Étude randomisée en double aveugle

L'étude randomisée en double aveugle, avec répartition aléatoire, randomisée ou à double insu (ou en double aveugle) est une démarche expérimentale utilisée dans de nombreuses disciplines de recherche telles que la médecine, les sciences sociales et la psychologie, les sciences naturelles telles que la physique et la biologie. En pharmacie, elle est utilisée dans le développement de nouveaux médicaments et pour évaluer l'efficacité d'une démarche ou d'un traitement. Par exemple, durant l'étude sur un médicament, ni le patient ni le prescripteur ne savent si le patient utilise le médicament actif ou le placebo. Le rôle d'un tel protocole, relativement lourd à mettre en place, est de réduire au mieux l'influence sur la ou les variables mesurées que pourrait avoir la connaissance d'une information à la fois sur le patient (premier « aveugle ») et sur le médecin (deuxième « aveugle »). C'est la base de la médecine fondée sur les faits. Il existe même un raffinement supplémentaire avec la

Fabrication and validation of an intraneural interface tailored for optic nerve stimulation

Eleonora Borda

Technological progress in materials science and microengineering along with new discoveries in neuroscience have contributed to restore lost or impaired sensory functions by closely interfacing with the nervous system. Electronic devices have begun to be integrated within the body to artificially reproduce or record the electrical encoding of neural signals, the language of the nervous system. This has allowed us to restore the impaired communication between the missing or defective organ and the brain. As evidence of this, cochlear implants have returned hearing to millions of people world wide. On the other hand, there is no suitable solution yet for the 43 millions people who are currently blind. Nevertheless, several research groups and companies are trying to tackle this issue. So far, different devices have demonstrated the capability of restoring a certain degree of artificial vision, however, with limited success in delivering meaningful improvements in daily life activities. This is because, unlike hearing, vision is an extremely complex sense and requires higher stimulation resolution. Limitations of retinal prostheses have pushed further the investigation of other targets along the visual pathway, such as the optic nerve, the thalamus and the visual cortex. Among these, our group has started to explore the possibility of stimulating the optic nerve. The main advantages are the direct stimulation of the axon fibers and the access to the entire visual field with only one device. It is also interesting because it could work for those patients who are not eligible for retinal prostheses, due to severe eye trauma or retinal detachment, and it does not require optical transparency.In this thesis, we investigate stimulation strategies and materials to improve the outcome of optic nerve prostheses and make them one step closer to a viable option for blind patients. We first propose the use of machine learning algorithms to classify cortical activity upon electrical stimulation of the optic nerve. Secondly, we investigate a strategy to achieve higher spatial selectivity of the optic nerve stimulation. We design a three-dimensional (3D) multilayer concentric bipolar (CB) configuration and fabricate a modified version of the OpticSELINE. We validate the efficacy of the novel design during in-vivo experiments on rabbits and find that cortical activation is reduced when using the 3D multilayer CB electrodes compared to the classic monopolar configuration. In parallel, we explore the use of novel polymers, namely Off-Stoichiometry Thiol- Ene Epoxy (OSTE+), to design conformable neural interfaces. Their chemistry makes them a suitable candidate for easy integration in cleanroom processes and they show superior adhesion properties with respect to standard thin films currently in use. Hence, we characterise their usability as substrate and encapsulation for neural interfaces in-vitro and in-vivo. Lastly, we propose an alternative fabrication technique, ink-jet printing of platinum on flexible substrates, for neurophysiology applications. Altogether, the findings highlighted in this thesis will hopefully lead to a more in-depth investigation of the optic nerve prosthesis and can also be relevant for other applications in the field of neuroprosthetics.

EPFL2022

Virtual reality simulation of epiretinal stimulation highlights the relevance of the visual angle in prosthetic vision

Diego Ghezzi, Enrico Migliorini, Jacob Thomas Thorn

Objective. Retinal prostheses hold the potential to restore artificial vision in blind patients suffering from outer retinal dystrophies. The optimal number, density and coverage of the electrodes that a retinal prosthesis should have to provide adequate artificial vision in daily activities is still an open question and an important design parameter needed to develop better implants. Approach. To address this question, we investigated the interaction between the visual angle, the pixel number and the pixel density without being limited by a small electrode count. We implemented prosthetic vision in a virtual reality environment in order to simulate the real-life experience of using a retinal prosthesis. We designed four different tasks simulating: object recognition, word reading, perception of a descending step and crossing a street. Main results. The results of our study showed that in all the tasks the visual angle played the most significant role in improving the performance of the participant. Significance. The design of new retinal prostheses should take into account the relevance of the restored visual angle to provide a helpful and valuable visual aid to profoundly or totally blind patients.

2020

POLYRETINA restores light responses in vivo in blind Gottingen minipigs

Marta Jole Ildelfonsa Airaghi Leccardi, Diego Ghezzi, Golnaz Sherafatipour, Paola Vagni, Charles-Henri Puncho Jérôme Vila, Elodie Geneviève Zollinger

Retinal prostheses hold potential for artificial vision in blind people. Here, authors show that POLYRETINA, a large and high-density photovoltaic epiretinal device, restores light-evoked cortical responses in blind Gottingen minipigs at safe irradiance levels. Retinal prostheses hold the potential for artificial vision in blind people affected by incurable diseases of the outer retinal layer. Available technologies provide only a small field of view: a significant limitation for totally blind people. To overcome this problem, we recently proposed a large and high-density photovoltaic epiretinal device, known as POLYRETINA. Here, we report the in vivo assessment of POLYRETINA. First, we characterise a model of chemically-induced blindness in Gottingen minipigs. Then, we develop and test a minimally invasive injection procedure to insert the large epiretinal implant into the eye. Last, we show that POLYRETINA restores light-evoked cortical responses in blind animals at safe irradiance levels. These results indicate that POLYRETINA holds the potential for artificial vision in totally blind patients affected by retinitis pigmentosa.

NATURE PORTFOLIO2022

Fabrication and validation of an intraneural interface tailored for optic nerve stimulation

Eleonora Borda

EPFL2022