Electronically restoring vision to patients blinded by severe retinal degenerations is rapidly becoming a realizable feat through retinal implants. Upon receiving an implant, previously blind patients can now detect light, locate objects, and determine object motion direction. However, the restored visual acuity (VA) is still significantly below the legal blindness level (VA < 20/200). The goal of this research is to optimize the inner electrode geometry in photovoltaic subretinal implants in order to restore vision to a VA better than blindness level. We simulated neural stimulation by 20 μm subretinal photovoltaic implants featuring square or fractal inner electrodes by: (1) calculating the voltage generated on the inner electrode based on the amount of light entering the photodiode, (2) mapping how this voltage spreads throughout the extracellular space surrounding retinal bipolar neurons, and (3) determining if these extracellular voltages are sufficient for neural stimulation. By optimizing the fractal inner electrode geometry, we show that all neighboring neurons can be stimulated using an irradiance of 12 mW/mm, while the optimized square only stimulates ~10% of these neurons at an equivalent irradiance. The 20 μm fractal electrode can thus theoretically restore VA up to 20/80, if other limiting factors common to retinal degenerations, such as glia scarring and rewiring of retinal circuits, could be reduced. For the optimized square to stimulate all neighboring neurons, the irradiance has to be increased by almost 300%, which is very near the maximum permissible exposure safety limit. This demonstration that fractal electrodes can stimulate targeted neurons for long periods using safe irradiance levels highlights the possibility for restoring vision to a VA better than the blindness level using photodiode-based retinal implants.
PMID: 29740278 [PubMed]