Gibran Khurshid, MD, Associate Clinical Professor, University of Florida Department of Ophthalmology, expertise in Retinitis Pigmentosa, age related Macular Degeneration, Diabetic Retinopathy and all the other medical and surgical retina conditions, talks about a new device that could help patients blinded by certain degenerative retinal diseases.
Interview conducted by Ivanhoe Broadcast News in August 2017.
For more than two decades doctors have not been able to help patients like Mr. Lopez. You knew he was suffering from degenerative eye disease, so tell me about this procedure that you were able to give him.
Dr. Khurshid: The procedure we offered Mr. Lopez and other patients, is basically implanting a retinal prosthesis or bionic eye. The way the normal vision works is there are small cells at the back of our eyes and they are called photoreceptors and they are connected to the brain through a nerve called the optic nerve. The way we see normally is light falls in the back of eye on these cells and they generate small electro chemical currents, which are transmitted to the brain via the optic nerve and back of the brain interprets these as vision and that is how we see what we see. In retinitis pigmentosa these small cells suffer degeneration and are incapable of perceiving light, and producing small electric currents; which means the brain is not getting any responses and just sitting in the dark and that is what blindness is. With this bionic eye which is called, Argus II Bionic Chip, we are able to bypass those nonfunctioning retinal cells and use this implant as an artificial layer of those cells; which can generate these small electric currents in response to light and that can be transferred to the brain and that is how they see. It is like waking the vision center of brain again.
So it is technically like a device that you put inside; it is embedded first and it responds?
Dr. Khurshid: The way the device works is there is an electrode array a retinal chip, which is implanted inside the eye on the back; it is a very complex surgery. That chip is connected with other computer modules which are implanted on the surface of the eye, just behind the muscles and you are not able to see them. Then the patient wears special glasses and the glasses have a camera and processor unit, which they usually hang as a bag around their waist. The camera captures images. Those images are transferred to the processer unit, the processer unit processes them and translates them into signals, electric signals. Those signals go to computer modules implanted behind muscles and then transmitted wirelessly to that retina chip in the eye and that is how the chip generates small electric currents which are transmitted to the brain through the optic nerve and that is how the patient perceives vision again.
Pretty unique.
Dr. Khurshid: Yes, for decades there was nothing for these patients. These are the patients that have been blind for almost 30 or 40 years of their life and just listening to this mantra nothing can be done, you have to live with it. They cope with it, but no matter how much they cope with it they are always looking for hope. Many times they come to our clinics despite knowing that there is nothing that I can offer, but they were just there to see if there is anything new came up; but now I mean it is a very powerful moment when you tell them, I might be able to help you and it is exciting for them very emotional for them and their family. Then we counsel them about what it is and how the surgery is done, the complex is the surgery higher are the risks of complication. We explain to them the integrative process of after surgery vision rehabilitation. Following implantation surgery, patients return to the clinic several times over the next few months for medical follow-up, to have their system custom programmed, and to receive training on how to use the system. Once this fitting and training is completed, the patients may begin to use the device at home. At this point, patients may elect to receive rehabilitation sessions conducted by a low-vision therapist. These sessions are intended to teach patients how to interpret and use their new visual input to develop skills in their daily lives.
How personal is it for you?
Dr. Khurshid: The effect of this bionic eye? I mean on the first mornings when you turn the device on and the patient is able to see light, sunlight through the window, see the door frame, it is very emotional for us, and it is a very humbling moment too that you have done something for the desperate patient. Being a doctor that is what our priority is, our patients and what we can do for them; so yes, it is a very powerful moment for all of us too.
You tried to feel what a patient felt like by blindfolding yourself as well tell me about that experience, you could not do it for very long, right?
Dr. Khurshid: Yes. I wanted to see what my patient experience being blind, so I blindfolded myself. I sat for five minutes on the couch, it was okay, but then I tried to get up and make a cup of tea. Of course I made a mess and luckily the water was not boiling; but that gives you a sense what a blind patient’s inner world is like and because of this device if they can see again and carry on their day to day activities it really means a lot for them and reciprocally for us.
And for Mr. Lopez he was able to see his son, who he had not seen since the child was two, and he never saw his daughter?
Dr. Khurshid: Yes and that was a very emotional and powerful moment for all of us.
That is pretty incredible.
Dr. Khurshid: Incredible, yes. We have to counsel the patients, I mean it is not that we are giving you artificial vision and you are seeing perfectly the next day. What it is in reality is that we are giving you a seventh sense and then we teach you how to use it as vision, which means it is a continuous process of rehabilitation, learning, and device calibrations and all of that kind of stuff; so it is vision but it is not the vision that me or you know. The device is not capable of helping patients to see color or detail but they would be able to make out the outlines of objects due to the contrast of light and dark around the edges. Patients see black-and-white edges and contrast points, and the brain can be trained to use this artificial data as a visual guide. The Argus II System may help you do tasks visually, rather than by touch. During the clinical trial, some subjects were able to locate lights and windows, follow lines in a crosswalk, or avoid running into things as they walked. Some subjects could sort laundry or determine where other people were located in a room. About half of the subjects were able to read very large letters (about 9 inches high viewed from 1 foot away or about 23 centimeters high viewed from 0.3 meters away). A few subjects were able to read smaller letters (about 1-2 inches high viewed from 1 foot away or about 2.5-5 centimeters high viewed from 0.3 meters away) and short words. In addition, many subjects reported enjoying seeing light and motion after being blind for many years and having a greater feeling of connection to their environment and to other people.
Results varied among clinical trial subjects. While the majority of subjects received a benefit from the Argus II System on multiple tests and exams, some subjects reported receiving no benefit.
You have to practice wearing it? They just can’t wear it and wear it for 24 hours?
Dr. Khurshid: Yes, once you turn on the device which is after a month because you have to give time to the eye to heal and everything they have to start wearing it and start getting used to it slowly and steadily, we start them with 30 minutes then increasing it to one hour, and after a period of time, I mean then they can use it as much as they like and comfortable with it.
Mr. Lopez and his family, he was the first person that you asked to get this procedure, correct?
Dr. Khurshid: Yes, the company which makes the device, they have a database of patients who call them and who are blind from retinitis pigmentosa and are inquiring about if anything can be done for them. That is when we opened the center in University of Florida and basically the patient was told that we are now able to offer him this treatment and that is how he came to us and we took care of him.
Are there any concerns or reasons why other doctors would not do a procedure like this or use the device on their patients?
Dr. Khurshid: Not many people are using this device for multiple reasons and we are lucky in the state of Florida that we have this whole system and set up. It is not just the patient comes to you and you do the surgery and you are done with it, it is a continuous process as I mentioned before and surgery itself is really complex and you have to have a dedicated team which includes, myself, my staff, then you have vision rehabilitation specialists, it is like a establishing a personalized whole network around the patient. But, sometimes it is difficult for other people in the practice and that is one of the reasons, since the surgery is highly complex, which means it can have a lot of complications. You should be in a position to deal with these complications as well and that requires state of art equipment, and all of what we have here, and that is why this is one of few centers in the country.
How long is the actual surgery?
Khurshid: Surgery takes about almost two hours. And it consists of some parts inside the eye some parts outside the eye, it is a quite complex and during each and every step during the surgery you have to make sure the components of the device are working properly because you do not want to perform an implant in eyes and find out that it is not working; so there are a series of checks during the surgery.
Is someone funding this device, like is it paid for by insurance, or does the government pay for this device?
Dr. Khurshid: This device is FDA approved for humanitarian use and since it is FDA approved the insurance companies are paying for it.
What types of blindness would be treatable and what would not?
Dr. Khurshid: At the moment the device is approved for blindness as a result of retinitis pigmentosa, which is a specific group of diseases affecting the retina. We are not able to treat many other causes of blindness yet.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Gibran Khurshid MD FSC
Shannon Hampton
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