light at the end of the tunnel for blind

[dragon]

Well slowly but surely we are getting to the point of fixing blindness. Now all we need are the bionic eyes they have in Shadowrun.

A blind woman fitted with a “bionic eye” has spoken of her joy after she was able to tell the time for the first time in more than six years.

Rhian Lewis, 49, was given the retinal implant as part of an ongoing trial at Oxford’s John Radcliffe hospital. Surgeons at the Oxford Eye hospital implanted a tiny electronic chip at the back of her right eye’s retina in an attempt to help her see.

The mother of two, from Cardiff, has suffered from retinitis pigmentosa – an inherited disorder – since she was five. The condition causes gradual deterioration of photoreceptors, the light-detecting cells in the retina, which can lead to blindness. One in 3-4,000 people in the UK have the disease, for which there is currently no cure.

Lewis is completely blind in her right eye and has virtually no vision in her left eye. The implant, made by a German firm, Retina Implant AG, was placed in Lewis’s eye in June in an operation that can last six to eight hours.

During follow-up tests, Lewis was asked to look at a large cardboard clock to see whether she could tell the time. She had not been able to tell the time with her right eye in 16 years or with her left eye for about six years.

She said “Oh my god” when she realised she had managed to recognise it was three o’clock. She added: “Honest to god, that felt like Christmas Day.”


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Rhian Lewis reading a clock face after the retinal implant was installed at John Radcliffe hospital, Oxford. Photograph: BBC/PA
The implant – a 3mm sq array of around 1,500 light sensors which sends pulsed electrical signals to nerve cells – is connected to a tiny computer that sits underneath the skin behind the ear. This is powered by a magnetic coil on the skin. From the outside, it looks like a hearing aid.

When the device is first switched on, patients see flashes of light, but over a few weeks the brain learns to convert those flashes into meaningful shapes and objects. The images can be black and white and grainy but still have the power to transform lives.

Describing the moment the device was turned on, Lewis said: “They said I might not get any sensation and then all of a sudden within seconds there was like this flashing in my eye, which has seen nothing for over 16 years, so it was like, oh my god, wow!”

Lewis was then taken to the cloisters of New College, Oxford, to see whether she could make out its features. She said: “I walked up the street, and the lady from social services said to me to point out anything I thought might or might not be there. And the first thing I thought ‘there might be something there,’ there was a car, a silver car, and I couldn’t believe it, because the signal was really strong, and that was the sun shining on the silver car.

“And I was just, well, I was just so excited, I was quite teary. The enormity of it didn’t hit me until I’d actually got home, thinking ‘Oh my god, what have I done? I’ve actually spotted something out that I haven’t been able to do.’”


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The second-generation ‘bionic eye’ implant given to Rhian Lewis. Photograph: University of Oxford/PA
Lewis is able to manipulate the implant using dials on a small wireless power supply held in her hand. This helps her adjust sensitivity, contrast and frequency.

“The problem with having no sight is that you also lose your confidence because you lose your mobility,” Lewis said. “It’s simple things like shopping, clothes shopping, you don’t know what you look like.

“It’s been maybe eight years that I’ve had any sort of idea of what my children look like. Now, when I locate something, especially like a spoon or a fork on the table, it’s pure elation. I just get so excited that I’ve got something right.”

The “bionic eye” has been tested as a treatment for retinitis pigmentosa since 2012. Lewis is the first patient outside Germany to be fitted with a newer second-generation device.

Prof Robert MacLaren, who is leading the research at Oxford, said the technology had huge potential benefits. “It’s an amazing process because what Rhian and others are trying to do is reactivate a part of the brain that hasn’t been doing anything for the last 10 years or so,” he said. “There is a lot of rehabilitation because basically they are learning to see again.”

George Freeman, the minister for life sciences, said: “This groundbreaking research to create the world’s most advanced bionic eye highlights the crucial role of the NHS as a test bed for 21st-century medicine.”

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[Broomstick]

That is "fixing" blindness in the sense than a prosthetic hand is "fixing" amputation - it's an improvement, but not a cure. The people with with these implants have, at best, low vision. Which is nothing to sneeze at, but it's nowhere near normal and of limited overall utility even if the increase of personal quality of life is increased. Worthwhile, but let's not over-sell what this actually does.

I also suspect that, like cochlear implants, this will not help everyone. It only deals with problems with the retina, not along the optic nerve or in the brain.

[Simon_Jester]

The key here is that they're replacing a specific part of the eye- the retina. A lot of useful bionic implants for the next twenty years or so are probably going to be like this; we duplicate the functions of a very particular part of the body, in a very particular way.

This isn't a full replacement for the eyeball, even aside from the fact that it only provides, as Broomstick says, "low vision."

[Starglider]

I think Dragon's point was that steady progress is being made and there is no fundamental barrier to a complete functional replacement. It will take several decades to reach equivalence with natural sight, but capability will keep improving and that's good for everyone.

[dragon]

I think Dragon's point was that steady progress is being made and there is no fundamental barrier to a complete functional replacement. It will take several decades to reach equivalence with natural sight, but capability will keep improving and that's good for everyone.

See someone gets it.

[Zeropoint]

Oh, why stop at "equivalence with natural sight"?

[biostem]

So how good could they get if they wren't concerned with making the implant fit in her real eye? It's fantastic, but I just wonder what they could accomplish if they focus on restoring full vision, rather than trying to make it less conspicuous...

Especially nowadays, I wouldn't mind some little thing mounted on an eyeglass frame, if it gave me better vision.

[Lord Revan]

Oh, why stop at "equivalence with natural sight"?

since getting there is already so bloody hard that getting past it won't provide that much more gain compared to the cost and even if the prostetic would able show at higher resulution or frequency range then a natural eye that image still has to interpted by the brain to be seen and there's limits to what the brain is capable of.

TL:DR, it's not worth it to go beyond natural sight.

[bilateralrope]

This isn't a full replacement for the eyeball, even aside from the fact that it only provides, as Broomstick says, "low vision."

But an improved version of it is likely to be a component of the replacement eyeball.

Oh, why stop at "equivalence with natural sight"?

Lets get there first.

[Jub]

since getting there is already so bloody hard that getting past it won't provide that much more gain compared to the cost and even if the prostetic would able show at higher resulution or frequency range then a natural eye that image still has to interpted by the brain to be seen and there's limits to what the brain is capable of.

TL:DR, it's not worth it to go beyond natural sight.

Once you've already made it to the level of sight you could enhance vision just by having lenses that can act as magnifying glasses, binoculars, and microscopes. They might be an add-on, but even if they work by physically switching between sets of lenses, it's a cheap way to improve things. Making them more sensitive to low light and able to dim for very bright lights would also be a great enhancement over regular vision. You could toss in something like a laser range finder with a numerical display pretty cheaply. You could also map infrared and UV light to the normal visual spectrum. You could go for manual switching between infrared and UV or, if it turns out the brain can handle it, switch between the three every fraction of a second.

These are all pretty low hanging fruit in terms of ways to make an eye better for not much extra cost.

[Broomstick]

None of which does any good if you can't get a reasonable resolution quality, field of view, and compatibility with biological systems. We've got the last bit to a reasonable degree, but the first two still need a gargantuan amount of work.

This is what annoys me - we don't have anything near normal vision and the technophiliacs are already getting their rocks off on wild fantasies. Until we have something that allows sufficient vision to, say, safely drive a car none of the rest of it is important. And we're a long ways off even from that modest goal.

So how good could they get if they wren't concerned with making the implant fit in her real eye? It's fantastic, but I just wonder what they could accomplish if they focus on restoring full vision, rather than trying to make it less conspicuous...

It's not about making it inconspicuous, it's about anatomy - the implant needs to contact the retina directly, that means it has to be in the eyeball itself. There have been experiments utilizing external cameras, but so far this method give the best success.

It's like cochlear implants - they don't put the mechanism into the inner ear to be inconspicuous, they put it there because that's how it works. Meanwhile, there are obvious external bits and I'd guess the same may be true for this visual implant, there's even some mention of that in the article.

[Guardsman Bass]

I also suspect that, like cochlear implants, this will not help everyone. It only deals with problems with the retina, not along the optic nerve or in the brain.

Getting the vision equivalent of a cochlear implant would be a massive improvement. It wouldn't cure all forms of blindness (you'd still have some issues with, as you said, people whose blindness was caused by brain issues or optic nerve damage), but it would vastly ameliorate impaired vision for just about any eye condition involving problems with the eyeballs themselves.

Of course, if we really wanted to reduce impaired vision, bionic eyes are only the third-best way to do it. You could fix nearly three-quarters of worldwide cases of visual impairment through universal access to means of ameliorating refractive errors in eyes (i.e. glasses, surgery, etc) and cataract surgery.

[Jub]

None of which does any good if you can't get a reasonable resolution quality, field of view, and compatibility with biological systems. We've got the last bit to a reasonable degree, but the first two still need a gargantuan amount of work.

This is what annoys me - we don't have anything near normal vision and the technophiliacs are already getting their rocks off on wild fantasies. Until we have something that allows sufficient vision to, say, safely drive a car none of the rest of it is important. And we're a long ways off even from that modest goal.

I did say once we get to that level, and my post was a reply to Lord Revan.

More generally, I'm just happy to any advancement at all. It helps restore some function to the blind, but also progress the field of mind-machine interface. Both of which are things that can and should be used to improve lives.

I'm also unsure that we are a long way off, generation 2 of these implants has advanced by leaps and bounds from the earliest prototypes in a relatively short span of years. Assuming we don't hit any major roadblocks, I think we could see decent resolution colour vision in as little as a decade.

[Starglider]

Until we have something that allows sufficient vision to, say, safely drive a car none of the rest of it is important. And we're a long ways off even from that modest goal.

To be fair, driving a car is not a modest goal. It's one of the most visually challenging tasks the average person does. This is in fact why all viable self-driving car concepts use laser rangefinders as the primary sensor, radar as the secondary and then maybe some conventional vision for specific tasks (e.g. road signs and a backup pedestrian detector). Trying to do it the way humans do, with just a visual spectrum camera (and no pre-mapping), would be much much harder.

[Broomstick]

We're not developing a system for an AI to drive a car, we're developing prosthetic sight for a human being who already has a bajillion years of evolution-developed software for visual processing on board.

Getting computer to interpret human speech is challenging, too, but humans with cochlear implants learn to decipher a crapload of info from what is still rather paltry data input. Why? Brain-processing. The implant doesn't have to do all the work.

The same should hold true for retina-replacements.

[Starglider]

We're not developing a system for an AI to drive a car, we're developing prosthetic sight for a human being who already has a bajillion years of evolution-developed software for visual processing on board.

My point was that driving cars is difficult enough that it uses a typical person's visual capability to near capacity (in high stress situations). There is not much room for tolerance of degraded capability, which is why we're pretty strict about barring people with partial loss of visual from driving. Most human visual tasks don't combine time pressure, multi-object tracking requirement, high optical flow, fine detail sensitivity, flicker, shape recognition with partial occlusion, poor lighting and high contrast ratios. You can't just take it a bit slower to work around perceptual limitations; driving significantly slower than everyone else is itself a major risk. I would expect being rated to drive safely (in all weather conditions) would be one of the last hurdles for prosthetic vision, not one of the early ones. Although by then the abovementioned self-driving cars are likely to make that achievement much less important.

[Broomstick]

We're not developing a system for an AI to drive a car, we're developing prosthetic sight for a human being who already has a bajillion years of evolution-developed software for visual processing on board.

My point was that driving cars is difficult enough that it uses a typical person's visual capability to near capacity (in high stress situations). There is not much room for tolerance of degraded capability, which is why we're pretty strict about barring people with partial loss of visual from driving.

Well... yes and no. I mean, at least in my country, one-eyed people are allowed to drive, the colorblind are allowed to drive, those will less that 20/20 vision (but still meeting a minimum standard) are allowed to drive, people with night-blindness are allowed to drive (although restricted to daytime)...

[Zeropoint]

Driving under normal circumstances isn't that visually challenging. I'm not legally allowed to drive without my glasses, and while I'm not admitting anything, in a PURELY HYPOTHETICAL circumstance involving me locking myself out of a friend's house with my car keys and wallet but not my glasses, I would be capable of driving to the store and back in daylight and decent weather. I wouldn't be able to read street signs, but I could still identify cars, pedestrians, and other obstacles, and locate them in three dimensions with enough accuracy for the driving task. Stop lights would be colored glowing blobs, but still easily identifiable.

Driving on a rainy night, though . . . I certainly wouldn't want to try that without my corrective lenses.

[Lord Revan]

The point that Broomstick and I (mostly Broomstick as I've only made a single post in this thread) is that getting to a point that most people achivive naturally (it's called "normal" vision for a reason) is a long way from being possible and before we get even there we shouldn't seriously think about turning the implants into techophile's wet dream.

And that's ignoring the possible limits from human physiology

To use a camera as an analogy, it doesn't matter how top quality zoom lenses and night vision equipment what not if you're using poor quality film (or sensor for a digital camera), the brain is the "film" for the eyes and before we can certain what quality "film" we're using we shouldn't think about "lenses" that are better then ones out of the box or addons that don't come as default.

[Broomstick]

Driving under normal circumstances isn't that visually challenging. I'm not legally allowed to drive without my glasses, and while I'm not admitting anything, in a PURELY HYPOTHETICAL circumstance involving me locking myself out of a friend's house with my car keys and wallet but not my glasses, I would be capable of driving to the store and back in daylight and decent weather. I wouldn't be able to read street signs, but I could still identify cars, pedestrians, and other obstacles, and locate them in three dimensions with enough accuracy for the driving task. Stop lights would be colored glowing blobs, but still easily identifiable.

Well, sure - without my glasses it would be debatable if I could even find my car, much less drive it safely. Eyeglasses are such a common prosthetic we no longer thing anything about them...but it took several hundred years to get to that point.

Happily, we make technological progress a little faster these days. And society seems much more accepting of prosthetics than even when I was a kid.

The point that Broomstick and I (mostly Broomstick as I've only made a single post in this thread) is that getting to a point that most people achivive naturally (it's called "normal" vision for a reason) is a long way from being possible and before we get even there we shouldn't seriously think about turning the implants into techophile's wet dream.

^ That.

And that's ignoring the possible limits from human physiology

Which are important - we've seen that with cochlear implants, where it's young children that get the most benefit from them due to the plasticity of the young brain and it's ability to adapt to new input. Which will result in the same moral issues we see with giving implants to kids before the age of consent vs. waiting but getting much poorer results.

[FireNexus]

Oh, why stop at "equivalence with natural sight"?

Because, from a medical standpoint, enhancing sight past normal for healthy people would be unethical. At least with our current ethical model. The risks of the procedure would likely not be 0, and you only treat problems medically when the risks are outweighed by the benefits. Since the benefits are not to improve a deficit to allow normal functioning, and the risks could be anything up to total loss of vision, no ethics board would approve it.

That's why you don't see trials for use of, say, anabolic steroids in healthy people. It would enhance muscle growth and strength, but it would do so at positive risk without any clear need.

[Lord Revan]

Oh, why stop at "equivalence with natural sight"?

Because, from a medical standpoint, enhancing sight past normal for healthy people would be unethical. At least with our current ethical model. The risks of the procedure would likely not be 0, and you only treat problems medically when the risks are outweighed by the benefits. Since the benefits are not to improve a deficit to allow normal functioning, and the risks could be anything up to total loss of vision, no ethics board would approve it.

That's why you don't see trials for use of, say, anabolic steroids in healthy people. It would enhance muscle growth and strength, but it would do so at positive risk without any clear need.

this is very much the reason I keep using glasses even though laser surgery exists, my glasses are so weak that the benefit I get from the surgery is far less then the potential downsides and risks from it.

[FireNexus]

this is very much the reason I keep using glasses even though laser surgery exists, my glasses are so weak that the benefit I get from the surgery is far less then the potential downsides and risks from it.

My glasses are strong, and I still make that calculation. My understanding of the procedure is that it creates a ring of scar tissue that can cause a halo when your pupils dilate in low light conditions. The glare from my glasses is not-insignificant, but I'm not willing to risk that.

[Jub]

this is very much the reason I keep using glasses even though laser surgery exists, my glasses are so weak that the benefit I get from the surgery is far less then the potential downsides and risks from it.

My glasses are strong, and I still make that calculation. My understanding of the procedure is that it creates a ring of scar tissue that can cause a halo when your pupils dilate in low light conditions. The glare from my glasses is not-insignificant, but I'm not willing to risk that.

I think your results depend on what exactly needs to be done. In the case of halos in low light conditions, it seems like they're very likely to be gone less than 6 months after the surgery. The risk of serious complications are less than 1% and my understanding is that those issues can usually be correct with follow-up surgery. Military studies found that a very high percentage of those who underwent the procedure thought it improved their effectiveness and an even higher percentage would recommend the prodedure.

They're not my eyes, but costs aside, the risks seem minimal and manageable.

[Broomstick]

Yes and no.

The more correction you need the more likely you are to have side effects.

You need an impartial evaluation - when I last inquired about laser surgery I was told, based on my needed correction and anatomy, I was at very high risk of side effects, I'd almost certainly have permanent halos at night, and could very well lose my night-driving privileges.

Needless to say, I opted not to have surgery.

As for re-operating... not always possible. Again, it depends on your anatomy. Some people have thin corneas to begin with and a second operation may cause more problems than it fixes for them.

All of which is why you need an actual doctor's evaluation and you should be cautious about getting it done. Yes, the vast majority of the time everything is OK and the patient is happy. You still want to maximize your chances of being happy with the results.

Military pilots are a sub-set that should not be compared with the civilian population as a whole. They will tend to be younger, healthier, and less likely to have multiple problems or need a strong correction.