On a sun-splashed morning, Jamie Carley sat on a couch facing a brightly lit window in a waiting area on the east side of the UCHealth Eye Center. Two Eye Center physicians, Naresh Mandava, MD, and Scott Oliver, MD, flanked her. Her mother, son, sister, and cousin stood nearby, looking on with a mixture of anticipation and anxiety.
When she arrived at the Eye Center a short time earlier on this December day, Carley, 51, had worn dark glasses. She now wore a different kind of glasses – still dark, but equipped to help restore a small measure of something she lost many years ago: her vision.
Carley suffers from retinitis pigmentosa, a disease that progressively damages the cells in the retina, called photoreceptors, that receive the light that is ultimately transformed to visual information in the brain. The glasses she wore are part of the Argus II Retinal Prosthesis System (Argus II), which includes a microchip implanted in the eye. Carley is the first patient in the Rocky Mountain region to complete the procedure, led by Mandava and Oliver.
That’s right: Carley now has a bionic eye.
The microchip, which Mandava and Oliver sutured to the surface of Carley’s right eye, contains an array of 60 electrodes with an antenna. The special glasses are outfitted with a camera that receives images and transmits them to a video processor Carley and other Argus II patients carry. The processor transforms the images into instructions – areas of light and dark, for example – and sends them back to the glasses.
The glasses then wirelessly transmit the information to the antenna in the implant, which sends it on to the electrodes on the retina. The electrodes fire, stimulating the small number of remaining undamaged retinal cells, which relay information via the optic nerve to the brain. The brain converts the signals to gray-scale images – nothing like normal vision, but a semblance of the long-unseen world.
The long view
The sophisticated technology has been more than two decades in the making, Mandava said. For Carley, Argus II is a conduit to her most basic desires. By the time she was 17, her vision had deteriorated to the point she needed adaptive equipment. She has only childhood memories of watching with her family as fireworks exploded in colors above a lake in Kansas. She knows her son Jon, 29, by sound, not by sight.
“The first thing I want to lay my eyes on is my son,” she said in the days before the device was turned on. “I remember glimpses of him growing up, but I don’t know if it’s what I really saw or what I imagined.”
After months of working with a team that includes Mandava, Oliver, professional research assistant Mary Preston, and Cynthia Cruz, a clinical representative from Second Sight, which manufactures the Argus II device, Carley had realistic expectations of what the Argus II could do. Seeing shadows, doorways, window frames, or a person walking toward her would be “a gift” after decades in darkness, she said.
Her practical view and determination are major advantages, Cruz said in the moments before Carley donned the Argus II glasses.
“The device needs a participating patient who works hard,” Cruz said. “I think that’s right up her alley.”
Her family could second that. Sitting together at the Eye Center shortly before the big test, they talked about Carley’s determination to adapt to her blindness.
“She knew all the bumps in the road when we drove,” her sister Kim recalled. “She’d say, ‘Mom, you missed that turn.’ ”
Jon recalled his mother having him wear a blindfold to understand the reality of lost sight. “Eating Chinese food was the worst,” he said. “Rice all over the table, and you didn’t know.”
The first step of many
That lesson underscored the importance of adjusting to change – the fundamental theme of Carley’s life. The disease took her vision in stages, with peripheral, night, and central vision gradually fading. Finally, even colors were gone; only an annoying brightness in the left eye remained.
“At every stage, I had to learn to adapt,” she said.
Now it is on to another stage of adaptation. The bionic eye doesn’t deliver even rudimentary vision at the simple flip of a switch. Carley will need extensive rehabilitation to train her brain to interpret the signals the device transmits. She will also continue to rely on the skills she developed to help her navigate the unseen world, Mandava said.
“She will still use tactile cues and memories of the space she lives in and works around,” he said.
But Cruz said she saw encouraging signs nearly as soon as Carley looked through the new glasses.
“From the moment we turned the device on, she instinctively started scanning left to right,” Cruz said. The movements were a sign that Carley was looking for the corner of the bright window. Cruz was similarly encouraged when Carley stepped out of the waiting room for a short walk along the east side of the Eye Center. She tucked in her chin, looking down to make out the contrast of dark grass against snow on the north side of the Eye Center. Mandava also noted Carley’s awareness of movement when a car drove past on 17th Avenue.
Those practical successes, however, faded in comparison to several poignant moments a few minutes earlier. Sitting on the couch inside, with Mandava’s arm around her and Oliver holding a laptop computer that displayed the images from the video processor, Jon positioned himself in front of the window.
Mandava instructed Carley to look for an edge to the white square as she slowly moved her head. The laptop screen showed a silhouetted figure.
“Who is that?” Carley asked.
“She senses me; she doesn’t have to see me,” Jon said.
Carley’s mother was next, then Kim, each of them standing near the window. Carley looked ahead raptly, slowly moving her head. “You’re tracking perfectly,” Mandava said. Soon it was his turn at the window, where he joined Kim and Wendy, the sisters’ cousin.
“That’s Dr. Mandava,” someone said. “You’ve never seen him before.” Mandava appeared on the laptop screen as the tallest of the three silhouettes.
“I really had to go up for that one,” Carley said.
Her spirits also rose, along with those of her family.
Asked whether the morning had been all she hoped for, Carley’s mother had a ready reply.
“All that,” she said, “and more.”