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7.27.2015

Blind for 16 Years, Patient Finally Sees Light

After 16 years of blindness, Carmen Torres can finally see the light thanks to an innovative “bionic eye” system implanted by a surgical team at Bascom Palmer Eye Institute. The procedure – the first of its kind in Florida – took place at Bascom Palmer, part of UHealth – the University of Miami Health System, and the No. 1 eye hospital in the nation for 12 consecutive years as ranked by U.S. News & World Report. “I am very happy with the results of this new procedure,” says Torres, who is now able to locate doors and windows, see sidewalks and buildings, and watch the stars outside her Tampa home at night. “I can watch my grandson roll a ball across the carpet in my living room, catch it, and roll it back to him. I also love the way my eyes look – there is no difference from before I had the surgery.”

Torres became the first patient in Florida to receive the Argus II Retinal Prosthesis System last November. In patients like Torres with severe retinitis pigmentosa (RP), this system delivers electrical stimulation to the retina in order to restore visual perception. Currently, the Argus II system is only approved for “compassionate use” for patients with severe vision loss due to advanced RP, specifically with bare light perception or no light perception vision only. Argus II, which is made by Second Sight Medical Products Inc., a California medical device manufacturer, also holds hope for patients with other retinal degenerations such as age-related macular degeneration, and has recently entered a clinical study phase for this condition in the United Kingdom. About 100 patients worldwide have received the bionic eye so far.

Only institutions such as Bascom Palmer Eye Institute have the resources and ability to help patients with very difficult visual problems like Carmen,” said Eduardo C. Alfonso, M.D., Bascom Palmer’s chairman and holder of the Kathleen & Stanley J. Glaser Chair in Ophthalmology. “Bascom Palmer care is defined by providing this type of precision breakthrough procedure to each of our patients. No individual specialist could do a procedure of this magnitude or provide this type of precision medicine without an enormous amount of support from others.” Alfonso estimates that more than 30 professionals at Bascom Palmer including physicians, scientists, researchers, nurses, and technicians participated in some aspect of the bionic eye project.

Growing up in Puerto Rico, Torres did not think about her vision until she was diagnosed with RP at the age of 18. “I continued with my life, driving a car, going to college and raising my family,” she says. But she began losing her vision and became blind at age 45. “I had one daughter in college, another in high school and a son in kindergarten. Then, one day, I couldn’t see myself in the mirror.

Having moved from Puerto Rico to Wisconsin to Tampa, Torres talked with her ophthalmologists who told her there was no cure for RP. But she refused to give up hope. She began researching the possibility of getting an artificial eye. “When I heard that the Argus II system had been approved in the U.S. I jumped up and cheered!”

First, Torres’ local ophthalmologist tested her eye to see if it would be feasible to handle the new electrical input from the bionic eye. After getting the okay, Torres reached out to Bascom Palmer’s Byron L. Lam, M.D., professor of ophthalmology and the Robert Z. & Nancy J. Greene Chair in Ophthalmology. “Dr. Lam conducted extensive testing and then told me I was the perfect candidate for the implant,” she said.

After learning more about the surgery and recovery, Torres gave a “thumbs up” for the procedure. “I completely trust my excellent team of doctors at Bascom Palmer and told them I was ready to move forward,” she said.

Bascom Palmer’s retina surgeons, Janet L. Davis, M.D., professor of ophthalmology and Leach Chair in Ophthalmology and Ninel Z. Gregori, M.D., associate professor of clinical ophthalmology and chief of the Ophthalmology Section at the Miami Veterans Affairs Medical Center, led the surgical team during the five-hour surgery. “Carmen was the ideal patient for this surgery,” said Gregori. “She had realistic expectations and hoped to see shapes and objects and gain better mobility. She was extremely motivated to work with the device and undergo a long and continuous rehabilitation.”
The Argus II system includes several components, including hardware worn by the patient and a prosthesis surgically implanted around and inside the eye. A tiny photosensitive array of electrodes is implanted on the retina. After recovering from the surgery, the patient begins wearing special glasses with a miniature video camera that captures a visual scene.

The signals from that camera are sent to a small computer called a video-processing unit (VPU) that can be attached to a belt or carried in a pocket or purse. The reprocessed signal is then sent back to the glasses and transmitted wirelessly to an antenna in the retinal implant. That causes the implant to emit small pulses of electricity that bypass the damaged photoreceptors in the eye and stimulate the retina’s remaining cells, which transmit the visual information along the optic nerve to the brain, creating the perception of patterns of light.

“Following the surgery, patients must learn to interpret visual patterns of light with their retinal implant – it is almost like learning a new language,” said Davis. The patient has to be an active participant in the process and Carmen has been an ideal patient from the very first day.” Within a few days after the surgery, Torres began her visual training. Jean-Marie Parel, Ing, ETS-G, Ph.D., the Henri & Flore Lesieur Chair in Ophthalmology, along with biomedical engineers Mariela Aguilar and Alex Gonzalez of Bascom Palmer’s Ophthalmic Biophysics Center, were responsible for Carmen’s post-ARGUS II implantation “fitting” process following special training from Second Sight. Carmen also received extensive occupational and low vision therapy from the Miami Lighthouse.

Five months after her surgery, Torres received a software upgrade from Second Sight for her prosthetic system. “I was able to see my hand, leg, coins on a table and light from our fireplace,” she said. “I could also clean the table with a white napkin and see contrasting patterns, such as stripes or lines. I can’t make out faces, because there is little difference between the dark and light areas.”
Over the past eight months since the surgery, Bascom Palmer’s biophysics team developed several digital techniques to assess her vision and created special software for her to test and provide feedback. With this personalized instruction, Bascom Palmer’s scientists were able to improve their understanding of what Carmen really sees. Because Carmen is able to accurately describe what she is seeing, she has also traveled to California to meet with Second Sight trainers and technicians to advise them on improvements of the device for her and other patients.

Reflecting on her experience, Torres says the bionic eye is not for everyone. “You have to retrain your eye to interpret the signals, and that takes long hours and many days. I think getting this implant is a personal decision for everyone. For me, it’s been a great improvement in my life and I’m very grateful to Bascom Palmer for making it happen.”

How the Argus II Retinal Prosthesis System Works
The Argus II Retinal Prosthesis System provides electrical stimulation of the retina to induce visual perception in blind patients with severe to profound retinitis pigmentosa. A miniature video camera housed in the patient’s glasses captures a scene. The video is sent to a small patient-worn computerized video processing unit where it is processed and transformed into instructions that are sent back to the glasses via a cable. These instructions are transmitted wirelessly to an antenna in the retinal implant. The signals are then sent to the electrode array, which emits small pulses of electricity. These pulses bypass the damaged photoreceptors and stimulate the retina’s remaining cells, which transmit the visual information along the optic nerve to the brain, creating the perception of patterns of light. Patients learn to interpret these visual patterns with their retinal implant.

About Retinitis Pigmentosa
Retinitis pigmentosa (RP) is a group of genetic diseases that cause progressive degeneration of the retina in both eyes. The signs of the disease usually present in youth or young adulthood, but can occur at any age. The symptoms of RP vary and can include night blindness in early stages of the disease. During later stages, patients experience a progressive loss of peripheral vision that leads to blindness. Researchers at Bascom Palmer’s Retinal Degeneration Center are studying the genetic causes and possible treatment options for RP, but unfortunately, there is currently no cure for this blinding disease. However, many patients with progressive RP may continue to perform daily tasks with the help of telescopic lenses, magnifying lenses, field enhancers, and other low vision aids. There 100,000 people in the United States are affected by RP.

About Bascom Palmer Eye Institute
In addition to its international reputation as one of the premier providers of eye care in the world, Bascom Palmer is the largest ophthalmic care, research and educational facility in the southeastern United States. More than 250,000 patients are treated each year with nearly every ophthalmic condition and more than 18,000 surgeries are performed annually. With four patient care facilities in Florida, (Miami, Palm Beach Gardens, Naples and Plantation), the Institute serves as the Department of Ophthalmology for the University of Miami Miller School of Medicine, part of UHealth-University of Miami Health System. Bascom Palmer faculty members also staff the Miami and West Palm Beach Veterans Administration Hospital, Jackson Memorial Hospital and Miami Children’s Hospital.

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