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Low vision and ultimately, profound blindness can result from impaired connectivity or dysfunctional elements in the neural pathways transferring visual information to the brain. Blindness is one of the most debilitating sensory impairments affecting tens of millions of people worldwide, with its prevalence constantly increasing as the global population ages. Immense progress in the last decade has revealed the potential of electronic devices to restore visual perception through applying artificial electrical stimulation to neurons along the pathway from the eye to the brain. Prostheses implanted in the visual cortex, optic nerve, lateral geniculate nucleus, and the retina have led to elicitation of visual perceptions and improvement in functional visual ability in individuals with severe vision disorders. Here, we review the progress in visual bionics, focusing on retinal and cortical prostheses, and discuss key challenges and next-generation technologies.

Retinal neuromodulation is an emerging therapeutic approach to restore functional vision to those suffering retinal photoreceptor degeneration. The retina encodes visual information and transmits it to the brain. Replicating this retinal code through electrical stimulation is essential to improving the performance of visual prostheses. In doing so, the first step relies on precise neural recordings from visual centers that allow studying the response of these neurons to electrical stimulation of the retina. This paper demonstrates the feasibility of a rat model to conduct highly reliable electrophysiological studies in the field of retinal neuromodulation. A disc electrode, implanted in the retrobulbar space was used to stimulate the retina of Long-Evans rats. Buzsaki multi-electro arrays were inserted in the superior colliculus (SC) to record electrical activity propagated from the retinal ganglion cells (RGCs). Activation thresholds calculated from local field potentials (visual cortex) and from neural spikes (SC) were contrasted. Both values were comparable to those in humans and in other animal models, and were slightly higher when estimated from SC recordings. However, differences were not statistically significant.

Retinal implants have proven their ability to restore visual sensation to people with degenerative retinopathy, characterized by photoreceptor cell death and the retina's inability to sense light. Retinal bionics operate by electrically stimulating the surviving neurons in the retina, thus triggering the transfer of visual sensory information to the brain. Suprachoroidal implants were first investigated in Australia in the 1950s. In this approach, the neuromodulation hardware is positioned between the sclera and the choroid, thus providing significant surgical and safety benefits for patients, with the potential to maintain residual vision combined with the artificial input from the device. Here we review the latest advances and state of the art devices for suprachoroidal prostheses, highlight future technologies and discuss challenges and perspectives towards improved rehabilitation of vision.

Retinal neuroprostheses or ‘bionic eyes’, aim to restore patterned vision to those with vision loss by electrically stimulating the remaining neurons in the degenerate retina. Despite considerable progress over the last two decades, such devices generally stimulate indiscriminately both the ‘ON’ and ‘OFF’ visual pathways in the retina, conveying highly non-physiological signals to the brain.

Researchers continue to develop visual prostheses towards safer and more efficacious systems. However limitations still exist in the number of stimulating channels that can be integrated. Therefore there is a need for spatial and time multiplexing techniques to provide improved performance of the current technology. In particular, bright and high-contrast visual scenes may require simultaneous activation of several electrodes. In this research, a 24-electrode array was suprachoroidally implanted in three normally-sighted cats. Multi-unit activity was recorded from the primary visual cortex. Four stimulation strategies were contrasted to provide activation of seven electrodes arranged hexagonally: simultaneous monopolar, sequential monopolar, sequential bipolar and hexapolar. Both monopolar configurations showed similar cortical activation maps. Hexapolar and sequential bipolar configurations activated a lower number of cortical channels. Overall, the return configuration played a more relevant role in cortical activation than time multiplexing and thus, rapid sequential stimulation may assist in reducing the number of channels required to activate large retinal areas.

PURPOSE: To investigate the efficacy of electric field shaping in modulating the extent and activation threshold in retinal neurostimulation. This study aims to quantify the interference of neighboring stimulation sites by assessing the shift in the activation threshold produced by a concomitant interfering stimulus. METHODS: Electrical stimuli were applied to healthy retinae in a feline model (n = 4) using a 24-channel electrode array surgically implanted in the suprachoroidal space. A 96-channel penetrating electrode array was used for recording cortical responses to a number of stimulation paradigms. Data were analyzed offline. Concurrent monopolar and hexapolar stimuli were delivered at primary and interfering sites separated by up to 2.19 mm to evaluate electric cross-talk. The spike rate was fit to a sigmoidal curve to estimate the P50 threshold. The slope of the linear regression of the P50 value versus interfering current level was considered as a measure of cross-talk. RESULTS: Concurrent monopolar stimulation produced a proportional drop in the P50 of approximately 20% of the interfering current level in presence of a primary monopolar and hexapolar stimulus. On the other hand, hexapolar interference did not alter activation thresholds at the primary site. CONCLUSIONS: Hexapolar stimulation reduces electric cross-talk between neighboring sites and represents a technique to reduce interference between individual stimulation sites. In contrast, concurrent monopolar stimulation produces a reduction of the activation threshold of stimuli delivered nearby. Thus, a single source of subthreshold monopolar charge injection can provide benefit in the form of significant threshold reduction simultaneously at multiple stimulation sites.

Visual prostheses are becoming a reality as a therapy to restore functional vision to the blind. New stimulation strategies and novel electrode designs are contributing to accelerate the development of such devices triggering the interest of scientists, clinicians and the blind community worldwide. In this scenario, there is a need for large animal models that are suitable for preclinical testing of retinal neuroprostheses. This study presents an electrophysiology assessment of an ovine model for single and simultaneous electrode stimulation from the suprachoroidal space, using symmetric biphasic current pulses with a monopolar return configuration. Visually and electrically evoked potentials were recorded using supradural surface electrodes, showing charge thresholds comparable to those in humans. This model represents an alternative to feline or canine models with analogous activation levels and an eye anatomy similar to that of humans.

Investigators around the world are working on retinal neurostimulation as it may restore functional vision to the blind. The image is captured by a camera and after being processed, a series of electrical stimuli are applied to the surviving ganglion cells of the retina. This visual perception is expected to have low resolution. Therefore, there is a need of new algorithms that present the information contained in a visual scene understandable to humans. This study presents a novel multi-resolution algorithm based on wavelet analysis to extract the useful features of an image. Participants in this experiment were able to configure a filter bank to complete a set of everyday tasks. This study shows that wavelet-based algorithms may facilitate improved functional performance in prosthetic vision.

Visual prosthesis is competing with biological approaches to restore vision to the blind. Understanding and developing the ability to replicate the neural code of the retina are key factors that can bring bionic vision significant advantage. Here, electrically evoked potentials were recorded in anesthetized rats from the dorsal surface of the superior colliculus. Electrical stimuli of different amplitudes were delivered at the retina and the optic nerve. An evoked potential appeared in both cases within the first 5 ms post-stimulus suggesting that this component of the response was initiated by direct activation of the retinal ganglion cells. However, in the case of retinal neurostimulation, a second evoked potential occurred $9.0 \pm 3.4$ ms after the stimulus delivery. Because this component was not present in the case of optic nerve electrostimulation, it is expected to be originated by the activation of other cells in the retinal network.