Vision Quest04 Mar 2014, Posted by Article Sampler in
I’m sitting across from a blind man — call him patient Alpha — at a long table in a windowless conference room in New York. On one end of the table there’s an old television and a VCR. On the other end are a couple of laptops. They’re connected by wires to a pair of homemade signal processors housed in unadorned gunmetal-gray boxes, each no bigger than a loaf of bread. In the corner stands a plastic ficus tree, and beyond that, against the far wall, a crowded bookshelf. Otherwise, the walls are white and bare. When the world’s first bionic eye is turned on, this is what Patient Alpha will see.
Our guinea pig is 39, strong and tall, with an angular jaw, bold ears, and a rugged face. He looks hale, hearty, and healthy — except for the wires. They run from the laptops into the signal processors, then out again and across the table and up into the air, flanking his face like curtains before disappearing into holes drilled through his skull. Since his hair is dark and the wires are black, it’s hard to see the actual points of entry. From a distance the wires look like long ponytails.
“Come on,” says William Dobelle, “take a good look.” From a few steps closer, I see that the wires plug into Patient Alpha’s head like a pair of headphones plug into a stereo. The actual connection is metallic and circular, like a common washer. So seamless is the integration that the skin appears to simply stop being skin and start being steel. “It’s called a percutaneous pedestal,” Dobelle tells me.
All I can do is stare. The man has computer jacks sunk into both sides of his skull. On the far side of the pedestal, buried beneath hair and skin, is the wetware: a pair of brain implants. Each one is the size of a fat quarter, a platinum electrode array encased in biocompatible plastic.
Dobelle has designed a three-part system: a miniature video camera, a signal processor, and the brain implants. The camera, mounted on a pair of eyeglasses, captures the scene in front of the wearer. The processor translates the image into a series of signals that the brain can understand, then sends the information to the implant. The picture is fed into the brain and, if everything goes according to plan, the brain will “see” the image.
But I’m getting ahead of myself. The camera’s not here yet. Right now the laptops are taking its place. Two computer techs are using them to calibrate the implants. One of the techs punches a button, and a millisecond later the patient rotates his head, right to left, as if surveying a crowded room.
“What do you see?” asks Dobelle.
“A medium-size phosphene, about 5 inches from my face,” responds the patient.
“How about now?”
“That one’s too bright.”
“OK,” says Dobelle, “we won’t use that one again.”
This goes on all morning, and it’s nothing new. For almost 50 years, scientists have known that electrical stimulation of the visual cortex causes blind subjects to perceive small points of light known as phosphenes. The tests they’re running aim to determine the “map” of the patient’s phosphenes. When electrical current zaps into the brain, the lights don’t appear only in one spot. They are spread out across space, in what artificial-vision researchers call the “starry-night effect.”
Dobelle is marshaling these dots like pixels on a screen. “We’re building the patient’s map, layer by layer,” he explains. “The first layer was individual phosphenes. The next layer is multiples. We need to know where his phosphenes appear in relation to each other so a video feed can be translated in a way that makes sense to his mind.”
Some phosphenes look like pinpricks or frozen raindrops. Others appear as odd shapes: floating bananas, fat pears, lightning squiggles. Of course, the use of the word appear is misleading, since the phosphenes appear only in the patient’s mind. To the sighted, they are completely invisible.
Dobelle sits in a wheelchair beside the patient. His left leg was amputated a year ago after an ulcerated infection in his big toe spread out of control. Because being in a wheelchair makes it hard to dig into his pants pockets, he favors T-shirts – “the good kind” – with a chest pocket to carry his keys, a couple of pens, his wallet. His shirt is so weighed down that it sags from his neck, drooping cleavage-low. He has a patchy, unkempt gray beard. His forehead is high and wrinkled, and his glasses are thick and wide.
“Are we ready for multiple phosphenes?” asks one of the techs.
Dobelle nods his head.
So smoothly has the morning been going that while we’re talking, the techs allow the patient to take control of the keyboard and begin stimulating his own brain. This isn’t standard operating procedure, but with the excitement, the techs don’t stop him and the doctor doesn’t notice.
Suddenly, the color drains from the patient’s face. His hand drops the keys. His fingers crimp and gnarl, turning the hand into a disfigured claw. The claw, as if tethered to balloons, rises slowly upward. His arm follows and suddenly whips backward, torso turning with it, snapping his back into a terrible arch. Then his whole body wrenches like a mishandled marionette — shoulders tilting, neck craning, legs twittering. Within seconds his lips have turned blue and his deadened eyes roll back, revealing bone-white pupils, lids snapping up and down like hydraulic window shades. There’s another warping convulsion, and spittle sails from his mouth. Since the doctor’s in a wheelchair and the techs seem hypnotized, I rush over and grab him.
“Call 911!” one of the computer techs shouts.
But the doctor yells back: “No!”
“Lie him down,” cries the other. “Get him some water!”
My arms are under his, trying to steady the weight. His head snaps toward mine, and I take it on the chin with the force of a solid right cross. We’re now close enough that I can count the wires going into his head. I can see a faint scar where a surgeon’s saw cut a hole in his skull and removed a chunk of it like a plug from a drain. Finally, the techs move to action. They’re up and struggling to unhook the patient from the seeing machine — but really, what can they do? It’s in his brain. I’m pretty sure he’s going to die in my arms.
WILLIAM DOBELLE LIKES A GOOD WRIGHT BROTHERS’ STORY. Like how the first plane the Wright brothers built didn’t have a steering mechanism, that it merely went up and down and straight. Or if you look at a plane these days you won’t see their names on the side. Instead there’s Boeing or Airbus, but even so, you know these makers are merely historical recipients of the Wright stuff, just as you know that your voting privileges are somehow owed to Thomas Jefferson. Of all the Wright brothers stories, Dobelle likes the one about Lieutenant Tom Selfridge the best.
The Wright brothers ran low on money. They built their airplane, but they needed more cash for further experimentation. A lieutenant from the US Army showed up for a demonstration, and after watching Orville pilot around for a little while he said, “That’s great, now take me for a ride.” So Orville strapped Selfridge into the passenger seat, took off, and promptly crashed. Crashed! The plane was wrecked, Orville was in the hospital for months, and Selfridge was killed — yet they still managed to land a contract for a military flier.
The doctor treats this story like a talisman. Its moral — with great risk comes great reward — has been an inspiration for him during the past 30 years, since 1968, when he began working on an artificial-vision system to restore sight to the blind. The moral was there in the ’70s, when he went under the hot knife of surgery and had his own eye slit open to test the feasibility of a retinal implant. It was there when he looked over the work that had been done on the visual cortex and realized the only way to create a visual neuroprosthesis was to slice through the skull and attach an implant to the human brain. It was there two years ago, when he decided to skirt the Food and Drug Administration by sending his patients to a surgeon in Lisbon, Portugal, because he knew there was little chance the US government was ever going to give him permission to experiment on humans in America.
There was one lab rat, however. In 1978, shortly before the FDA passed the last in a series of medical device amendments that would outlaw testing a visual neuroprosthesis on a human, Dobelle installed his prototype into the head of a genial, big-bellied, blind Irishman from Brooklyn named Jerry.
“When my grandkids meet a blind guy with a brain implant,” says Jerry, explaining his participation in Dobelle’s experiments, “I wanted them to be able to say, ‘Let me tell you about my grandfather.'”
For years the prototype sat in Jerry’s occipital lobe, largely unused. Back then Dobelle’s concerns were infection and biocompatibility. When neither turned out to be a problem, he edged the research forward. Over the years, Jerry’s visual field was mapped, but his implant never produced true “functional mobility.”
Functional mobility is a bit of jargon defined as the ability to cross streets, take subways, navigate buildings without aid of cane or dog. For the past 40 years this has been the goal of artificial-vision research. But Jerry’s not there, instead caught halfway between sight and shadow.
When hooked up to a video camera, he sees only shades of gray in a limited field of vision. He also sees at a very slow rate. It helps to think of film. Normal film whirls by at 24 frames per second — but Jerry sees at merely a fifth of that speed. The effect, Dobelle tells me, is a bit like looking at snapshots in a photo album through holes punched in a note card.
Patient Alpha, on the other hand, has the full upgrade: the Dobelle Institute Artificial Vision System for the Blind. Because the system has yet to be patented, the doctor is cagey about specifics. He won’t say how many electrodes are inside the patient’s head, though by my count the number is around 100. Other changes have been made as well. Instead of Jerry’s one implant, the patient has two, one in each side of his head. Materials, as well, have been updated, and the power pack and signal processor made portable. But the biggest difference is that it took Dobelle 20 years to work Jerry up to any sort of vision. Patient Alpha got out of surgery a month ago.
WILLIAM DOBELLE WAS BORN IN 1941 IN PITTSFIELD, MASSACHUSETTS, the son of an orthopedic surgeon. Ask Dobelle how he got into this game and he’ll say: “I’ve always done artificial organs; I’ve spent my whole life in the spare-parts business. I just inherited it from my father. By age 8, I was doing real research.”
Which sounds like hooey, until you check the records. He applied for his first patent, on an artificial hip improvement, at age 13. He was into college at 14 and hooked on the artificial-vision challenge by 18. He dropped out of Vanderbilt to pursue independent research on visual physiology, supporting himself as a Porsche mechanic.
In 1960 he returned to school, earning an MS in biophysics from Johns Hopkins. This time he covered costs by selling scientific ephemera: iguana gall bladders and whale hearts which he collected in South America. He finished his PhD in physiology from the University of Utah and became the director of artificial organs at Columbia Presbyterian Medical Center. By 1984, he had a lab of his own.
Located in Hauppauge, New York, near the center of Long Island, Dobelle’s lab sits inside one of the largest industrial parks in America. All around are the offices of high tech whatevers — Aerostar, Gemini, Forest Labs, Nextech, Bystronic — housed in grim, squat warehouses accented only by trim lawns and odd awnings. Most of the buildings have them, these decorous afterthoughts: green shingles attached to aluminum siding, Spanish tile against cold stone. “We don’t have an awning,” notes Dobelle, proud of his austerity.
Walk inside and you’ll see a carpet so thin it could be cement. The furniture in the front offices looks anonymous, wood-veneered, bought by the pound. Behind the offices is a larger workshop — the home to the breadwinners of the operation.
During his tenure as a spare-parts man, Dobelle built hiccup suppressors and erection stimulators and pain inhibitors. Right now, there are 15,000 people running around the world with his inventory inside their bodies. The workshop is currently used to build lung, spinal cord, and deep-brain stimulators. Since he’s never wanted to be beholden to anyone and thus never accepted venture capital, these devices pay the rent so Dobelle can pursue his real goal: artificial sight.
“It doesn’t come cheap,” says Dobelle, rolling himself into the workshop so I can get a look. We pass a machine shop — drill presses, lathes, saws of all varieties, tools hung on pegs and others left out among the dust and metal filings — then out onto an assembly room floor. In the center, separated from the rest by long sheets of heavy plastic, there’s a clean room for delicate procedures. And against a far wall stands an ancient computer, weighing 2 tons, complete with a punch-paper tape input and a Teletype output. It measures 10 feet wide and 7 feet tall.
“What is that for?” I ask.
“That was the first artificial-vision system, the one I built for Jerry. It’s my past. Thirty-four years of work and $25 million.”
THE COST HAS COME DOWN QUITE A BIT. According to a printout Dobelle hands me, the price tag for curing blindness is now around $115,000:
Visual Prosthesis System : $100,000
1 miniature camera mounted on eyeglasses
1 frame grabber
1 stimulus generation module
2 implanted electrode arrays with percutaneous pedestals
3 sets of rechargeable batteries and 1 charger (customer is responsible for replacement batteries as needed)
5-year full warranty (not including travel or freight)
5 years of annual follow-up examinations in Portugal (not including travel) unlimited telephone consultation
Evaluation of patient : $2,000 psychiatric evaluation/all other testing
Hospital expenses : $10,000
Miscellaneous expenses : $5,000 airfare to Lisbon, hotel and food for one week (2 people) miscellaneous (such as taxis)
The first person ever to receive this bill was Patient Alpha. His given name is Jens — pronounced “Yens.” Twenty-two years ago, at age 17, while nailing down railroad ties, an errant splinter took his left eye. Then, three years later, this time fixing a snowmobile, a shiv of clutch metal broke free and took out his right.
He lives in rural Canada, where the winters are brutal. He makes his living by selling firewood. Working alone, he splits logs with the largest chain saw currently available on the market. During the high season, he’ll manhandle 12,000 pounds of wood in a day. He helped his wife deliver six of his eight children at home, without a physician or midwife. Jens dismisses the whole hospital birthing process as rapacious big business.
Starting from scratch and without the aid of sight, Jens designed and built a solar-and wind-powered house and pulled his family off the grid. In his spare hours, he programs computers, tunes pianos, and gives the occasional concert. For a blind man to give a classical recital requires memorizing whole scores — a process that can take nearly five years. To cover his surgery, Jens gave quite a few recitals.
BACK IN THE LAB, I’m still supporting Jens’ weight. He’s panting and jerking. Every pore on his body leaks sweat. His neck has gotten too slippery to hold, so I’ve jammed my right hand into his armpit. I can feel the throb of his axillary artery. His heart is beating. Thankfully, he’s still alive.
Over the next five minutes, the gasping subsides. Respiration returns to normal. The full-body twitch stills to the occasional flutter. Soon the grim rigor of his hand relaxes, his fingers merely stretching now, as if reaching for the far notes on his piano.
Dobelle’s glaring at the techs.
“What happened?” he demands.
“He was overstimulated.”
“Yeah, I know that.”
Beside him, Jens’ head bobs once and then again. Slowly, motor control returns. He stretches his arms as if waking from a long sleep.
“What happened?” echoes Jens, his voice a low, percolating gurgle.
“You had a seizure,” says Dobelle.
“I wha …”
“A seizure. Jerry never had one, but it was always a possibility.”
“I wha …”
“You’ll be fine,” says Dobelle.
“For what I paid …”
“For what I paid, I better be.”
“OK,” says Dobelle, “I think we’re done for today.”
LATER THAT NIGHT, Dobelle calls to explain. His voice is balmy, preternaturally pacific. “My surgeon is the world’s foremost expert on epilepsy. When someone’s having a seizure you don’t lie them down or give them water — they could choke. I knew he would be OK.”
And the next morning, when I walk into the lab, Jens is OK. He’s back at the table, amid another round of testing. He doesn’t remember much of the seizure, but he remembers seeing the phosphenes.
“It was wonderful,” says Jens. “It is wonderful. After 18 years in a dark jail, I finally got to look out the door into the sunlight.”
“Are you ready for a little more?” asks Dobelle. In his hand is a pair of oversize tortoiseshell glasses. The left lens is dark, and affixed to the right is a miniature video camera: black, plastic, and less than 1 inch square. The wires that yesterday ran from the laptops are now plugged into the camera. It’s time to see if Jens can see.
“Are you ready?” repeats Dobelle.
“I’ve been ready for 20 years.”
Jens slides the glasses onto his face, and the techs power up the system. I am sitting across the table from him. As it turns out, when the world’s first bionic eye is turned on, Jens sees me.
“Wow!” says Jens.
“Wow what?” I ask.
“I’m really using the part of my brain that’s been doing dick-all for two decades.”
“And that’s only one implant,” says Dobelle. “We still have to integrate the other side, and we haven’t installed the edge-recognition software yet. The image is going to get better and better.”
Jens turns away, and we clear all objects off the conference table. Dobelle picks up a telephone and puts it down on the far corner. Jens turns back around. The camera is sending data down the pipe and to the implant in his brain at 1 frame per second. So when he first scans the table his head swivels, robotic and turtle-slow. It takes him nearly two minutes to find the phone — but he finds the phone. Then we do it again. Fifteen minutes later, Jens can pick up the receiver in less than 30 seconds. Within a half hour, it takes him less than 10.
They gradually work the frame speed up until there’s nothing left to do but strap the signal processor and power pack to Jens’ hips, like guns in their holsters. Then Jens heads out back, where he climbs inside a convertible Mustang. The top is down. The wind is in his hair. He fires up the ignition. Dobelle doesn’t let him tour the freeways, but he has his way with the parking lot.
“The next version,” Dobelle tells me, “may have enough resolution to use while driving in traffic.” In fact, since this is only a simple camera we’re talking about, one could imagine the addition of any number of superhuman optical features: night vision, X-ray vision, microscopic focus, long-range zoom. Forget the camera even; there’s no reason you couldn’t jack directly into the Net. In the future, the disabled may prove more abled; we may all want their prostheses.
PUBLIC DISCUSSION OF ELECTRICITY’S EFFECT ON VISION DATES TO 1751, when it was addressed by Benjamin Franklin following his celebrated kite-and-key experiment. Despite some advocates, the idea of treating blindness through electrical stimulation did not catch on.
The human eye occupies a weird place in history. For more than a century, creationists, staring down Darwin’s evolutionary barrel, claimed sight as proof positive of God’s existence. The eye was too complicated for anything as seemingly accidental as natural selection. By extension, curing blindness was the sole province of faith healers. “It used to be a religious miracle,” says Tom Hoglund of the Foundation Fighting Blindness, “but now it’s a scientific miracle.”
On June 13 Dobelle addressed the annual meeting of the American Society of Artificial Internal Organs in New York. He told the stunned, packed house about eight patients of his who’d had the surgery, with Jens the first to have his implant turned on. Then he showed a tape of Jens driving. “I got the most applause,” Dobelle told me, “but I don’t think anyone really knew what they were seeing.”
In fact, to most of the artificial-vision community, Dobelle’s breakthrough came out of the blue. For years he had been merely a footnote, known mainly for his early work in phosphene stimulation. People had heard of Jerry, but because the testing was done privately, outside of academia, many felt the work suspect.
Dobelle leads one of a dozen teams spread out over four continents racing ahead with all sorts of artificial-vision systems. There are teams working on battery-powered retinal implants and solar-powered retinal implants, and teams growing ganglion cells on silicon chips, and teams working on optic-nerve stimulators. And there is Dick Normann, the former head of the University of Utah’s Department of Bioengineering, who up until Dobelle’s success was among the front-runners.
Like Dobelle, Normann is working on a visual neuroprosthesis. I was the first to tell him that the race was over: He lost.
“That’s fantastic,” Normann says.
“You’re not even mad?”
“Fantastic, fantastic, fantastic” — and then he pauses — “if it works.”
“What do you mean? I was there. I saw it work.”
“But what do you mean by work? If a patient sees a point of light and it moves, is that sight? I need to know what the patient sees.”
“OK. But what does it mean for your research?”
“Mean? It doesn’t mean anything. We’re going to keep going like we were going.”
Normann also envisions a three-part system — implant, signal processor, camera — but with a critical difference. While Dobelle’s implant rests on the surface of the visual cortex, Normann’s would penetrate it.
Normann’s implant is much smaller than Dobelle’s — about the size of a nail’s head and designed to be hammered into the cortex, sinking to the exact spot in the brain where normal visual information is received. According to Normann, the implant is so precise that each electrode can stimulate individual neurons.
“The reason this matters,” he explains, “is that the cornerstone of artificial vision is the interaction between current and neurons. Because Dobelle’s implant sits on the surface of the visual cortex, it requires a lot of current and lights up a whole bunch of neurons. Something in the 1- to 10-milliamp range. With that much juice, a lot can go wrong.”
Tell me about it.
“With penetrating electrodes, we’ve got the current down to the 1- to 10-microamp range. That’s a thousandfold difference.” Lowering the amperage lowers the risk of seizure.
But that’s not all. Decreasing the amount of current also allows an increase of resolution: “The lower the current, the more electrodes you can pack on an implant,” explains Normann. “We’re not there yet, but with my electrodes there’s the chance of creating a contiguous phosphene field — that’s exactly what you and I have — and that’s just not possible with Dobelle’s surface implant.”
Which is the way things go when what was once a land of mystics becomes a field for engineers. Just like every other new technology, like operating systems and Web browsers, artificial vision is heading toward a standards war of its own.
Now that it’s not faith healing, it’s Beta versus VHS.
TO REALLY TRY TO UNDERSTAND WHAT JENS SEES, I head to USC in Los Angeles, where Mark Humayun has his lab. Like the competition, Humayun uses eyeglass-mounted video cameras and signal processors to generate an image, but unlike Normann’s and Dobelle’s neuroprostheses, his implant sits atop the retina. It’s designed to take the place of damaged rods and cones by jump-starting the still-healthy ones and then use the eye’s own signal processing components — the ganglion cells and optic nerve — to send visual information to the brain.
“It’s a limited approach, aimed at a limited number of pathologies, but it has its advantages,” says Humayun. “We thought it was a better idea to operate on a blind eye than on a normal brain.”
Humayun’s Retinal Prosthesis Lab runs out of USC’s Doheny Eye Institute. The room is small and square. Piles of electronic gear sit atop counters of maroon plastic — the same hue that offsets the bright yellow on Trojan football jerseys. Lab-coated technicians hunch over computers, barely registering my arrival.
James Weiland, an assistant professor at the institute, helps me into an elaborate headdress: Wraparound goggles cover my eyes, and black, light-blocking cloth hangs down over my ears. Plastic straps secure a miniature camera to the middle of my forehead, and wires run down my back and to a laptop computer to my left. The camera moves where my eyes move and then projects that image onto the “screen” of the goggles. The device, called a Glasstron and built by Sony, turns my normal eyesight into a pixelated version of itself.
With the power shut off, the view is complete darkness. Weiland flips a switch and asks me what I see.
“Vague gray shapes. Big dots. Blurry edges.”
“Can you see the door? Could you walk to the door?”
“Yeah, I could, if you want me to trip over things and fall down.”
“That’s a 5-by-5 display. Hold on,” says Weiland, “I’m going to up your pixel count to 32 by 32.”
It’s Weiland’s belief that a 32-by-32 array, 1,024 pixels, should satisfy most vision needs. This is probably 10 times the count on Dobelle’s implant and much closer to Normann’s design.
Beside me I can hear Weiland futzing with the computer. There’s a sudden wash of light, like viewing the Star Wars jump to hyperspace through a waterfall.
“Can you see now?”
“Give it a minute, let yourself adjust.”
“OK, I’ve got blobs and edges and motion.”
Suddenly, things become clearer. What moments ago was attack of the Jell-O creatures has become doorways and faces.
“What happened?” I ask. “Did you up the resolution again?”
“No,” says Weiland, “that’s your brain learning to see.”
It’s a weird feeling, watching my brain reorganize itself, but that’s exactly what’s happening. Beside me the fuzzy edge of the counter becomes a strong line, and then the computer atop it snaps into place.
I take one last glance around. Weiland is still not visible. Then there is a subtle shift in color. A drizzle of gray firms up, and I can see the white plane of his forehead offset by the darkness of his hair.
I look around: door, desk, computer, person.
So this is what a miracle looks like.