Blind World



June 13, 2002.

BY Deborah L. Shelton,
St. Louis Post-Dispatch.

A St. Louis University neurosurgeon has become the first American doctor to implant an electronic artificial eye that makes it possible for a blind person to see.

Dr. Kenneth R. Smith Jr., a professor of neurosurgery at St. Louis University School of Medicine, was one of four surgeons who implanted into eight blind patients devices that stimulate the visual cortex of the brain.

The device doesn't restore normal sight and doesn't work for all types of blindness. But it permitted some patients to recognize large objects and walk without aids. The two- to three-hour operations took place in Lisbon, Portugal, in April, with patients coming from six countries, including one from the United States.

The device has been compared to the one worn by actor Lavar Burton on the TV show "Star Trek: The Next Generation." Burton played a blind engineer on the futuristic science fiction drama who wore a visor over his eyes that allowed him to see.

William H. Dobelle, inventor of the device implanted in April, is presenting data -- along with the patients -- for the first time today at the annual meeting of the American Society for Artificial Internal Organs in New York.

"Personally I think it's just a matter of time before electrical stimulators will replace the long cane, Braille and guide dog," Dobelle said. "It will be a gradual process. It could take the rest of the century."

Work on the device began in 1968. Two years later, Smith began collaborating with The Dobelle Institute, a private company based in New York and Lisbon that develops medical devices.

Born in St. Louis and raised in Greenville, Ill., Smith has been with St. Louis University for 36 years, specializing in treatment of brain tumors and traumatic injury to the brain and spinal cord.

"Our earliest collaborations were with doctors at St. Louis University," said Dobelle, president and chief executive officer of the institute. "Ken Smith did some of the first cases, so there is a very long connection to St. Louis."

Another major step also could take place here.

Plans are under way, Smith said, to establish a center at St. Louis University that would be the first to do the operations in the United States.

Thousands of patients nationwide, especially those who have suffered degeneration of the retina from diabetes, could benefit from the device, Smith said.

The procedure, hospitalization and equipment cost about $98,000.

It was designed for people who went blind due to injury but were not candidates for retinal implants. Those who lost sight in early childhood or at birth would not be good candidates because the visual cortex of their brains would not be fully developed, Dobelle said.

Patients see white flashes of light in patterns that resemble stars on a black background, like a photographic negative.

"Four of the eight patients saw brilliantly colored phosphenes, giving hope that future prostheses will work in full color," Smith said. Phosphenes are flashes of light caused by stimulation of the brain.

Two of the patients were totally blind before their surgeries but see well enough now to practice driving under controlled circumstances.

One of those patients, Jens, who has asked that his last name not be published, has been blind for 19 years after two accidents.

"When I first got this (device), I just looked around," Jens said from the conference in New York. "Now, I don't want to watch where I'm going. I get distracted and just look at everything. This brings me back to the world I used to be in. I think, 'My goodness, how did I ever make it in this darkness?'"

The patients wear special sunglasses fitted with a miniature television camera. A microcomputer and stimulator are carried on the waist on a belt or in a bag. The equipment attaches by cable to a tiny fire hydrant-like device implanted in the skull that connects to two electrodes on the surface of the part of the brain that controls sight.

To get started, Jens, 39, of Kingston, Ontario, wears the device for an hour each day to get his brain adjusted to visual stimuli. He was the first to get the artificial eye since it became commercially available in April.

Although patients are enthusiastic, raising false hopes is a concern.

David Elkin, executive director of the St. Louis Society for the Blind and Visually Impaired, said the technology sounds interesting. But he feared it "could generate a lot of false hope for people who have never seen."

Smith shares that fear.

"I'm always worried about raising false hopes," Smith said. "I don't want to be overly optimistic. But this looks very promising at the moment."

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