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Bionic Eye : An Iconic Innovation

Article in TNOA Journal of Ophthalmic Science and Research · March 2021

DOI: 10.4103/tjosr.tjosr_168_20

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Review Article

Bionic Eye: An Iconic Innovation

Tarun Kumar Suvvari, Mansi Thipani Madhu1, Sowmyashree Nagendra2
Rangaraya Medical College, Kakinada, Andhra Pradesh, 1Vydehi Institute of Medical Sciences and Research Centre,
2
Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India

Abstract
The bionic eye is a visual prosthesis that restores the vision fully or partly in blind people suffering from retinitis pigmentosa and macular
degenerations. Many bionic eyes have completed human clinical trials and become functional but still need newer technical approaches to
make it available to all people. A bionic eye illuminates the dark world of blind people. To date, many bionic eyes were developed like Argus
II Retinal Prosthesis System, Artificial silicon retina and many more, whereas Gennaris Bionic vision System is the recent advanced bionic
eye. In our paper, we have covered the basic structure and working of the bionic eye, projects on the bionic eye to date, vision through the
bionic eye, implants and restoration of sight, limitations, and the future of the bionic eye.

Keywords: Bionic eye, retina, vision, visual prostheses

Introduction for patients with defects in light processing functions (damage

People having a near or distance vision impairment are
estimated to be at least 1 billion globally that could have been
prevented or has yet to be addressed. Uncorrected refractive
error, cataracts, and diabetic nephropathy are the major causes
of vision impairment and blindness. The most common age
group suffering from vision impairment and blindness is
over 50 years.[1]
The eye receives a light stimulus and transforms into a
nerve impulse, which runs along the optic nerve reaching
the visual cortex and gives rise to visual sensation. The
retina is the innermost membrane of the eye that contains
photoreceptors (rods and cones), and the macula (fovea
centralis) is the most sensitive spot, and cones are concentrated
at that point. The retina transforms light energy into an
electrical stimulus and transmits them to the brain through
optic nerves to create vision.[2]
A bionic eye is a form of a neural prosthesis intended to restore
lost vision or partially amplify existing vision. The bionic eye
was developed in view of patients with vision loss due to the
degeneration of photoreceptors like retinitis pigmentosa (RP),
macular degeneration. Visual prosthetic implants are suitable
Received: 12-11-2020      Revised: 22-12-2020
Accepted: 13-01-2021      Published: 27-03-2021
to the retina, macula, and optic nerve). But for patients who
were born blind, it was not convenient to implant a bionic eye
them due to not well developed optic nerve.[3]
Overview of Basic Structure and Working of the
Bionic Eye
The bionic eye is a visual prosthesis which helps to restore the
vision fully or partly. Visual prostheses are implanted based
on neuronal electric stimulation at different locations along
the visual pathway, i.e., subretinal, epi‑retinal, optic nerve,
and visual cortex.
The bionic eye consists of image sensors, radio transmitters,
microprocessors, receivers, and retinal chips. This electronic
system helps blind people to get back good vision. Bionic
eyes have a computer chip located at the back eye and linked
to a small video camera built into glasses, which they wear.
The camera’s captured images are focused on the chip, which
converts it into an electronic signal and sends it to the brain.
Electrodes on the implanted chip cover these signals into
electrical impulses to stimulate cells in the retina that connect
Address for correspondence: Mr. Tarun Kumar Suvvari,
Rangaraya Medical College, Kakinada, Andhra Pradesh, India.
E‑mail: tarunkumarsuvvari234@gmail.com

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DOI:
10.4103/tjosr.tjosr_168_20 How to cite this article: Suvvari TK, Madhu MT, Nagendra S. Bionic eye:
An iconic innovation. J Ophthalmic Sci Res 2021;59:52-5.

52 © 2021 TNOA Journal of Ophthalmic Science and Research | Published by Wolters Kluwer - Medknow
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Suvvari, et al.: Bionic eye
to the optic nerve. These impulses are then passed down along
the optic nerve to the brain’s visual cortex, where they are
interpreted as an image. The images produced by the bionic
eye do not have high clarity, but they are good enough to
recognize the things/places.[4,5]
Projects Till Date on Bionic Eye
Argus II retinal prosthesis
Argus II Retinal Prosthesis System is also called an “artificial
retina” or “bionic eye.” It is the epi‑renal implant and approved
by the US Food and Drug Administration on February 14,
2013. Argus II consists of a mini video camera, the transmitter
set up into eyeglasses, a video processing unit (VPU), and
implanted retinal prosthesis (array of electrodes).[6] The video
camera captures images and transforms it into electronic
data with the help of VPU, which sends signals to a wireless
receiver (the retinal prosthesis electrodes). The electrodes sent
the electronic signals to bypass the damaged retina and transmit
directly to the brain’s visual cortex and interpreted as visual
images. The criteria to get implant Argus II are aged 25 or older,
aphakic or pseudophakic, having bare light or no light perception
in both eyes, and previous history of good visual acuity.[7]
Artificial silicon retina
Artificial silicon retina (ASR) is a subretinal implant, a silicon
microchip of 2 mm diameter that contains approximately 5000
microelectrode‑tipped micro photodiodes and is powered
by incident light. It is a solid‑state biocompatible chip that
contains an array of photoreceptors. It is implanted to replace
the functionality of defective photoreceptors.[8] The need for
external supply was eliminated in the ASR. The ASR was
shown excellent vision restoration and did not lead to any side
effects like rejection, inflammation, neovascularization…etc.[9]
Harvard/Massachusetts Institute of Technology Retinal
Implant
It is an epi‑retinal implant where a microelectrode array
replaces damaged photoreceptors. The image acquisition was
using a charged couple device (CCD) camera. The patient
spectacle holds the power source and camera. The subretinal
stimulator (array of electrodes) is placed beneath the retina in
the subretinal space, which receives image signals from the
camera and the stimulator chip, decodes signals, and stimulates
retinal ganglion cells. The secondary receiver coil was sutured
around the iris.[10,11]
Multiple units of artificial retinal chipset system
Multiple units of artificial retinal chipset system (MARC) uses
a CCD camera input and radio frequency signals to transmit the
image into the microchip present in the retina. The image has
a resolution of 100 pixels, which is achieved using a 10 × 10
array. It contains a platinum/rubber silicon electrode array
placed inside the eye, which stimulates the cells. It also consists
have a secondary receiving coil mounted near to the cornea.
An external mini low‑power CMOS camera was attached to
an eyeglass frame. It captures an image and transfers the visual
TNOA Journal of Ophthalmic Science and Research ¦ Volume 59 ¦ Issue 1 ¦ January-March 2021
information and power to the intraocular components through
radiofrequency waves. The intraocular prosthesis will decode
the signals and send electrical stimulus to retinal neurons
through the electrodes, which visualize images acquired by
the CMOS camera. The MARC system has a compact size
of 6 mm × 6 mm, good diagnostic capability, and low stress
on the retina.[12]
There are many more similar projects mentioned above
like Alpha IMS (subretinal visual implant),[13] holographic
technology (based on optogenetics),[14] microsystem‑based
visual prosthesis, implantable miniature telescope, [15]
photovoltaic retinal prosthesis (PRIMA), intracortical visual
prosthesis….etc.
Recent Advances in Bionic Eye
Gennaris bionic vision system
Gennaris[16] is a project by the Monash Vision Group (MVG)
of Monash University in collaboration with Alfred Health,
Grey Innovation, and MiniFAB. It is designed in a way where
people with optic nerve damage can also get vision.
Gennaris consists of headgear with a camera, a vision processor
unit and software, a wireless transmitter, and a series of 9 mm × 9
mm tiles for implanting into the brain. The video recorded by
the camera will be sent to the vision processor, where it will be
processed to extract the required information. The data will be
transmitted wirelessly to the circuitry within each implanted
tile. The data will be converted into electrical pulses, which will
stimulate the brain through the microelectrode array. The visual
pattern will be created with combinations of up to 473 spots of
light (phosphenes), which will provide necessary information
for the user regarding indoor and outdoor environments and
recognize the presence of people and objects around them. The
headgear of gennaris encases MVG’s wireless transmission
technology, sending data to up to 10 implants where each can
stimulate 43 points of the human visual cortex. Because of direct
involvement with the cortex, MVG’s technology has hopes to
assist most people who have total blindness also.[16]
Many projects related to the bionic eye are still under clinical
trials. Approximately 1 million electrodes are necessary for
natural sight. Developers are currently working on implants
with 240 electrodes and peripheral electrodes to improve the
size of the person’s visual field.
Vision through the Bionic Eye
The bionic eye technology is complex. It depends on the
specific eye or prototype, as well as the associated condition.
The bionic eye architecture consists of both external and
internal components.[17] The external components include
glasses with a video micro camera mounted in it and an external
connection coil. The Visual Processing Unit (VPU), which is
a portable computer customized for the patient., the internal
component is the implant, and it consists of the receiver’s coil,
electronic case, microelectrode array.[17,18]
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Suvvari, et al.: Bionic eye
When the system is turned on, the micro‑camera in the glasses
records and transmits the images to the VPU. The image is
converted into electrical stimulations and sent to the external
transmitter coil. These signals are then transmitted to the
receiver coil of the implant. The receiver coil and electronics
case are sutured to the sclera of the eye. The received signals
are decoded, and stimulation output is generated, sent to the
microelectrode array. Microelectrodes deliver stimulation to
the retina. The impulses are relayed to the brain through the
normal optic nerve tract, generating vision.[18,19]
Implants and Restoration of Sight
The flickering light is designed to reflect an object’s
fundamental form in front of the camera, with its approximate
height, width, and position. The electrical stimulation of the
surviving neurons causes the person to perceive tiny light
spots called phosphenes. A phosphene is a phenomenon of
experiencing seeing light without light actually entering the eye
- like the colours you may see when you close your eyes.[20,21]
These phosphenes can be used to map out the visual scene in
bursts of light in anyone with a bionic eye. The vision provided
by a bionic eye, therefore, is not like a natural vision. It is a
set of flickering spots and shapes that the individual uses to
view the world. The vision created by the system is distinct
from the premorbid vision of the patient. To process light
patterns, patients must understand its working. To interpret the
camera image, recipients need to use these irregular flashes.
After postoperative care and years of rehabilitation, several
individuals who acquired the implant were able to identify
everyday objects, faces of loved ones, even cross streets, and
read large‑print books without aid.[20,21]
Global Marketing on Bionic Eye
Bionics (a combination of biology and electronic equipment)
is gaining an increase in demand in India. Bionics is still in its
developing stages, but many hospitals and medical institutes
favor using bionics rather than organ transplants or traditional
methods such as a wooden leg/marble/glass eye.
Bionic eye or retinal implant was co‑invented by an Indian
origin Scientist, Dr. Rajat N Agrawal, an ophthalmologist and
retina surgeon, University of Southern California, USA. He is
currently working in collaboration with the All India Institute
of Medical Sciences, and IITs develop a cheaper native variant
of the bionic eye so that people in India can afford it. The
natively developed implant is assumed to be Rs 5 lakhs, which
is affordable and very less than Rs 45 lakhs’ present cost. He
was the founder of a nongovernmental group called “Retina
India” to research retinal implants.[22]
North America currently dominates the global market; some
reasons include a patent for Argus II, higher per capita, and
increased awareness. Following North America, Europe and
Asia‑Pacific are leading. The Asia‑Pacific market is filled and
is penetrated only to a limited extent. The market has been
54 TNOA Journal of Ophthalmic Science and Research ¦ Volume 59 ¦ Issue 1 ¦ January-March 2021
growing since 2012 and is expected to surge in the upcoming
years. Unfortunately, the awareness about the bionic eye is
still less than the assumption.[23]
Limitations
The ultimate aim of the invention is to reach maximum people,
so it is all about the cost for Bionic eye, which is $30,000
approximately where many people cannot afford it. The cost
is the main factor of the bionic eye; hopefully, the cost will
decrease, and these will become more common in the medical
world in the coming years. The bionic eye is not suitable for all
blind people (e.g., glaucoma); it is mainly for people who have
retinal damage due to RP …etc. The percentage of restoration
of vision is not high enough. Unfortunately, the vision offered
by a bionic eye is not clear enough for recipients to rely on to
navigate the world since they generate streaky images and are
too slow to catch rapid movements. Overall, the vision still falls
short of a natural human eye. Researchers hope potential bionic
eye implants can generate higher resolution vision, but this has
inherent challenges. The Argus system allows recipients to say
the difference between forms, motion, and light. However,
since only 60 electrodes are part of the system, it does not
allow us to see in the same way that healthy eyes operate.
In comparison, we will need around a million electrodes to
achieve the natural vision. However, the Argus company plans
to add more electrodes in future models.
Another factor why the bionic eye cannot replicate human
eye vision is due to lack of perception of color as the retina
has many types of neurons, but the electrodes are too large
to target individual types selectively. This long procedure
is surely a very expensive one and may not be covered by
medical insurance. Apart from that, recipients must learn the
working of the device and the interpretation of flashes. The
patient must use head motions to scan the area, which is surely
tedious. The long‑term stability and long‑term impact of the
system’s electronic components on the retina are still not well
established.
The future of bionic eye
Although the vision provided by the bionic eye is far from
that of a natural eye, this system has endless opportunities for
improvement. Many surgeons are now becoming aware of the
benefits of the bionic eye over the traditional glass eye, but
choosing these over surgical and medical treatments is still a
long way down the road.
The major focus is to increase the number of electrodes in
the implants and decrease host immune response, contact
blood clotting, and device failures. Future implants may
enable people to see in color and they could also be extended
to a broader spectrum of diseases causing blindness. We
need to increase the number of electrodes that can produce
sharp, colorful, and more functional vision. The upcoming
generation of Argus II retinal stimulator is under design with
60 controllable electrodes, which can project high beam rays
and form high‑resolution images. Technology is advancing
more and more every day, and with inventions like this, it is
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Suvvari, et al.: Bionic eye
quite likely that in the near future, vision loss will be curable,
and its permanence will be a thing of the past.
Conclusion
The research and development in bionics are developing day
by day. Bringing back vision through a bionic eye will be a
boon to blind people in the upcoming days. There is a need to
investigate several technical limitations and missing links while
developing a bionic eye. On the other hand, integrative courses
bridging medical and technical knowledge like biomedical
engineering, biotechnology have been greatly underestimated
in developing countries, although the scope is rising recently.
Let us hope that the future research on the bionic eye will bring
out more accurate devices than the current ones.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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