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Like subretinal prostheses, suprachoroidal implants utilize the bipolar cells and the retinal network down to the ganglion cells, which process the visual information before relaying it to the brain. But devices implanted in this suprachoroidal location can be larger than those implanted directly above or below the retina, allowing them to cover a wider visual field, ideal for navigation purposes. In addition, suprachoroidal electrode arrays do not breach the retina, making for a simpler surgical procedure that should reduce the chance of adverse events and can even permit the device to be removed or replaced with minimal damage to the surrounding tissues.
In a healthy retina, photoreceptor cells—the rods and cones—convert light into electrical and chemical signals that propagate through the network of retinal neurons down to the ganglion cells, whose axons form the optic nerve and transmit the visual signal to the brain. (See .) Prosthetic devices work at different levels downstream from the initial reception and biochemical conversion of incoming light photons by the pigments of photoreceptor rods and cones at the back of the retina. Implants can stimulate the bipolar cells directly downstream of the photoreceptors, for example, or the ganglion cells that form the optic nerve. Alternatively, for pathologies such as glaucoma or head trauma that compromise the optic nerve’s ability to link the retina to the visual centers of the brain, prostheses have been designed to stimulate the visual system at the level of the brain itself. (See .)
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In the subretinal approach to visual prosthetics, electrodes are placed between the retinal pigment epithelium (RPE) and the retina. (See .) There, they stimulate the nonspiking inner retinal neurons—bipolar, horizontal, and amacrine cells—which then transmit neural signals down the retinal network to the retinal ganglion cells (RGCs) that propagate to the brain via the optic nerve. Stimulating the retinal network helps preserve some aspects of the retina’s natural signal processing, such as the “flicker fusion” that allows us to see video as a smooth motion, even though it is composed of frames with static images; adaptation to constant stimulation; and the nonlinear integration of signals as they flow through the retinal network, a key aspect of high spatial resolution. Electrical pulses lasting several milliseconds provide selective stimulation of the inner retinal neurons and avoid direct activation of the ganglion cells and their axons, which would otherwise considerably limit patients’ ability to interpret the spatial layout of a visual scene.
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