–0.8 V (vs. Ag|AgCl) prior to the stimulation pulse [6]. The bias acts to convert the AIROF from a mixed Ir 3+/Ir 4+ valence state to the Ir 4+ valence state, not only making the film significantly more electronically conductive, but also richer in the Ir 4+ needed for reduction during the cathodal phase. In some cases, the use of bias allows for as much as a factor of three increase in charge capacity [16].
It is not surprising that iridium oxide films have emerged as the preferred coatings for intracortical, and other neural prosthesis, electrodes. AIROF has been shown, in vitro, to allow for about 10–20 times the maximum injectable charge, when compared to bare Pt, achieving a charge density limit of up to 3.5 mC/cm2 for anodally-biased cathodal-first pulses [6]. However, the use of AIROF, rather than bare metal, is fraught with some additional peril. AIROF is susceptible to damage if the electrode polarization moves outside of the water window. Initiating water decomposition reactions can cause the AIROF to delaminate from the underlying metal surface, thus rendering the electrode non-usable for continued charge injection. While it is generally regarded that it is not viable, for any electrode, to inject charge outside of the water window, there is often uncertainty about the voltage and current conditions for which the electrode polarization exceeds the water window limits. If using a Pt electrode, a momentary transgression of the water window limits may cause highly undesirable reactions and residual by-products that enter the tissue. Yet the surface of the electrode may remain relatively unharmed. For the AIROF electrode, the films acts as a buffer zone that protects the tissue, and therefore reactions outside of the water window can potentially damage the AIROF in an irreversible manner.
11.5 Characterization of Intracortical Electrodes
11.5.1 Cyclic Voltammetry
Since the faradaic reactions used for electrode/tissue charge transfer are initiated by polarization of the electrode-electrolyte interface, it is useful to use an analytical method for examining how this interface behaves within, and outside of, the water window. Cyclic voltammetry (CV) is a commonly-utilized method for accessing the nature and behavior of stimulating electrodes. As derived from standard electrochemical methods, CV uses three-electrodes within an electrolyte. The potential of the intracortical electrode, with respect to a reference electrode, is periodically swept between two predetermined potential limits, usually at the water window
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boundaries, while measuring the current that flows between the intracortical electrode and a larger counter electrode. The potential sweep shifts the electrode-electroyte interface through the full range of reversible redox reactions while the measured current provides an indication of the capacity and rate of these reactions. Integration of the CV current waveform is often used to calculate a total charge storage capacity (CSC), for both anodic-(CSCA) or cathodic-(CSCC) first stimulation. Typically, CV electrode measurements are made at sweep rates that are much slower than the voltage changes which the electrode-electrolyte interface experiences during a typical stimulation pulse, with CV sweeps typically on the order of 50 mV/s. Since the charge injection redox reactions are rate dependent, it is important to understand that CSC values are always larger than maximum charge injection values for any given electrode. Typically, less than 20% of the CSC can be utilized during a stimulus pulse. In this regard, review of the literature can often become confusing when comparing reported values of CSC to reported values of charge injected in vitro and in vivo. In other words, only a fraction of the CSC can be accessed during a short duration stimulus pulse. The CV measurement is highly sensitive to the condition of the electrode-electrolyte interface, the morphology the electrode coating, the electrode surface roughness, the geometric shape of the electrode tip, and the nature of the electrolyte. For any electrode metal, or coating, the shape of the CV can vary dramatically, depending upon how the electrode is fabricated and in what electrolyte the measurement is performed, even though the nature of the redox reactions themselves remains the same.
11.5.2 Electrode Stimulation Voltage Waveforms
Stimulation of cortical neural tissue is most commonly accomplished by driving the electrode with a two-phase waveform that consists of a first neural-stimulation phase and a second charge-recovery phase. Typically, each of these phases are generated by constant-current electronic circuits producing rectangular pulses. Often the first phase consists of a cathodal (negative) constant current pulse, followed by a second phase anodal (positive) constant current pulse as depicted in Fig. 11.3. In Fig. 11.3, a highly simplified model for an intracortical electrode is presented consisting of a series resistive-capacitive network. While simplistic, this model does allow for a first-order understanding of the relationship between the electrodeelectrolyte interface and the voltage/current waveforms. The resistive component is commonly called: the access resistance, and the capacitive component is commonly called: the electrode pseudocapacitance. These are, of course, merely lumpedmodel approximations for the electrical and electrochemical processes that take place during a stimulation pulse.
Referring to Fig. 11.3, during the first cathodal phase, constant current is forced through the electrode for the purpose of activating near-by cortical neurons. At the leading edge of the current pulse, an immediate voltage drop across
218
Fig. 11.3 Depiction of a model for a stimulator passing balanced biphasic current from a microelectrode to a counter electrode. The components of the electrode voltage excursion waveform are identified and related to the electrode model R and C
P.R. Troyk
Counter Electrode
Access Resistance Drop
voltage
Electrode Polarization
Want < |0.6 |
microelectrode 

current
Stimulator
the electrode-electrolyte interface is observed. For this simplified model, this leading-edge drop is caused by the IR drop on the access resistance. In accordance with circuit theory, the voltage on the capacitor remains unchanged at the current pulse leading edge. As current is forced through the electrode, the capacitance, C, charges in a time-linear manner, deriving from I = C(dv/dt). In the model of Fig. 11.3, the charging of this capacitor (dv) represents the electrode polarization, and the redox reactions should remain within the water window provided that dv < 0.6 V.
At the end of the first phase, the current changes from cathodal to anodal as the second charge-recovery phase is initiated. For the lumped model, the magnitude of the first-phase trailing edge step of the voltage waveform is twice that of the firstphase leading edge because the summation of the turning off of the cathodal current and the turning on of the anodal current produce a current step of twice that of the leading edge. This voltage step is the drop across the access resistance, R. During the second phase, anodal current is forced through the electrode in an attempt to restore the electrode to the pre-stimulus condition. In the simple model of Fig. 11.3, use of equal (but opposite) first and second phase currents, with equal pulse durations, produces equal first and second phase charges, thus exactly returning the electrode to the pre-stimulus voltage level in anticipation of the next stimulus pulse. During the interval between biphasic stimulation pulses, some method of electrode voltage control is typically employed to assure that the electrode potential remains stable, at a pre-determined level, so that for repeated stimulation pulses the electrode can stimulate neurons in a consistent manner.
In practice, the simplistic model of Fig. 11.3 fails to account for important aspects of the electrode’s charge injection process. These include: (1) Multiple contributions to the access resistance drop that are inconsistent with an ideal resistor model, (2) Non-linear behavior of the electrode polarization that is inconsistent with an ideal capacitor model, and (3) Imbalances in the stimulator phase charges.
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11.5.3 Non-ideal Access Resistance Behavior
Historically, the leading edge voltage drop was attributed to the electrolyte resistance caused by limitations in ionic conductivity of the electrolyte. Thus it was common practice to subtract the entire leading edge drop from the total electrode voltage excursion, during the first phase, as a means of determining the electrode polarization. However, the leading edge drop can include other effects besides simple electrolyte resistance, specifically, concentration polarization near the electrode-electrolyte interface. Concentration polarization is essentially caused by a depletion in electrolyte charge carriers (counter ions) at the onset of the current pulse. For coated metal electrodes, such as AIROF, near instantaneous changes in film conductivity at the leading edge of the current can be a secondary contribution to the access voltage drop.
11.5.4 Non-linear Electrode Polarization
Based upon the earlier discussion, it is obvious that the dynamics of charge injection via redox reactions cannot be directly compared to the charging and discharging of an ideal capacitor. Owing to the complex geometric shape of the electrode tip, and the highly non-uniform current densities, as well as the range of possible of redox reactions that might be experienced, the behavior of the electrode-electrolyte interface might be better explained by a set of distributed RC networks, however even this remains an oversimplification. Rather, the behavior of the electrode during what is often called the electrode polarization phase, or the capacitive charging phase, is driven by the rates of one or more reactions, the changes in interfacial and film conductivity, and the closeness of the electrode voltage to the edge of the water window. Strictly speaking, the electrode polarization is comprised of the reaction activation overpotential and a shift in the electrode equilibrium potential. However, these components cannot be easily derived from the stimulus voltage excursion waveform.
11.5.5 Determining Electrode Safety
The uncertainties in determining the components, and magnitude, of the leading-edge access voltage drop make the estimation and prediction of electrode polarization, during any given stimulus pulse, difficult. Often the leading edge drop is by far the largest component of the total voltage excursion experienced by an electrode during a stimulation pulse. Simply subtracting the measured access voltage from the total voltage excursion is most often inadequate for estimating whether the electrode polarization is within the water window. It is unclear how much of the leading edge access voltage drop is truly caused by a benign resistive drop, and how much is caused by an interfacial process that might contribute to undesirable redox reactions.
