The Future of Vision and Eye Care
3D printed digital contact lenses, bionic eye implants, augmented reality: the future of vision and eye care is full of science fiction-sounding innovations. Here is where digital health will take ophthalmology in the future!
More than 80 percent of perception comes through vision
Researchers estimate that 80-85 percent of our perception, learning, cognition, and activities are mediated through vision. Compared to that, our hearing only processes 11 percent of information, while smell 3.5 percent, touch 1.5 percent and taste 1 percent. Don’t you think that’s possible? Renowned scholars, L.D. Rosenblum, Harold Stolovitch and Erica Keeps explained these numbers with the following, rather convincing story.
Imagine you are in an open field, the sun shines on you, with the bees humming softly in the air. How far can you see and hear? When it comes to vision, it’s around 50 miles, talking about hearing, it’s only 1-2 miles at best! What about the smell of the flowers? Without the wind blowing, only 10-20 meters. How about touching or tasting? Well, it depends on your arm’s length, but obviously not further than that. And the same goes for your tongue and tasting.
It is almost a cliché to emphasize the importance of the eyes and vision, but it’s a luminous example to illustrate how the eyes are our most important sensory organ. Hence, if you catch an eye disease or have to face a serious eye condition, you feel very motivated to get better immediately.
Eye conditions affect way too many people worldwide
The International Agency for the Prevention of Blindness estimated in 2015 that 36 million of people are blind, and 217 million people suffer from moderate or severe distance vision impairment. It is a hopeful tendency that the prevalence of blindness and vision impairment combined has dropped from 4.58% in 1990 to 3.37% in 2015. The decrease can be attributed to progress in technology, for example in surgical techniques and concerning treating eye infections.
Yet, digital health still has a lot to do for lessening plenty of suffering which comes from not being able to see the world clearly. In the last couple of years, it actually started to undertake the task to transform the field of ophthalmology, offering its innovative solutions for the broadest spectrum of eye conditions. Treating less serious ailments gets faster, more targeted and more efficient, while the means for curing more serious and life-altering illnesses improve. Here, I outlined the way technology delineates for the future of eye care and vision.
With “bionic eyes” for reversing blindness
Disruptive technologies gave a huge boost to the creative minds of ophthalmology. Types of conditions causing blindness, such as AMD or retinitis pigmentosa, an inherited eye condition causing loss of sight gradually and causing blindness for an estimated 1.5 million people worldwide, have been treated successfully with mind-blowing innovations.
The California-based firm, Second Sight, the German company, Retina Implant AG, and French venture, Pixium Vision, develops implantable visual prosthetics to restore vision to patients who are blind as a result of the rare condition of retinitis pigmentosa. In 2016, The Guardian reported that a blind woman suffering from it was fitted with the implant labeled “bionic eye” in the UK as part of a trial at the Oxford Eye Hospital. She has spoken of her joy after she was able to tell the time for the first time in more than six years. That must have been truly amazing!
In 2015, surgeons in Manchester, UK have performed the first bionic eye implant for an AMD patient using Second Sight’s innovation. The 80-year-old Ray Flynn lost entirely his central vision, but with the help of the retinal implant, he could make out shapes on the computer screen. Researchers say that the implant cannot provide any highly detailed vision – but it can help patients detect distinct patterns such as door frames and shapes.
Brain implants and artificial retina instead of bionic eyes?
As Second Sight’s current Argus II device for helping people with retinitis pigmentosa only restore minimal vision and cost $150,000, they only sold 250 of them so far. A while ago, the company started to develop a modified version of its innovation, which completely leaves the eye out of the procedure and instead mobilizes the part of the brain responsible for processing visual information, the visual cortex. Delivering electrical pulses here should tell the brain to perceive patterns of light. The company hopes that this new innovation could help about 6 million people in the future who are blind due to other causes, like cancer, diabetic retinopathy, glaucoma, or trauma. The company hopes to begin enrolling patients for trials in October and do its first implant by the end of the year. We can’t wait to know more about it!
Instead of “bionic eyes” that stimulate brain cells with lights coming from a tiny video camera or stimulate the visual cortex directly through electrodes, the Italian Institute of Technology has developed a new approach for treating retinal degeneration, with a prosthesis implanted into the eye that serves as a working replacement for a damaged retina – basically an artificial retina. Their research showed promising results for lab rats, and they plan to carry out the first human trials in the second half of 2017 and gather preliminary results during 2018.
The miraculous CRISPR and other gene therapies for regaining vision
CRISPR-Cas9 or as used in plain language, CRISPR, the breakthrough gene editing method, has already shown its potential future use in eye care. Experts even say the eye is an ideal place to start for the first clinical use of CRISPR. Compared to other parts of the body, the eye is easy to access for surgery, readily accepts new tissue and can be noninvasively monitored.
Scientists at Columbia University Medical Center and the University of Iowa used CRISPR to repair a genetic mutation responsible for retinitis pigmentosa in induced pluripotent stem cells derived from a patient with the disease. The team reported a 13 percent success rate at converting the mutated gene variant into the normal one which is way better than previous studies. In February 2017, experts at the Center for Genome Engineering, within the Institute for Basic Science (IBS) reported the use of CRISPR in performing “gene surgery” in the layer of tissue that supports the retina of living mice. After the intervention, the mice showed signs of improvement from AMD. It is a ground-breaking experiment suggesting that CRISPR can not only be used to correct mutations causing hereditary diseases but also in the case of non-hereditary degenerative diseases.
Beyond CRISPR, other gene therapies also have a great chance to become a common treatment method for specific eye conditions in the future. Early October 2017, the FDA’s advisory panel approved a gene therapy called Luxturna, which targets a rare condition called Leber congenital amaurosis. Thus, the treatment method got one step closer to full FDA approval. The agency will make its final decision by next January. If the verdict is positive, the gene therapy will be the first approved treatment in the US to correct an inherited genetic trait – but it might be followed very soon by much more.
Eye care patients will also become the point of care
With the advancement of smartphones and other smart gadgets at lightning speed, it is only a matter of time before portable devices will appear on a large scale in ophthalmology as well. The tiny, well-designed and connected instruments and the accompanying apps make it possible to undertake eye examinations anywhere in the world – making patients the point of care.
For example, Peek Retina is the flagship product of Peek Vision, a UK-based company and foundation, a portable ophthalmoscope that enables you to view and capture retinal images on your smartphone wherever you are. The venture also offers smartphone-based vision eye tests, e.g. for measuring visual acuity. It greatly helps physicians in remote areas such as Sub-Saharan Africa diagnose and treat patients.
The MIT-spinout company, EyeNetra developed a diagnostic device for signaling refractive errors fast and accurately. The device, called Netra, is a plastic, binocular-like headset to be used with an app which calculates the difference between what the user indicates as “aligned” and the actual alignment of various patterns. This signals any refractive errors, such as near-sightedness, farsightedness, and astigmatism. The app then displays the refractive powers, the axis of astigmatism, and the pupillary distance required for eyeglasses prescriptions. EyeNetra will make school or workplace eye examinations in the future a lot easier than today.
Are 3D printed and digital contact lenses the future?
Digital contact lenses sound as science fiction: the translucid layer on your eye transmitting special information about your body to an outside device. Yet, it might be a reality soon. For example, Google teamed up with Novartis, to produce digital, multi-sensor contact lenses which are designed to be able to measure blood sugar levels.
Google and Novartis said the lens would contain a tiny and ultra slim microchip that would be embedded in one of its thin concave sides. Through its equally tiny antenna, it would send data about the glucose measurements from the user’s tears to his or her paired smartphone via installed software. Originally, the companies promised to put the digital contact lens around 2020 on the market. However, in March 2017 Novartis Chairman Joerg Reinhardt talked down the chances of the project bringing visible results in the next couple of years. I truly hope this is just a temporary setback.
Meanwhile, researchers at the University of Washington have created a contact lens with an LED display built into it – with the help of a 3D printer! While it is really difficult to manufacture a contact lens, which is one-third of a millimeter in diameter, a 3D printer sandwiches together different layers of interacting material, which makes it easier to place together so tiny pieces. While it was only an experiment, the research has important implications to improve the display technology of small devices. Maybe Google will 3D print the next generation of digital contact lenses, who knows?
Healing the eye faster
Innovation in regenerative medicine is flourishing: dentistry, dermatology, ophthalmology. A few specialties which can take pride in healing injured or diseased body parts faster and in a more efficient way.
For example, researchers in Turkey developed a regenerative medicine, that can heal the front of the eye in as little as two days after surgery. The drug called Cacicol stimulates faster tissue repair, appears to relieve eye pain, burning, and light sensitivity following an invasive intervention. Scientists treated with Cacicol patients suffering from a rare disease called keratoconus who went through a surgery known as corneal cross-linking. The drug helped decrease the initial healing from 5 days.
Artificial Intelligence for detecting eye conditions in time
Image recognition algorithms have the capacity to transform diagnostics based on medical imaging. In 2016, Google developed an eye-scanning technique for looking at retinal images and detecting diabetic retinopathy as well as a trained ophthalmologist. The disease is quite common among diabetes patients, and if it is not spotted early enough it may cause blindness. The machine-learning algorithm uses Google’s method for labeling millions of Web images as it examines photos of a patient’s retina to spot tiny aneurisms indicating the early stages of diabetic retinopathy. A year later, the search giant announced they have begun working on integrating the technology into a chain of eye hospitals in India.
Google is not the only one working on A.I. solutions for eye care, though. A teenage girl from India, whose grandfather in India was diagnosed with diabetic retinopathy, developed a smartphone app that can screen for the disease with the help of a specially trained artificial intelligence program and a simple 3D-printed lens attachment. A truly disruptive innovation: smart, cheap and potentially life-changing!
Eye conditions through augmented reality
Patient education is key in prevention and it also gives the best chance for physicians arriving at the most accurate diagnosis based on their patients’ explanation of their symptoms.
The use of Orca Health’s EyeDecide could bring exactly this result. The innovative, Utah-based mobile software company’s medical app uses an augmented reality camera display for simulating the impact of specific conditions on a person’s vision. EyeDecide can fully demonstrate the consequences of cataract or AMD and thus help patients understand their actual medical state.
Cyborgization is upon us?
I’m hopeful that eye conditions, visual impairment, and blindness will be entirely treatable in the future, even if that would mean their replacement with fully capable technologies. I believe the biggest ethical challenge of eye implants or devices replacing visual functions could be that it might facilitate cyborgization.
What if healthy people would like to live as Neil Harbisson? As someone whose vision is extended through an external technology? What if the average user will ask for bionic eyes as it does not get tired, you can zoom with it, browse and search online, even take photos that no one else could see?
Neil Harbisson is actually an artist born with achromatopsia or extreme colorblindness meaning he could only see in black-and-white. Harbisson received a specialized electronic eye, his “eyeborg” to be able to render perceived colors as sounds on the musical scale. He is capable of experiencing colors beyond the scope of normal human perception: Amy Winehouse is red and pink, while ringtones are green. In his view, cyborgization might start with a third eye on the back of the head or an implanted sensor indicating whether there is a car behind you.
If you are entirely freaked out by now, I have to tell you, we are rather far from implanting third eyes into people. However, we have to start to contemplate about the possibilities of such scenarios as we will arrive at the boundaries of privacy, ethics – and the ultimate merging of the human body with technology. We have to be ready for that!
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