Factors affecting perceptual thresholds in epiretinal prostheses.

PURPOSE: The goal was to evaluate how perceptual thresholds are related to electrode impedance, electrode size, the distance of electrodes from the retinal surface, and retinal thickness in six subjects blind as a result of retinitis pigmentosa, who received epiretinal prostheses implanted monocularly as part of a U.S. Food and Drug Administration (FDA)-approved clinical trial. METHODS: The implant consisted of an extraocular unit containing electronics for wireless data, power recovery, and generation of stimulus current, and an intraocular unit containing 16 platinum stimulating electrodes (260- or 520-microm diameter) arranged in a 4 x 4 pattern. The electrode array was held onto the retina by a small tack. Stimulation was controlled by a computer-based external system that allowed independent control over each electrode. Perceptual thresholds (the current necessary to see a percept on 79% of trials) and impedance were measured for each electrode on a biweekly basis. The distance of electrodes from the retinal surface and retinal thickness were measured by optical coherence tomography on a less regular basis. RESULTS: Stimulation thresholds for detecting phosphenes correlated with the distance of the electrodes from the retinal surface, but not with electrode size, electrode impedance, or retinal thickness. CONCLUSIONS: Maintaining close proximity between the electrode array and the retinal surface is critical in developing a successful retinal implant. With the development of chronic electrode arrays that are stable and flush on the retinal surface, it is likely that the influence of other factors such as electrode size, retinal degeneration, and subject age will become more apparent. (ClinicalTrials.gov number, NCT00279500.).

Retinal and post-retinal contributions to the quantum efficiency of the human eye revealed by electrical neuroimaging.

The retina is one of the best known quantum detectors with rods able to reliably respond to single photons. However, estimates on the number of photons eliciting conscious perception, based on signal detection theory, are systematically above these values after discounting by retinal losses. One possibility is that there is a trade-off between the limited motor resources available to living systems and the excellent reliability of the visual photoreceptors. On this view, the limits to sensory thresholds are not set by the individual reliability of the receptors within each sensory modality (as often assumed) but rather by the limited central processing and motor resources available to process the constant inflow of sensory information. To investigate this issue, we reproduced the classical experiment from Hetch aimed to determine the sensory threshold in human vision. We combined a careful physical control of the stimulus parameters with high temporal/spatial resolution recordings of EEG signals and behavioral variables over a relatively large sample of subjects (12). Contrarily to the idea that the limits to visual sensitivity are fully set by the statistical fluctuations in photon absorption on retinal photoreceptors we observed that the state of ongoing neural oscillations before any photon impinges the retina helps to determine if the responses of photoreceptors have access to central conscious processing. Our results suggest that motivational and attentional off-retinal mechanisms play a major role in reducing the QE efficiency of the human visual system when compared to the efficiency of isolated retinal photoreceptors. Yet, this mechanism might subserve adaptive behavior by enhancing the overall multisensory efficiency of the whole system composed by diverse reliable sensory modalities.

A preliminary feasibility study of different implantable pulse generators technologies for diaphragm pacing system.

Diaphragm pacing stimulation (DPS) for ventilator-dependent patients provides several advantages over conventional techniques such as phrenic nerve pacing or mechanical ventilator support. To date, the only existing system for DPS uses lead electrodes, percutaneously attached to an external pulse generator (PG). However, for a widespread use of this technique it would be more appropriate to eliminate the need for percutaneous wire and use a totally implantable system. The aim of this study was to determine if it were feasible to replace the external PG by an implantable system. We present here the results of a preliminary study of two different PG, currently used in other electrical stimulation (ES) clinical applications, which could be used as implantable DPS systems. One radio-frequency-powered PG, one rechargeable battery-powered PG, and the current external PG were tested. Each was attached to the externalized part of the wires, connected to the diaphragm and tidal volume (TV) was measured in one ventilator-dependent patient who has been using the current percutaneous stimulator for 3 years. Results indicated that both implantable PGs could achieve equivalent ventilatory requirements to the current external stimulator. No significant differences were observed between the three PG systems when stimulating the electrodes as used in the patient's own chronically attached PG system. We found that TV increased with increases in charge and frequency as expected when stimulating the patient's electrodes individually and in combination with each PG system. These results are a significant step toward developing a totally implantable DPS system for the ventilator-dependant patients. Further clinical tests to demonstrate the safety and efficacy of a fully implanted DPS system are warranted.

Electrical field interactions in different cochlear implant systems.

The goal of this study was to evaluate electrical field interactions produced by the stimulation of different types of intracochlear electrodes in 12 adult subjects (three Ineraid, four Clarion S-Series, three S-Series with the electrode positioning system-EPS and two Clarion HiFocus-I with the EPS). Psychophysical measurements were conducted with biphasic stimuli (813 pulse per second, 153.8 micros/phase). "Perturbation" signals (300 ms) were applied to one electrode chosen at the middle of the array and their effects on detection thresholds of "probe" signals (30 ms) were measured on the neighbor basal electrode. Perturbation levels were set below the detection threshold of the perturbation electrode (-2 dB re threshold). Measurements were first conducted for simultaneous stimulation of the probe and of the perturbation electrodes, for monopolar for all subjects and for bipolar stimulus configurations for both Clarion HiFocus-I subjects. The tested Clarion electrodes did not present lower monopolar interactions than the Ineraid electrodes. Nevertheless, considering the shorter distance between electrodes for the Clarion than for the Ineraid, the tested Clarion electrodes might be more selective than the Ineraid. We did not find any significant monopolar electrical field-interaction differences between subjects who received the S-Series array with and without the EPS. We did not find lower interactions for both subjects who received the HiFocus-I array than for subjects who received the S-Series. Electrical field interactions were lower for bipolar than for monopolar configurations for both HiFocus-I subjects. A second set of measurements was conducted for nonsimultaneous stimulation similar to the one used in continuous interleaved sampling sound strategy. These measurements showed that interactions evaluated for simultaneous biphasic stimuli were larger than for nonsimultaneous stimulation.