Lights go on for another ‘bionic eye’ patient

Raymond Graber, 88, got his first glimpse of the outside world in more than half a century, thanks to surgery and a still-emerging technology
January 27th, 2017
CU School of Medicine Chair of Ophthalmology Dr. Naresh Mandava (left) and Dr. Scott Oliver operate on Raymond Graber at University of Colorado Hospital Aug. 31. The “bionic eye” device was turned on and tested about five weeks after this operation to install the components.

Holly Henning was driving to Hutchinson, Kan., her radio tuned to the “Bobby Bones Show” out of Nashville. At 7:55 a.m. that morning last January, the show aired its regular “Tell Me Something Good” segment which, as the name suggests, features good-news stories.

The subject caught Henning’s attention. Bones and his team reported that a blind man had received a “bionic eye” that allowed him to see his wife for the first time in 30 years. Henning was intrigued. She is activity director at Prairie Sunset Home, an assisted living and skilled nursing facility in tiny Pretty Prairie, Kan. One of the residents, Raymond Graber, then 87 years old, had been blind a good part of his life.

As soon as she got a chance, Henning pulled up YouTube videos about the “bionic eye,” which she learned was a device developed by a company called Second Sight. Dubbed the “Argus II Retinal Prosthesis System,” it restores limited vision in people with retinitis pigmentosa, a disease that progressively destroys the cells in the retina that receive light and capture images.

“That’s what I have,” Graber said when Henning told him what she had learned.

Raymond Graber, flanked by retinal specialists Naresh Mandava (left) and Scott Oliver, looks at his hand against a bright screen shortly after his Argus II device was turned on.

With further research, they learned that the UCHealth Eye Center in Aurora had implanted the device. That ultimately led them to Mary Preston, professional research assistant with the University of Colorado School of Medicine’s Department of Ophthalmology. Graber provided Preston with records from his ophthalmologist in Kansas for review, and she later asked him to come to Aurora for tests. Henning drove him to the Eye Center for what turned out to be an all-day session to determine Graber’s suitability for surgery to implant the Argus II.

Preston later visited Graber at the Prairie Sunset Home, where she saw that he lived in a neat environment with plenty of support from Henning and other staff. Most importantly, she came away impressed with Graber’s drive and positive attitude about taking on advanced technology.

“I wanted to see his living situation and if he could handle it. He was so driven,” Preston recalled. “He wanted to be able get out more and was excited about it.”

Into the light

Looking on behind Graber, Mandava and Oliver are (from left) Holly Henning, who drove him to the Eye Center from his home in Kansas; Cynthia Cruz of Second Sight; and Mary Preston, professional research assistant with the CU Department of Ophthalmology.

What began with Henning’s chance listen on the radio culminated Sept. 28 with Graber seated in a small waiting area of the Eye Center, flanked on either side by Scott Oliver, MD, and Naresh Mandava, MD of the Department of Ophthalmology. He wore what looked at a casual glance like a pair of sunglasses. They were, in fact, the linchpin to a sophisticated system designed to bring Graber a glimmering of the sight he had completely lost to disease 56 years ago.

Some weeks earlier, Mandava and Oliver had sutured unit containing a microchip and an antenna to Graber’s left eye. The chip, with 60 electrodes, acts as a sort of motorized wheelchair for a damaged retina.

A camera in the glasses sends image data via a cable to a video processor that Argus II patients carry. The processor converts the feed into simple light-and-dark imagery and returns it to the glasses. The glasses wirelessly send the grayscale image data returned from the video processor to the antenna in the eye. The images pass to the microchip, which activates electrodes based on the data. The electrodes stimulate the small number of remaining undamaged cells in the retina. These electrically stimulated cells send the information along to the optic nerve and on to the brain, to be interpreted as grayscale images.

Oliver and Mandava help Graber look at his hand.

Graber sat before a brightly lit screen, a black cloth overhanging the top to provide contrast. With the Argus II turned on, Oliver watched a laptop computer that displayed the images produced by the video processor. He and Mandava helped him begin to move his head, using the camera on the glasses to “scan” the light and dark areas before him and pick up the edges between them. With consistent practice, they hope, Graber will be able to use the device to help him with everyday activities, such as getting through doorways more easily.

Graber stared at the screen and pointed. “It’s going to take a lot of therapy and a lot of practice,” he said.

“Therapy goes along with it,” Oliver said. “You’ll use it every day and get practice in following the images.”

A short time later, Graber pushed his walker outside to walk along the east edge of the Eye Center in the soft light of the late September afternoon. Oliver walked alongside, gently moving Graber’s head from time to time to help him find the edge of the sidewalk. Graber reached 17th Avenue, where the sun lit the south side of the Barbara Davis Center for Childhood Diabetes, then turned back, looking down as his face creased with emotion and Henning hugged him.

Oliver stood nearby. “You did a great job,” Graber said to him.

“So did you,” Oliver replied.

Henning and Oliver watch as Graber points toward an object during a short walk outside the Eye Center.

Another tool

Graber, now 88, is the second patient the Eye Center has implanted with the Argus II. The first stood alongside him, looking on as he glimpsed the light. Jamie Carley, 52, lost all her vision to retinitis pigmentosa more than two decades ago. She’d had the device turned on in December 2015 in the same room where Graber had sat and ventured down the same path on which he now stood.

Carley had spoken with Graber frequently before and after his surgery. She said she will continue to help him in any way she can – just as other Argus II patients around the country have helped her.

“He had many questions,” Carley said in an interview a week after Graber had the device turned on. “We went through everything.”

Sitting in her tidy northern Colorado home, Carley spoke clearly about both the capabilities and limitations of the Argus II.

Jamie Carley, the first patient to receive the Argus II at UCHealth, with Henning and Graber.

“It’s another tool for dealing with blindness,” she said. “It’s also a slower tool.”

Carley explained that people might believe the device restores sight with the flip of a switch, but the reality is far more subtle. The Argus II brings back perceptions of light and dark – fleeting shadows of the long-vanished world. Wearers don’t see colors. And after spending years in the absence of light, they have to work hard to retrain their brains to do things that the sighted take for granted – finding the edge of a desk, for example, or the point where carpeting meets a wall.

In addition, the camera that sits between the right and left eyeshades of the Argus II glasses picks up only a relatively small section of the vast array of images that make up the outside world, Carley said. A compelling moment for Graber came when Oliver and Mandava had him put his hand in front of his face. It made a powerful impression on him because the hand fit the world of the Argus II camera, Carley said.

“His hand fit in that 9-inch window and he could follow the lines and shape of it,” she said.

Carley uses a magnetic board to practice using the Argus II at her home.

Talking about practice

But more often, gathering information outside that comparative peephole requires scanning, right and left, up and down. It takes plenty of practice. Carley does hers every day, putting on the glasses and sitting before a two-sided magnetized board. She places white pieces cut in various shapes – rectangular strips, half-moons and circles – on the black background, then scans until she finds the edges. The reverse side has a white background for holding black shapes.

The repetitive work helps her when she dons the glasses to do some household tasks, like vacuuming. “I follow the line of the wall so I don’t smack into it,” Carley said.

She has found that some tasks are easier without the device, though. For example, for years she’s cut vegetables by touch; trying to make out their dark shapes against a white cutting board just slowed her down, she said.

Carley is hardly helpless without the glasses. As she put it, “Everything in my world is talking.” Many other devices feed her information verbally, from her iPhone to her computer to her thermostat. Instead, she said, “I use the glasses for fun, crazy things, like watching TV.” She sees the scenes shift frequently; the movement stimulates her brain and makes her feel more involved.

For Carley the Argus II is another tool for finding her way in a mostly sightless world.

Memories and more

The biggest pay-offs from the Argus II have been emotional. Carley has strong memories during her youth in Emporia, Kan., of watching from a boat floating in nearby Lake Kahola as fireworks lit the night sky. The memories fired again this year when she donned the Argus II glasses and watched fireworks set off at nearby Colorado National Speedway. At a barbecue last July 4, she gazed at sparks set off by ground fountains. One rainy summer evening her son Jon stopped at her house, telling her a lightning storm was putting on quite a display. The glasses gave her a glimpse of nature’s light show.

She’s looking forward to the next big harvest moon and, especially, the holidays. “I love the lights at Christmas,” she said. “They’re awesome.”

Much as she values these moments, Carley continues to look for ways to use the Argus II practically. She will be traveling to Michigan next spring to practice working with a cane in conjunction with the device. She says she’d like to see Second Sight develop an application to help her and other patients practice the magnet board activities on the computer. She is also part of a five-year study to measure how well patients adapt to the Argus II.

The Argus II was approved by the Centers for Medicare and Medicaid Services for coverage in 2013. But the device alone costs about $150,000. That makes finding the right patients a work in progress, Preston said. Carley’s experience is therefore all the more important – both for her and for others with retinitis pigmentosa.

“We’re hoping that Jamie sets a precedent,” Preston said.

Raymond Graber might be another to do so. Shortly after returning home, he slipped on the Argus II to attend a pep rally for the homecoming football game at Pretty Prairie High School, Henning said. He works every day with his magnetic board and wears the device to meals, she added.

He’s also a powerful advocate for all those who made the technology available, especially Preston, Oliver and Mandava.

“He said he’s never been treated so well as he was at the Eye Center,” Henning said.

For her part, Preston believes Graber’s outlook will continue to serve him well as he finds his way back to slender slices of light extinguished so long ago.

“Throughout the entire time I have been in contact with Raymond, he has never once complained about anything,” she said. “His positive attitude has buoyed him.”

 

About the author

Tyler Smith is a freelance writer based in metro Denver.