Improving the spatial resolution of epiretinal implants by increasing stimulus pulse duration.

Retinal prosthetic implants are the only approved treatment for retinitis pigmentosa, a disease of the eye that causes blindness through gradual degeneration of photoreceptors. An array of microelectrodes triggered by input from a camera stimulates surviving retinal neurons, with each electrode acting as a pixel. Unintended stimulation of retinal ganglion cell axons causes patients to see large oblong shapes of light, rather than focal spots, making it difficult to perceive forms. To address this problem, we performed calcium imaging in isolated retinas and mapped the patterns of cells activated by different electrical stimulation protocols. We found that pulse durations two orders of magnitude longer than those typically used in existing implants stimulated inner retinal neurons while avoiding activation of ganglion cell axons, thus confining retinal responses to the site of the electrode. Multielectrode stimulation with 25-ms pulses can pattern letters on the retina corresponding to a Snellen acuity of 20/312. We validated our findings in a patient with an implanted epiretinal prosthesis by demonstrating that 25-ms pulses evoke focal spots of light.

Quantifying the impact of expanded age group campaigns for polio eradication.

A priority of the Global Polio Eradication Initiative (GPEI) 2013-2018 strategic plan is to evaluate the potential impact on polio eradication resulting from expanding one or more Supplementary Immunization Activities (SIAs) to children beyond age five-years in polio endemic countries. It has been hypothesized that such expanded age group (EAG) campaigns could accelerate polio eradication by eliminating immunity gaps in older children that may have resulted from past periods of low vaccination coverage. Using an individual-based mathematical model, we quantified the impact of EAG campaigns in terms of probability of elimination, reduction in polio transmission and age stratified immunity levels. The model was specifically calibrated to seroprevalence data from a polio-endemic region: Zaria, Nigeria. We compared the impact of EAG campaigns, which depend only on age, to more targeted interventions which focus on reaching missed populations. We found that EAG campaigns would not significantly improve prospects for polio eradication; the probability of elimination increased by 8% (from 24% at baseline to 32%) when expanding three annual SIAs to 5-14 year old children and by 18% when expanding all six annual SIAs. In contrast, expanding only two of the annual SIAs to target hard-to-reach populations at modest vaccination coverage-representing less than one tenth of additional vaccinations required for the six SIA EAG scenario-increased the probability of elimination by 55%. Implementation of EAG campaigns in polio endemic regions would not improve prospects for eradication. In endemic areas, vaccination campaigns which do not target missed populations will not benefit polio eradication efforts.

Interphase gap as a means to reduce electrical stimulation thresholds for epiretinal prostheses.

OBJECTIVE: Epiretinal prostheses are designed to restore functional vision to the blind by electrically stimulating surviving retinal neurons. These devices have classically employed symmetric biphasic current pulses in order to maintain a balance of charge. Prior electrophysiological and psychophysical studies in peripheral nerve show that adding an interphase gap (IPG) between the two phases makes stimulation more efficient than pulses with no gap. This led us to investigate the effect of IPG duration on retinal stimulation thresholds. APPROACH: We measured retinal ganglion cell (RGC) electrical thresholds in salamander retina and phosphene perceptual thresholds in epiretinal prosthesis patients during stimulation with different IPG lengths. We also built Hodgkin-Huxley-type models of RGCs to further study how IPG affects thresholds. MAIN RESULTS: In general, there was a negative exponential correlation between threshold and IPG duration. Durations greater than or equal to ~0.5 ms reduced salamander RGC thresholds by 20-25%. Psychophysical testing in five retinal prosthesis patients indicated that stimulating with IPGs can decrease perceptual thresholds by 10-15%. Results from computational models of RGCs corroborated the observed behavior. SIGNIFICANCE: Incorporating interphase gaps can reduce the power consumption of epiretinal prostheses and increase the available dynamic range of phosphene size and brightness.

A quantitative survey of the literature on poliovirus infection and immunity.

OBJECTIVE: To examine forces that drive vaccination policy to eradicate wild- and vaccine-derived poliovirus, and to focus on the efficacy of vaccines to support decision-making and further research. METHODS: We searched PubMed and Ovid databases for English-language publications, without date restrictions. We also collected references from major reviews on polio vaccine immunogenicity or protection. We conducted a meta-analysis of human immunity to polio infections using multiple non-linear regression, and built a database from a broad (but not systematic) set of polio vaccine studies (46 studies, >10000 subjects). RESULTS: The outcome was an immunological model representative of many different datasets. Parameters measured immunogenicity to both humoral and mucosal immune compartments for Salk and Sabin vaccines. The immunity model was more highly correlated with the data than a simpler per-dose efficacy model. CONCLUSIONS: The model offers new insights for immunization policy. We measured the mucosal immunogenicity of IPV to a precision that is useful in decision-making for end-game polio immunization policies.

The Argus™ II retinal prosthesis: factors affecting patient selection for implantation.

The Argus II epiretinal prosthesis has been developed to provide partial restoration of vision to subjects blinded from outer retinal degenerative disease. To date, the device has been implanted in multiple subjects with profound retinitis pigmentosa as part of a worldwide clinical feasibility study (clinicaltrials.gov ID: NCT00407602). The Argus II is intended to provide partial restoration of functional vision. Most subjects showed an improvement in tasks assessing orientation & mobility, spatial-motor localization, and ability of discerning the direction of motion of moving stimuli. Roughly one third of subjects experienced measurable improvement in visual acuity with the implant. Some subjects identified words with high accuracy, a result that has also been reported by the leading subretinal implant group. Perceptual threshold was correlated with electrode-retina distance, electrode-fovea distance, and light sensitivity, either as single variables or in bivariate linear regression. Taken together these three variables may be used to inform patient selection and develop algorithms for the fitting of higher-electrode count systems. Visual acuity for future generations of the Argus implant may not hit theoretical limitations until arrays hold an excess of several hundreds of electrodes. Nevertheless, preliminary safety and efficacy data are supportive of the development of higher-resolution systems that target macular placement from implant design and surgical perspectives.

Imaging the response of the retina to electrical stimulation with genetically encoded calcium indicators.

Epiretinal implants for the blind are designed to stimulate surviving retinal neurons, thus bypassing the diseased photoreceptor layer. Single-unit or multielectrode recordings from isolated animal retina are commonly used to inform the design of these implants. However, such electrical recordings provide limited information about the spatial patterns of retinal activation. Calcium imaging overcomes this limitation, as imaging enables high spatial resolution mapping of retinal ganglion cell (RGC) activity as well as simultaneous recording from hundreds of RGCs. Prior experiments in amphibian retina have demonstrated proof of principle, yet experiments in mammalian retina have been hindered by the inability to load calcium indicators into mature mammalian RGCs. Here, we report a method for labeling the majority of ganglion cells in adult rat retina with genetically encoded calcium indicators, specifically GCaMP3 and GCaMP5G. Intravitreal injection of an adeno-associated viral vector targets ∼85% of ganglion cells with high specificity. Because of the large fluorescence signals provided by the GCaMP sensors, we can now for the first time visualize the response of the retina to electrical stimulation in real-time. Imaging transduced retinas mounted on multielectrode arrays reveals how stimulus pulse shape can dramatically affect the spatial extent of RGC activation, which has clear implications in prosthetic applications. Our method can be easily adapted to work with other fluorescent indicator proteins in both wild-type and transgenic mammals.

Detection of malarial byproduct hemozoin utilizing its unique scattering properties.

The scattering characteristics of the malaria byproduct hemozoin, including its scattering distribution and depolarization, are modeled using Discrete Dipole Approximation (DDA) and compared to those of healthy red blood cells. Scattering (or dark-field) spectroscopy and imaging are used to identify hemozoin in fresh rodent blood samples. A new detection method is proposed and demonstrated using dark-field in conjunction with cross-polarization imaging and spectroscopy. SNRs greater than 50:1 are achieved for hemozoin in fresh blood without the addition of stains or reagents. The potential of such a detection system is discussed.

Resolution of the epiretinal prosthesis is not limited by electrode size.

Epiretinal prostheses for the blind bypass diseased photosensitive cells in the retina, directly stimulating retinal neurons electrically and evoking signals that are relayed to the brain. Current clinical implants have few electrodes and provide limited visual acuity. Acuity may be improved by identifying electrode array design features and operational details that enhance or interfere with visual percept formation. We labeled all retinal ganglion cells in whole mount retina with a calcium reporter and then measured the number and pattern of cells responding, over a range of electrode diameters and stimulus durations. Span of the response scaled with electrode diameter for electrodes 60 µm and larger. Short stimulation pulse widths selectively activated cells nearest the electrode. Our measurements in the salamander retina suggest that the spatial resolution is 150 µm, which on a human retina is equivalent to 0.55(°) of human visual field and corresponding Snellen acuity of 20/660. Reading large print could be possible with such a prosthesis.

Selective labeling of retinal ganglion cells with calcium indicators by retrograde loading in vitro.

Here we present a retrograde loading technique that makes it possible for the first time to rapidly load a calcium indicator in the majority of retinal ganglion cells (RGCs) in salamander retina, and then to observe physiological activity of these dye-loaded cells. Dextran-conjugated calcium indicator, dissolved in water, was applied to the optic nerve stump. Following dye loading, the isolated retina was mounted on a microelectrode array to demonstrate that electrical activity and calcium activity were preserved, as the retina responded to electrical stimuli.

An in vitro model of a retinal prosthesis.

Epiretinal prostheses are being developed to bypass a degenerated photoreceptor layer and excite surviving ganglion and inner retinal cells. We used custom microfabricated multielectrode arrays with 200-microm-diameter stimulating electrodes and 10-microm-diameter recording electrodes to stimulate and record neural responses in isolated tiger salamander retina. Pharmacological agents were used to isolate direct excitation of ganglion cells from excitation of other inner retinal cells. Strength-duration data suggest that, if amplitude will be used for the coding of brightness or gray level in retinal prostheses, shorter pulses (200 micros) will allow for a smaller region in the area of the electrode to be excited over a larger dynamic range compared with longer pulses (1 ms). Both electrophysiological results and electrostatic finite-element modeling show that electrode-electrode interactions can lead to increased thresholds for sites half way between simultaneously stimulated electrodes (29.4 +/- 6.6 nC) compared with monopolar stimulation (13.3 +/- 1.7 nC, p < 0.02). Presynaptic stimulation of the same ganglion cell with both 200- and 10-microm-diameter electrodes yielded threshold charge densities of 12 +/- 6 and 7.66 +/- 1.30 nC/cm2, respectively, while the required charge was 12.5 +/- 6.2 and 19 +/- 3.3 nC.

The dependence of spectral impedance on disc microelectrode radius.

As microelectrodes gain widespread use for electrochemical sensing, biopotential recording, and neural stimulation, it becomes important to understand the dependence of electrochemical impedance on microelectrode size. It has been shown mathematically that a disc electrode, coplanar in an insulating substrate and exposed to a conducting media, exhibits an inhomogeneous current distribution when a potential step is applied. This distribution is known as the primary distribution, and its derivation also yielded an analytic solution for electrical resistance of the conducting media (R(s)), between the disc surface and a distant ground, which is inversely proportional to disk radius [R(s) = 1/(4kappar), where kappa is media conductivity and r is disk radius]. The dependence of spectral impedance on microelectrode radius, however, has not been explored. We verify the analytical solution for resistance using high-frequency (100 kHz) electrochemical impedance data from microelectrodes of varying radius (11-325 microm). For all disc radii, as we approach a lower frequency (--> 10 Hz), we observe a transition from radial to area dependence (e.g., 1/r --> 1/r2). We hypothesize that this transition is driven by the fact that the derivation of the primary distribution ignores concentration gradients, but that these gradients cannot be ignored at lower frequencies.

Dynamic current density of the disk electrode double-layer.

With applied potential, the current distribution at the surface of a disk electrode is spatially nonuniform and time dependent. This distribution is important to control in applications that desire a uniform current density profile or minimal corrosion. We examine the current density profile of a capacitive disk electrode subjected to a voltage-step using finite element analysis software to solve the system of partial differential equations. In detailed analyses we show quantitatively that the current density shifts from peripheral enhancement to near-uniformity following 1/2 of the lumped element time constant. As charging continues, the current density is slightly enhanced in the central region. We present curves for the evolution of local "time constants" as time progresses and calculate their effective values. The model is intended to be the basis of future work to control the corrosion profile of biologically implantable electrodes of arbitrary shape. Data suggest a means to control corrosion by retarding the edges of a stimulus pulse. Additionally, smaller electrodes may be more effective in fully utilizing surface area for charge transfer due to their shorter time constants.