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A tiny wireless implant inserted under the retina can restore central vision to patients with sight loss due to age-related macular degeneration (AMD). In an international clinical trial, the PRIMA (photovoltaic retina implant microarray) system restored the ability to read in 27 of 32 participants followed up after a year.
AMD is the most common cause of incurable blindness in older adults. In its advanced stage, known as geographic atrophy, AMD can cause progressive, irreversible death of light-sensitive photoreceptors in the centre of the retina. This loss of photoreceptors means that light is not transduced into electrical signals, causing profound vision loss.
The PRIMA system works by replacing these lost photoreceptors. The two-part system includes the implant itself: a 2 x 2 mm array of 378 photovoltaic pixels, plus PRIMA glasses containing a video camera that captures images and, after processing, projects them onto the implant using near-infrared light. The pixels in the implant convert this light into electrical pulses, restoring the flow of visual information to the brain. Patients can use the glasses to focus and zoom the image that they see.
The clinical study, led by Frank Holz of the University of Bonn in Germany, enrolled 38 participants at 17 hospital sites in five European countries. All participants had geographic atrophy due to AMD in both eyes, as well as loss of central sight in the study eye over a region larger than the implant (more than 2.4 mm in diameter), leaving only limited peripheral vision.
Around one month after surgical insertion of the 30 μm-thick PRIMA array into one eye, the patients began using the glasses. All underwent training to learn to interpret the visual signals from the implant, with their vision improving over months of training.
The PRIMA implant Representative fundus and OCT images obtained before and after implantation of the array in a patient’s eye. (Courtesy: Science Corporation)
After one year, 27 of the 32 patients who completed the trial could read letters and words (with some able to read pages in a book) and 26 demonstrated clinically meaningful improvement in visual acuity (the ability to read at least two extra lines on a standard eye chart). On average, participants could read an extra five lines, with one person able to read an additional 12 lines.
Nineteen of the participants experienced side-effects from the surgical procedure, with 95% of adverse events resolving within two months. Importantly, their peripheral vision was not impacted by PRIMA implantation. The researchers note that the infrared light used by the implant is not visible to remaining photoreceptors outside the affected region, allowing patients to combine their natural peripheral vision with the prosthetic central vision.
“Before receiving the implant, it was like having two black discs in my eyes, with the outside distorted,” Sheila Irvine, a trial patient treated at Moorfields Eye Hospital in the UK, says in a press statement. “I was an avid bookworm, and I wanted that back. There was no pain during the operation, but you’re still aware of what’s happening. It’s a new way of looking through your eyes, and it was dead exciting when I began seeing a letter. It’s not simple, learning to read again, but the more hours I put in, the more I pick up. It’s made a big difference.”
The PRIMA system – originally designed by Daniel Palanker at Stanford University – is being developed and manufactured by Science Corporation. Based on these latest results, reported in the New England Journal of Medicine, the company has applied for clinical use authorization in Europe and the United States.
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Researchers in the Netherlands have demonstrated the first chip-based device capable of splitting phonons, which are quanta of mechanical vibrations. Known as a single-phonon directional coupler, or more simply as a phonon splitter, the new device could make it easier for different types of quantum technologies to “talk” to each other. For example, it could be used to transfer quantum information from spins, which offer advantages for data storage, to superconducting circuits, which may be better for data processing.
“One of the main advantages of phonons over photons is they interact with a lot of different things,” explains team leader Simon Gröblacher of the Kavli Institute of Nanoscience at Delft University of Technology. “So it’s very easy to make them interface with systems.”
There are, however, a few elements still missing from the phononic circuitry developer’s toolkit. One such element is a reversible beam splitter that can either combine two phonon channels (which might be carrying quantum information transferred from different media) or split one channel into two, depending on its orientation.
While several research groups have already investigated designs for such phonon splitters, these works largely focused on surface acoustic waves. This approach has some advantages, as waves of this type have already been widely explored and exploited commercially. Mobile phones, for example, use surface acoustic waves as filters for microwave signals. The problem is that these unconfined mechanical excitations are prone to substantial losses as phonons leak into the rest of the chip.
Mimicking photonic beam splitters
Gröblacher and his collaborators chose instead to mimic the design of beam splitters used in photonic chips. They used a strip of thin silicon to fashion a waveguide for phonons that confined them in all dimensions but one, giving additional control and reducing loss. They then brought two waveguides into contact with each other so that one waveguide could “feel” the mechanical excitations in the other. This allowed phonon modes to be coupled between the waveguides – something the team demonstrated down to the single-phonon level. The researchers also showed they could tune the coupling between the two waveguides by altering the contact length.
Although this is the first demonstration of single-mode phonon coupling in this kind of waveguide, the finite element method simulations Gröblacher and his colleagues ran beforehand made him pretty confident it would work from the outset. “I’m not surprised that it worked. I’m always surprised how hard it is to get it to work,” he tells Physics World. “Making it to look and do exactly what you design it to do – that’s the really hard part.”
Prospects for integrated quantum phononics
According to A T Charlie Johnson, a physicist at the University of Pennsylvania, US whose research focuses on this area, that hard work paid off. “These very exciting new results further advance the prospects for phonon-based qubits in quantum technology,” says Johnson, who was not directly involved in the demonstration. “Integrated quantum phononics is one significant step closer.”
As well as switching between different quantum media, the new single-phonon coupler could also be useful for frequency shifting. For instance, microwave frequencies are close to the frequencies of ambient heat, which makes signals at these frequencies much more prone to thermal noise. Gröblacher already has a company working on transducers to transform quantum information from microwave to optical frequencies with this challenge in mind, and he says a single-phonon coupler could be handy.
One remaining challenge to overcome is dispersion, which occurs when phonon modes couple to other unwanted modes. This is usually due to imperfections in the nanofabricated device, which are hard to avoid. However, Gröblacher also has other aspirations. “I think the one component that’s missing for us to have the similar level of control over phonons as people have with photons is a phonon phase shifter,” he tells Physics World. This, he says, would allow on-chip interferometry to route phonons to different parts of a chip, and perform advanced quantum experiments with phonons.
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