At CERA, a new bionic eye prototype has given four blind patients a ‘sense of vision’ – the ability to detect edges, shapes and movement to aid them in navigating the everyday world.

Associate Professor Penny Allen, leader of the Bionic Eye Project at CERA, discusses this remarkable work in conversation with CERA Deputy Director, Associate Professor Peter van Wijngaarden.

This is an edited transcript from CERA’s Looking to the Future Forum, held on 10 October 2019.

A/Prof van Wijngaarden: To start with –what is a bionic eye, and what research has your team been doing?

A/Prof Allen:  A bionic eye is a device that can use electrical or light energy to stimulate visual impulses in patents who are otherwise severely visually impaired. We’ve been working on a device that we place within the eye, for patients with a disease called retinitis pigmentosa, which is really an umbrella term for many inherited retinal diseases.

However, some groups are working towards a cortical device – a device to implant in the brain. This would potentially provide visual impulses using low level electrical energy in patients who have either lost their eye to trauma or have had loss of the residual neurons or neural tissue within the eye or brain.

A/Prof van Wijngaarden: How many patients have had the device?

A/Prof Allen:  We had three patients in our proof-of-concept prototype trial, which ran from 2012 to 2014. In our current trial we have four patients, using our generation two device which they are able to use at home.

The plan for this second trial is to try to determine whether the device becomes more useful to the patients if they use it more frequently, for example at home and in situations outside the lab.

A/Prof van Wijngaarden: Are these patients who have previously been able to see anything at all?

A/Prof Allen:  Yes, they are patients who have had vision, but they have inherited retinal disease – rod cone dystrophy or retinitis pigmentosa. So they have progressively lost vision, usually starting from their late teens to early twenties. Some of these patients use a guide dog and some use a cane, but none of them have been able to navigate independently for at least 15 years.

The idea of the device is to provide what we call a ‘sense of vision’. It’s not detailed vision – it’s little flashes of light that can help the patients detect edges, outlines and movement, which will hopefully aid them in navigation and object identification. You have to think of it as an aid to a cane or a dog, or any other visual aid you may be using.

A/Prof van Wijngaarden: The trial is currently underway, but can you give us a sneak insight into what the experience has been like for these patients, and particularly what sort of functional impact it’s had on their lives?

A/Prof Allen:  I can give you some basic results. First, we’re very happy with the surgical approach – it’s been very safe and we’ve had no surgical complications, and the patients’ implanted eye is maintaining good health.

Each one of the patients has different aims to try to achieve with the device, usually around achieving greater independence of mobility. One patient has wanted to navigate independently to the local supermarket and be able to do some shopping. With training and use of the device, the idea is for him to be able to identify markers along the route that can help him navigate independently.

One of our patients commented recently that she was at a shopping centre with her daughter, which they had been going to for many years, and she asked, “Is there a mezzanine floor up there?” Her daughter said, “Yes, it’s always been there.” And she had never known that, but now she could see some movement up there.

A/Prof van Wijngaarden: You can imagine that would be profound for those patients who essentially haven’t had vision for so long.

A/Prof Allen:  They’re fantastic patients. It takes persistence. When you haven’t had visual information from your eyes for years, it takes quite a leap of faith to trust this information that is being presented. All of our patients work really hard at learning to interpret these flashes of light and we’re really pleased that they’re getting results that they feel are helpful.

A/Prof van Wijngaarden: I think that’s a really important point – in clinical research we can do nothing without our patients. These are remarkable people who have really taken a leap of faith.

A/Prof Allen:  Absolutely. When we did our prototype trial, the first patient said, “Have you done this surgery on anyone else?” And I said, “No, only cadavers in the anatomy school.” And she was prepared to take that leap, to trust the fact that we had worked up the surgery very rigorously and to be the first patent.

A/Prof van Wijngaarden: This is already very futuristic technology, but where do you see this going? How high-resolution vision could patients in the future expect?

A/Prof Allen:  I think at the moment a lot of the steps forward are going to be in software innovation. We work with a really innovative software engineer, Nick Barnes, who is based in Canberra. A lot of it is about how the software is able to manipulate the image being presented to the patients through the electrical stimulations, and we’re already trialling new algorithms and new ways of presenting that information.

A/Prof van Wijngaarden: This project has clearly been a massive undertaking, and it probably began as quite an audacious idea. How did it get started?

A/Prof Allen:  It really started when Hugh Taylor asked Mark McCombe and myself to collaborate with some engineers at the University of New South Wales. Then the Australia 2020 Summit happened, and the bionic eye was identified as a goal for the Australian community. So funding was put aside and a collaborative team of the Bionics Institute, CERA, the University of New South Wales, the University of Melbourne and NICTA all got together.

It’s essentially the teams from CERA and BI who developed this current device. We just could not have done it without our collaborators at the Bionics Institute, and we continue to collaborate closely.

A/Prof van Wijngaarden: I think that’s emblematic of modern science – now more and more we’re collaborating across disciplines and across boundaries, really bringing in expertise from a wide variety of sources with a very clear objective on improving outcomes for patients.

Have you had any surprises along the way – things you never expected you might achieve?

A/Prof Allen:  I think when the first patient’s device was switched on, that’s when I was really nervous. I remember that day while I was driving into work and I was stopped at a red light, I kept thinking about a conference a year before, when I’d spoken to a German retinal prosthesis surgeon. We were having a glass of wine at the bar and he said to me, “You know your approach will never work.” And I just thought, “Why would we do it if we didn’t think it would work?”

But that morning as I was driving into work and waiting at the red light, I kept thinking about that moment.

A/Prof van Wijngaarden: I think he owes you a drink now, Penny.

A/Prof Allen:  Yeah, he does!

A/Prof van Wijngaarden: It really is a remarkably exciting project. It’s a world-leading innovation and it’s something we’re all very proud of.  Penny is very modest about her leadership – but we would not be where we are without her. So we all celebrate your achievements, Penny.

A/Prof Allen:  Thank you very much, Peter.