Bloch Edward, Luo Yvonne, da Cruz Lyndon
Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK.
NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK.
Ther Adv Ophthalmol. 2019 Jan 17;11:2515841418817501. doi: 10.1177/2515841418817501. eCollection 2019 Jan-Dec.
Retinal prosthesis systems have undergone significant advances in the past quarter century, resulting in the development of several different novel surgical and engineering approaches. Encouraging results have demonstrated partial visual restoration, with improvement in both coarse objective function and performance of everyday tasks. To date, four systems have received marketing approval for use in Europe or the United States, with numerous others undergoing preclinical and clinical evaluation, reflecting the established safety profile of these devices for chronic implantation. This progress represents the first notion that the field of visual restorative medicine could offer blind patients a hope of real and measurable benefit. However, there are numerous complex engineering and biophysical obstacles still to be overcome, to reconcile the gap that remains between artificial and natural vision. Current developments in the form of enhanced image processing algorithms and data transfer approaches, combined with emerging nanofabrication and conductive polymerization techniques, herald an exciting and innovative future for retinal prosthetics. This review provides an update of retinal prosthetic systems currently undergoing development and clinical trials while also addressing future challenges in the field, such as the assessment of functional outcomes in ultra-low vision and strategies for tackling existing hardware and software constraints.
在过去的四分之一个世纪里,视网膜假体系统取得了重大进展,催生了几种不同的新型手术和工程方法。令人鼓舞的结果表明,部分视觉功能得以恢复,粗略的客观功能和日常任务表现均有所改善。迄今为止,已有四款系统在欧洲或美国获得上市批准,还有许多其他系统正在进行临床前和临床评估,这反映出这些设备用于长期植入时已确立的安全状况。这一进展首次表明,视觉修复医学领域有望为盲人患者带来切实且可衡量的益处。然而,仍有众多复杂的工程和生物物理障碍有待克服,以弥合人工视觉与自然视觉之间的差距。当前增强图像处理算法和数据传输方法的发展,再加上新兴的纳米制造和导电聚合技术,预示着视网膜假体将迎来令人兴奋的创新未来。本综述介绍了目前正在研发和进行临床试验的视网膜假体系统的最新情况,同时也探讨了该领域未来的挑战,例如超弱视功能结果的评估以及应对现有硬件和软件限制的策略。