315:"State-of-the-art" retinal implants incorporate 60-100 channels, sufficient for basic object discrimination and recognition tasks. However, simulations of the resultant pixelated images assume that all electrodes on the implant are in contact with the desired retinal cell; in reality the expected spatial resolution is lower, as a few of the electrodes may not function optimally. Tests of reading performance indicated that a 60-channel implant is sufficient to restore some reading ability, but only with significantly enlarged text. Similar experiments evaluating room navigation ability with pixelated images demonstrated that 60 channels were sufficient for experienced subjects, while naïve subjects required 256 channels. This experiment, therefore, not only demonstrated the functionality provided by low resolution
332:
low resolution, retinal implants are potentially useful in providing crude vision to individuals who otherwise would not have any visual sensation. However, clinical testing in implanted subjects is somewhat limited and the majority of spatial resolution simulation experiments have been conducted in normal controls. It remains unclear whether the low level vision provided by current retinal implants is sufficient to balance the risks associated with the surgical procedure, especially for subjects with intact peripheral vision. Several other aspects of retinal implants need to be addressed in future research, including the long term stability of the implants and the possibility of retinal
17:
183:
and hence they rely on external camera for capturing the visual information. Therefore, unlike natural vision, eye movements do not shift the transmitted image on the retina, which creates a perception of the moving object when person with such an implant changes the direction of gaze. Therefore, patients with such implants are asked to not move their eyes, but rather scan the visual field with their head. Additionally, encoding visual information at the ganglion cell layer requires very sophisticated image processing techniques in order to account for various types of the retinal ganglion cells encoding different features of the image.
77:. The first application of an implantable stimulator for vision restoration was developed by Drs. Brindley and Lewin in 1968. This experiment demonstrated the viability of creating visual percepts using direct electrical stimulation, and it motivated the development of several other implantable devices for stimulation of the visual pathway, including retinal implants. Retinal stimulation devices, in particular, have become a focus of research as approximately half of all cases of blindness are caused by retinal damage. The development of retinal implants has also been motivated in part by the advancement and success of
296:, and that five of the eight subjects reported various implant-mediated visual perceptions in daily life. One had optic nerve damage and did not perceive stimulation. The Boston Subretinal Implant Project has also developed several iterations of a functional subretinal implant, and focused on short term analysis of implant function. Results from all clinical trials to date indicate that patients receiving subretinal implants report perception of phosphenes, with some gaining the ability to perform basic visual tasks, such as shape recognition and motion detection.
256:
array associated with an epiretinal implant. The subretinal placement is also more straightforward, as it places the stimulating array directly adjacent to the damaged photoreceptors. By relying on the function of the remaining retinal layers, subretinal implants allow for normal inner retinal processing, including amplification, thus resulting in an overall lower threshold for a visual response. Additionally, subretinal implants enable subjects to use normal eye movements to shift their gaze. The
319:, but also the ability for subjects to adapt and improve over time. However, these experiments are based merely on simulations of low resolution vision in normal subjects, rather than clinical testing of implanted subjects. The number of electrodes necessary for reading or room navigation may differ in implanted subjects, and further testing needs to be conducted within this clinical population to determine the required spatial resolution for specific visual tasks.
274:
imposes significant size constraints on the implant. The close proximity between the implant and the retina also increases the possibility of thermal damage to the retina from heat generated by the implant. Subretinal implants require intact inner and middle retinal layers, and therefore are not beneficial for retinal diseases extending beyond the outer photoreceptor layer. Additionally, photoreceptor loss can result in the formation of a
121:. Other factors, including the amount of residual vision, overall health, and family commitment to rehabilitation, are also considered when determining candidates for retinal implants. In subjects with age-related macular degeneration, who may have intact peripheral vision, retinal implants could result in a hybrid form of vision. In this case the implant would supplement the remaining peripheral vision with central vision information.
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function of some patients improving significantly over time. Future versions of the ARGUS device are being developed with increasingly dense electrode arrays, allowing for improved spatial resolution. The most recent ARGUS II device contains 60 electrodes, and a 200 electrode device is under development by ophthalmologists and engineers at the USC Eye
Institute. The
323:
remaining small enough to implant, to restore sufficient visual function for those tasks. It is worth to note high-density stimulation is not equal to high visual acuity (resolution), which requires a lot of factors in both hardware (electrodes and coatings) and software (stimulation strategies based on surgical results).
204:. Another epiretinal device, the Learning Retinal Implant, has been developed by IIP technologies GmbH, and has begun to be evaluated in clinical trials. A third epiretinal device, EPI-RET, has been developed and progressed to clinical testing in six patients. The EPI-RET device contains 25 electrodes and requires the
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Clinical reports to date have demonstrated mixed success, with all patients report at least some sensation of light from the electrodes, and a smaller proportion gaining more detailed visual function, such as identifying patterns of light and dark areas. The clinical reports indicate that, even with
273:
The main disadvantage of subretinal implants is the lack of sufficient incident light to enable the microphotodiodes to generate adequate current. Thus, subretinal implants often incorporate an external power source to amplify the effect of incident light. The compact nature of the subretinal space
260:
stimulation from subretinal implants is inherently more accurate, as the pattern of incident light on the microphotodiodes is a direct reflection of the desired image. Subretinal implants require minimal fixation, as the subretinal space is mechanically constrained and the retinal pigment epithelium
182:
Since the nerve fiber layer has similar stimulation threshold to that of the retinal ganglion cells, axons passing under the epiretinal electrodes are stimulated, creating arcuate percepts, and thereby distorting the retinotopic map. So far, none of the epiretinal implants had light-sensitive pixels,
147:
Epiretinal implants are placed on top of the retinal surface, above the nerve fiber layer, directly stimulating ganglion cells and bypassing all other retinal layers. Array of electrodes is stabilized on the retina using micro tacks which penetrate into the sclera. Typically, external video camera on
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Optobionics was the first company to develop a subretinal implant and evaluate the design in a clinical trial. Initial reports indicated that the implantation procedure was safe, and all subjects reported some perception of light and mild improvement in visual function. The current version of this
291:
in
Germany has also developed a subretinal implant, which has undergone clinical testing in nine patients. Trial was put on hold due to repeated failures. The Retina Implant AG device contains 1500 microphotodiodes, allowing for increased spatial resolution, but requires an external power source.
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A subretinal implant is advantageous over an epiretinal implant in part because of its simpler design. The light acquisition, processing, and stimulation are all carried out by microphotodiodes mounted onto a single chip, as opposed to the external camera, processing chip, and implanted electrode
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received market approval in the US in Feb 2013 and in Europe in Feb 2011, becoming the first approved implant. The device may help adults with RP who have lost the ability to perceive shapes and movement to be more mobile and to perform day-to-day activities. The epiretinal device is known as the
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cells, leading to a visual perception representative of the original incident image. In principle, subretinal implants do not require any external hardware beyond the implanted microphotodiodes array. However, some subretinal implants require power from external circuitry to enhance the image
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lasers. The real-time image processing involves reducing the resolution, enhancing contrast, detecting the edges in the image and converting it into a spatio-temporal pattern of stimulation delivered to the electrode array on the retina. The majority of electronics can be incorporated into the
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Subretinal implants sit on the outer surface of the retina, between the photoreceptor layer and the retinal pigment epithelium, directly stimulating retinal cells and relying on the normal processing of the inner and middle retinal layers. Adhering a subretinal implant in place is relatively
191:
The first epiretinal implant, the ARGUS device, included a silicon platinum array with 16 electrodes. The Phase I clinical trial of ARGUS began in 2002 by implanting six participants with the device. All patients reported gaining a perception of light and discrete phosphenes, with the visual
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Simulation results indicate that 600-1000 electrodes would be required to enable subjects to perform a wide variety of tasks, including reading, face recognition, and navigating around rooms. Thus, the available spatial resolution of retinal implants needs to increase by a factor of 10, while
61:(between the choroid and the sclera). The implants introduce visual information into the retina by electrically stimulating the surviving retinal neurons. So far, elicited percepts had rather low resolution, and may be suitable for light perception and recognition of simple objects.
20:
Diagram of the eye, the retina, and location of the various retinal implants. Retinal layers, from bottom to top: retinal pigment epithelium (RPE), photoreceptors (PR), horizontal cells (HC), bipolar cells (BC), amacrine cells (AC), ganglion cells (RGC), nerve fiber layer
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in patients with severe Age
Related Macular Degeneration. These results are very impressive as it appears that the patients integrate the residual vision and the artificial vision. It potentially opens the use of retinal implants to millions of patients with AMD.
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Epiretinal implants directly stimulate the retinal ganglion cells, thereby bypassing all other retinal layers. Therefore, in principle, epiretinal implants could provide visual perception to individuals even if all other retinal layers have been damaged.
226:, which generate signals directly from the incoming light. Incident light passing through the retina generates currents within the microphotodiodes, which directly inject the resultant current into the underlying retinal cells via
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simple, as the implant is mechanically constrained by the minimal distance between the outer retina and the retinal pigment epithelium. A subretinal implant consists of a silicon wafer containing light sensitive
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There are two main types of retinal implants by placement. Epiretinal implants are placed in the internal surface of the retina, while subretinal implants are placed between the outer retinal layer and the
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S. Klauke; M. Goertz; S. Rein; D. Hoehl; U. Thomas; R. Eckhorn; F. Bremmer; T. Wachtler (2011). "Stimulation with a wireless intraocular epiretinal implant elicits visual percepts in blind humans".
1125:
J. Rizzo III; J. Wyatt Jr.; J. Lowenstein; S. Kelly; D. Shire (2003). "Perceptual efficacy of electrical stimulation of human retina with micro electrode array during short- term surgical trials".
196:
in
February 2011 (CE Mark demonstrating safety and performance), and it is available in Germany, France, Italy, and UK. Interim results on 30 patients long term trials were published in
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Humayun MS, Dorn JD, da Cruz L, Dagnelie G, Sahel JA, Stanga PE, Cideciyan AV, Duncan JL, Eliott D, Filley E, Ho AC, Santos A, Safran AB, Arditi A, Del Priore LV, Greenberg RJ (2012).
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M. Humayun; J. Weiland; G. Fujii; R. Greenberg; R. Williamson; J. Little; et al. (2003). "Visual perception in a blind subject with a chronic microelectronic retinal prosthesis".
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S. Kim; S. Sadda; J. Pearlman; M. Humayun; E. deJuan Jr.; B. Melia; et al. (2002). "Morphometric analysis of the macula in eyes with disciform age-related macular degeneration".
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S. Kim; S. Sadda; M. Humayun; E. deJuan Jr.; B. Melia; W. Green (2002). "Morphometric analysis of the macula in eyes with geographic atrophy due to age-related macular degeneration".
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Optimal candidates for retinal implants have retinal diseases, such as retinitis pigmentosa or age-related macular degeneration. These diseases cause blindness by affecting the
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A. Santos; M. Humayun; E. deJuan Jr.; R. Greenburg; M. Marsh; I. Klock; et al. (1997). "Preservation of the inner retina in retinitis pigmentosa: A morphometric analysis".
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Retina implant AG reported 12 months results on the Alpha IMS study in
February 2013 showing that six out of nine patients had a device failure in the nine months post implant
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A. Chow; V. Chow; K. Packo; J. Pollack; G. Peyman; R. Schuchard (2004). "The artificial silicon retina microchip for the treatment of vision loss from retinitis pigmentosa".
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J. Stone; W. Barlow; M. Humayun; E. deJuan Jr.; A. Milam (1992). "Morphometric analysis of macular photoreceptors and ganglion cells in retinas with retinitis pigmentosa".
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associated external components, allowing for a smaller implant and simpler upgrades without additional surgery. The external electronics provides full control over the
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W. Liu; K. Vichienchom; M. Clements; C. Demarco; C. Hughes; C. McGucken; et al. (2000). "A neurostimulus chip with telemetry unit for retinal prosthesis device".
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to be replaced with a receiver chip. All subjects have demonstrated the ability to discriminate between different spatial and temporal patterns of stimulation.
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device has been implanted in 10 patients, who have each reported improvements in the perception of visual details, including contrast, shape, and movement.
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for restoration of sight to patients blinded by retinal degeneration. The system is meant to partially restore useful vision to those who have lost their
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G. Dagnelie; P. Keane; V. Narla; L. Yang; J. Weiland; M. Humayun (2007). "Real and virtual mobility performance in simulated prosthetic vision".
45:(AMD). Retinal implants are being developed by a number of private companies and research institutions, and three types are in clinical trials:
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The
Manchester Royal Infirmary and Prof Paulo E Stanga announced on July 22, 2015, the first successful implantation of Second Sight's
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in the outer layer of the retina, while leaving the inner and middle retinal layers intact. Minimally, a patient must have an intact
1426:
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G. Chader; J. Weiland; M. Humayun (2009). "Artificial vision: Needs, functioning, and testing of a retinal electronic prosthesis".
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821:"Visual acuity and perimacular retinal layers detected by optical coherence tomography in patients with retinitis pigmentosa"
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M. Humayun (1999). "Morphometric analysis of the extra- macular retina from post mortem eyes with retinitis pigmentosa".
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at the boundary of the damaged photoreceptors, which can impede stimulation and increase the stimulation threshold.
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eyeglasses acquires images and transmits processed video information to the stimulating electrodes via wireless
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layer in order to be a candidate for a retinal implant. This can be assessed non-invasively using
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of the implant. Current prototypes of retinal implants are capable of providing low resolution,
230:. The pattern of microphotodiodes activated by incident light therefore stimulates a pattern of
81:, which has demonstrated that humans can regain significant sensory function with limited input.
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The quality of vision expected from a retinal implant is largely based on the maximum
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in 2013, making it the first wireless epiretinal electronic device to gain approval.
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O. Foerster (1929). "Beitrage zur
Pathophysiologie der Sehbahn und der Sehsphare".
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1008:"Interim results from the international trial of Second Sight's visual prosthesis"
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152:. An external transmitter is also required to provide power to the implant via
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611:"FDA approves first retinal implant for adults with rare genetic eye disease"
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97:. It completed a multi-centre clinical trial in Europe and was awarded a
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394:"The sensation produced by electrical stimulation of the visual cortex"
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in 2012. Argus II received approval from the US FDA on April 14, 2013
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Foerster was the first to discover that electrical stimulation of the
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891:. Progress in Brain Research. Vol. 175. pp. 0079–6123.
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Neurotherapy: Progress in
Restorative Neuroscience and Neurology
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Zeng, Q.; Zhao, S.; Yang, H.; Zhang, Y.; Wu, T. (2019-06-22).
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J. Weiland; T. Liu; M. Humayun (2005). "Retinal prosthesis".
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E. Zrenner (2002). "Will retinal implants restore vision?".
1264:"Micro/Nano Technologies for High-Density Retinal Implant"
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Retina
Implant and was originally developed in Germany by
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617:. U.S. Food and Drug Administration. 14 February 2013
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1160:A. Fornos; J. Sommerhalder; M. Pelizzone (2011).
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73:cortex could be used to create visual percepts,
1127:Investigative Ophthalmology and Visual Science
1057:Investigative Ophthalmology and Visual Science
825:Investigative Ophthalmology and Visual Science
708:Investigative Ophthalmology and Visual Science
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1162:"Reading with a simulated 60-channel implant"
1362:- The Retinal Implant Project - rle.mit.edu
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1723:Differential technological development
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472:10.1146/annurev.bioeng.7.060804.100435
375:Journal für Psychologie und Neurologie
336:in response to prolonged stimulation.
327:Current status and future developments
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930:IEEE Journal of Solid-State Circuits
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685:10.1001/archopht.1997.01100150513011
650:10.1001/archopht.1992.01080230134038
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1812:Future-oriented technology analysis
1475:Progress in artificial intelligence
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294:Proceedings of the royal society B
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1274:(6). Micromachines (Basel): 419.
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1335:from the original on 2023-06-27.
1325:"Bionic eye implant world first"
790:10.1097/00006982-200208000-00012
747:10.1097/00006982-200208000-00011
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43:age-related macular degeneration
37:due to retinal diseases such as
1512:Fourth-generation optical discs
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819:T. Matsuo; N. Morimoto (2007).
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410:10.1113/jphysiol.1968.sp008519
392:G. Brindley; W. Lewin (1968).
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1839:Technology in science fiction
1350:Japan Retinal Implant Project
1213:Journal of Neural Engineering
985:10.1016/s0042-6989(03)00457-7
897:10.1016/s0079-6123(09)17522-2
563:"Trends in cochlear implants"
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265:within the subretinal space.
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90:Second Sight Medical Products
1024:10.1016/j.ophtha.2011.09.028
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1844:Technology readiness level
1780:Technological unemployment
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132:retinal pigment epithelium
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1827:Technological singularity
1787:Technological convergence
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1166:Frontiers in Neuroscience
1092:Archives of Ophthalmology
673:Archives of Ophthalmology
638:Archives of Ophthalmology
228:arrays of microelectrodes
154:radio-frequency induction
57:(behind the retina), and
1639:Brain–computer interface
1522:Holographic data storage
1179:10.3389/fnins.2011.00057
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86:Argus II retinal implant
1792:Technological evolution
1765:Exploratory engineering
1517:3D optical data storage
1450:Artificial intelligence
837:10.1136/bjo.2007.114538
567:Trends in Amplification
532:10.1126/science.1067996
1895:Biomedical engineering
1802:Technology forecasting
1797:Technological paradigm
1770:Proactionary principle
1644:Electroencephalography
1611:Software-defined radio
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1411:Emerging technologies
398:Journal of Physiology
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1718:Collingridge dilemma
1438:Ambient intelligence
1139:10.1167/iovs.02-0817
1069:10.1167/iovs.09-4410
354:Retinal regeneration
39:retinitis pigmentosa
1905:Implants (medicine)
1832:Technology scouting
1807:Accelerating change
1460:Machine translation
1225:2007JNEng...4S..92D
942:2000IJSSC..35.1487L
524:2002Sci...295.1022Z
212:Subretinal implants
138:Epiretinal implants
111:photoreceptor cells
1849:Technology roadmap
1485:Speech recognition
1470:Mobile translation
1443:Internet of things
1372:2011-12-08 at the
1355:2008-10-19 at the
1281:10.3390/mi10060419
306:spatial resolution
300:Spatial resolution
165:for each patient.
88:, manufactured by
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1910:Artificial organs
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1133:(12): 5362–5369.
334:neuron plasticity
289:Retina Implant AG
263:negative pressure
217:Design principles
143:Design principles
95:Retina Implant AG
79:cochlear implants
31:visual prosthesis
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1900:Neuroprosthetics
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1817:Horizon scanning
1733:Ephemeralization
1666:Neuroprosthetics
1659:Neuroinformatics
1634:Artificial brain
1572:Racetrack memory
1507:Extended reality
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1925:Prosthetics
1822:Moore's law
1753:Neuroethics
1748:Cyberethics
1492:Atomtronics
741:(4): 4–10.
573:(1): 1–34.
466:: 361–401.
258:retinotopic
1889:Categories
1713:Automation
360:References
251:Advantages
236:horizontal
169:Advantages
105:Candidates
75:phosphenes
55:subretinal
47:epiretinal
1915:Blindness
1743:Bioethics
1676:Exocortex
1552:Millipede
381:: 463–85.
310:pixelated
156:coils or
150:telemetry
71:occipital
1587:UltraRAM
1370:Archived
1353:Archived
1333:Archived
1329:BBC News
1300:31234507
1249:28397414
1241:17325421
1198:21625622
1147:14638739
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621:14 March
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540:11834821
480:16004575
348:See also
341:Argus II
312:images.
276:membrane
261:creates
247:signal.
244:ganglion
240:amacrine
158:infrared
49:(on the
41:(RP) or
1533:Memory
1291:6630275
1221:Bibcode
1189:3089939
1033:3319859
938:Bibcode
846:1955635
720:9888437
693:9109761
658:1444925
615:fda.gov
588:4111484
548:1561668
520:Bibcode
512:Science
428:4871047
419:1351724
232:bipolar
99:CE Mark
65:History
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1738:Ethics
1706:Topics
1418:Fields
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1537:CBRAM
1529:GPGPU
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954:S2CID
802:S2CID
759:S2CID
544:S2CID
125:Types
29:is a
1873:List
1599:RFID
1577:RRAM
1567:PRAM
1562:NRAM
1557:MRAM
1547:FRAM
1296:PMID
1237:PMID
1194:PMID
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1108:PMID
1073:PMID
1038:PMID
989:PMID
911:PMID
901:ISBN
851:PMID
794:PMID
751:PMID
716:PMID
689:PMID
654:PMID
623:2015
593:PMID
536:PMID
476:PMID
424:PMID
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1920:Eye
1286:PMC
1276:doi
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1135:doi
1100:doi
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