What do blind people ‘see’ with retinal prostheses? Observations and qualitative reports of epiretinal implant users
Open accessPublished version of a preprint
Abstract
INTRODUCTION: Retinal implants have now been approved and commercially available for certain clinical populations for over 5 years, with hundreds of individuals implanted, scores of them closely followed in research trials. Despite these numbers, however, few data are available that would help us answer basic questions regarding the nature and outcomes of artificial vision: what do recipients see when the device is turned on for the first time, and how does that change over time? METHODS: Semi-structured interviews and observations were undertaken at two sites in France and the UK with 16 recipients who had received either the Argus II or IRIS II devices. Data were collected at various time points in the process that implant recipients went through in receiving and learning to use the device, including initial evaluation, implantation, initial activation and systems fitting, re-education and finally post-education. These data were supplemented with data from interviews conducted with vision rehabilitation specialists at the clinical sites and clinical researchers at the device manufacturers (Second Sight and Pixium Vision). Observational and interview data were transcribed, coded and analyzed using an approach guided by Interpretative Phenomenological Analysis (IPA). RESULTS: Implant recipients described the perceptual experience produced by their epiretinal implants as fundamentally, qualitatively different than natural vision. All used terms that invoked electrical stimuli to describe the appearance of their percepts, yet the characteristics used to describe the percepts varied significantly between recipients. Artificial vision for these recipients was a highly specific, learned skill-set that combined particular bodily techniques, associative learning and deductive reasoning in order to build a "lexicon of flashes"-a distinct perceptual vocabulary that they then used to decompose, recompose and interpret their surroundings. The percept did not transform over time; rather, the recipient became better at interpreting the signals they received, using cognitive techniques. The process of using the device never ceased to be cognitively fatiguing, and did not come without risk or cost to the recipient. In exchange, recipients received hope and purpose through participation, as well as a new kind of sensory signal that may not have afforded practical or functional use in daily life but, for some, provided a kind of "contemplative perception" that recipients tailored to individualized activities. CONCLUSION: Attending to the qualitative reports of implant recipients regarding the experience of artificial vision provides valuable information not captured by extant clinical outcome measures.
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The majority of research on visual prostheses and low vision aids has focused on technical aspects rather than usability.
“As pointed out by Htike et al. (2020) and Erickson-Davis and Korzybska (2021), the majority of research on visual prostheses (and more generally: low vision aids) has focused on the technical aspects rather than the usability of these devices.”
From Towards a <i>Smart Bionic Eye</i> : AI-powered artificial vision for the treatment of incurable blindness (2022) · cites this paper as Erickson-Davis and Korzybska, 2021
The Introduction says research on retinal prostheses has overlooked users’ subjective accounts, including what it is like to learn to use and live with the devices. The Discussion says qualitative reports have been neglected relative to functional outcome measures. The paper does not establish that a majority of research focuses on technical aspects, or extend that assessment to low-vision aids generally; page numbers are unavailable in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredInteractions between device electronics and the underlying neurophysiology can lead to perceptual distortions that severely limit the quality of the generated visual experience.
“Interactions between the device electronics and the underlying neurophysiology can lead to perceptual distortions that severely limit the quality of the generated visual experience (Fine and Boynton, 2015; Beyeler et al., 2019; Erickson-Davis and Korzybska, 2021).”
From Towards a <i>Smart Bionic Eye</i> : AI-powered artificial vision for the treatment of incurable blindness (2022) · cites this paper as Erickson-Davis and Korzybska, 2021
Results from clinical use of commercially available retinal prostheses showed that for now, patients affected by retinal degeneration could only expect a form of vision substitution (artificial vision) rather than vision restoration.
“Although remarkable engineering progress has been made since the very first prototype of a visual prosthesis [87], results from the clinical use of commercially available retinal prostheses showed that for now, patients affected by retinal degeneration could only expect a form of vision substitution (artificial vision) rather than vision restoration [221].”
From Advances in visual prostheses: engineering and biological challenges (2022) · cites this paper as [221]
Cognitive fatigue reported by users has discouraged them from using the implant long-term.
“Additionally, the cognitive fatigue reported so far by users has discouraged them from using the implant long-term [221].”
From Advances in visual prostheses: engineering and biological challenges (2022) · cites this paper as [221]
Current prosthetic vision quality is rudimentary and does not differ much across different device technologies.
“Despite recent advances in the development of visual neuroprostheses, the quality of current prosthetic vision is still rudimentary and does not differ much across different device technologies.”
From Towards a <i>Smart Bionic Eye</i> : AI-powered artificial vision for the treatment of incurable blindness (2022) · cites this paper as Erickson-Davis and Korzybska, 2021
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“Despite their potential, cortical implants to date have rarely elicited percepts beyond simple shapes or flashes of light [7, 17, 18, 20].”
- Authors
- Erickson-Davis, C., & Korzybska, H.
- Affiliations
- Stanford University (US)
- Université Paris Nanterre (FR)
- Corresponding author
- Erickson-Davis, Cordelia
- Korzybska, Helma
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2021-02-10
- Volume
- 16
- Issue
- 2
- Pages
- e0229189
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC7875418
- OpenAlex
- W3126955317
- Cited by
- 83
- References
- 64
- Citations by year
- 2026: 10 · 2025: 18 · 2024: 10 · 2023: 12 · 2022: 20 · 2021: 10 · 2020: 3
- FWCI
- 5.99
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- bioRxiv (Cold Spring Harbor Laboratory) (acceptedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Science Foundation (1753701)
- Topics
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neuroscience and Neural Engineering
- Life Sciences › Neuroscience › Cognitive Neuroscience › Tactile and Sensory Interactions
- Health Sciences › Health Professions › Occupational Therapy › Assistive Technology in Communication and Mobility
- Keywords
- retinal prosthesis, epiretinal implants, artificial vision, blind people, Argus II, perceptual experience, electrical stimulation, visual rehabilitation, mental fatigue, user experience
- MeSH terms
- Adult, England, Female, France, Humans, Male, Middle Aged, Retina, Vision, Ocular, Visual Perception, Epiretinal Membrane, Prosthesis Implantation, Persons with Visual Disabilities, Visually Impaired Persons, Visual Prosthesis
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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