For patients with macular degeneration, new hope for restored sight
For millions of people with macular degeneration, treatment options are slim. The disease causes loss of central vision, which allows us to see straight ahead, and is highly dependent on age, with people over 75 at approximately 30% risk of developing the disorder. The BrightFocus Foundation estimates 11 million people in the U.S. currently have one of three forms of the disease.
Recently, ophthalmologists including Daniel Palanker at Stanford University published research showing advances in the PRIMA retinal implant, which could help people with advanced, age-related macular degeneration regain some of their sight. In a feasibility study, five patients had a pixelated chip implanted behind the retina, and three were able to see using their remaining peripheral vision and—thanks to the implant—their partially restored central vision at the same time.
Should people with macular degeneration be excited about these results?
“Every week, if not every day, patients come to me with this question because it's devastating when they lose their central vision,” says retinal surgeon Lynn Huang. About 40% of her patients have macular degeneration. Huang tells them that these implants, along with new medications and stem cell therapies, could be useful in the coming years.
“The goal here is to replace the missing photoreceptors with photovoltaic pixels, basically like little solar panels,” Palanker says.
That implant, a pixelated chip, works together with a tiny video camera on a specially designed pair of eyeglasses, which can be adjusted for each patient’s prescription. The video camera relays processed images to the chip, which electrically stimulates inner retinal neurons. These neurons, in turn, relay information to the brain’s visual cortex through the optic nerve. The chip restores patients’ central sight, but not completely. The artificial vision is basically monochromatic (whitish-yellowish) and fairly blurry; patients were still legally blind even after the implant, except when using a zoom function on the camera, but those with proper chip placement could make out large letters.
“The goal here is to replace the missing photoreceptors with photovoltaic pixels, basically like little solar panels,” Palanker says. These pixels, located on the implanted chip, convert light into pulsed electrical currents that stimulate retinal neurons. In time, Palanker hopes to improve the chips, resulting in bigger boosts to visual acuity.
The pixelated chips are surgically implanted during a process Palanker admits is still “a surgical learning curve.” In the study, three chips were implanted correctly, one was placed incorrectly, and another patient’s chip moved after the procedure; he did not follow post-surgical recommendations. One patient passed away during the study for unrelated reasons.
University of Maryland retinal specialist Kenneth Taubenslag, who was not involved in the study, said that subretinal surgeries have become less common in recent years, but expects implants to spur improvements in these techniques. “I think as people get more experience, [they’ll] probably get more reliable placement of the implant,” he said, pointing out that even the patient with the misplaced chip was able to gain some light perception, if not the same visual acuity as other patients.
Retinal implants have come under scrutiny lately. IEEE Spectrum reported that Second Sight, manufacturer of the Argus II implant used for people with retinitis pigmentosa, a genetic disease that causes vision loss, would no longer support the product. After selling hundreds of the implants at $150,000 apiece, company leaders announced they’d “decided to pursue an orderly wind down” of Second Sight in March 2020 in the wake of financial issues. Last month, the company announced a merger, shifting its focus to a new retinal implant, raising questions for patients who have Argus II implants.
Retinal surgeon Eugene de Juan of the University of California, San Francisco, was involved with early studies of the Argus implants, though his participation ended over a decade ago, before the device was marketed by Second Sight. He says he would consider recommending future implants to patients with macular degeneration, given the promise of the technology and the lack of other alternatives.
“I tell my patients that this is an area of active research and development, and it's getting better and better, so let's not give up hope,” de Juan says. He believes cautious optimism for Palanker’s implant is appropriate: “It's not the first, it's not the only, but it's a good approach with a good team.”
How to have a good life, based on the world's longest study of happiness
What makes for a good life? Such a simple question, yet we don't have great answers. Most of us try to figure it out as we go along, and many end up feeling like they never got to the bottom of it.
Shouldn't something so important be approached with more scientific rigor? In 1938, Harvard researchers began a study to fill this gap. Since then, they’ve followed hundreds of people over the course of their lives, hoping to identify which factors are key to long-term satisfaction.
Eighty-five years later, the Harvard Study of Adult Development is still going. And today, its directors, the psychiatrists Bob Waldinger and Marc Shulz, have published a book that pulls together the study’s most important findings. It’s called The Good Life: Lessons from the World’s Longest Scientific Study of Happiness.
In this podcast episode, I talked with Dr. Waldinger about life lessons that we can mine from the Harvard study and his new book.
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More background on the study
Back in the 1930s, the research began with 724 people. Some were first-year Harvard students paying full tuition, others were freshmen who needed financial help, and the rest were 14-year-old boys from inner city Boston – white males only. Fortunately, the study team realized the error of their ways and expanded their sample to include the wives and daughters of the first participants. And Waldinger’s book focuses on the Harvard study findings that can be corroborated by evidence from additional research on the lives of people of different races and other minorities.
The study now includes over 1,300 relatives of the original participants, spanning three generations. Every two years, the participants have sent the researchers a filled-out questionnaire, reporting how their lives are going. At five-year intervals, the research team takes a peek their health records and, every 15 years, the psychologists meet their subjects in-person to check out their appearance and behavior.
But they don’t stop there. No, the researchers factor in multiple blood samples, DNA, images from body scans, and even the donated brains of 25 participants.
Robert Waldinger, director of the Harvard Study of Adult Development.
Katherine Taylor
Dr. Waldinger is Clinical Professor of Psychiatry at Harvard Medical School, in addition to being Director of the Harvard Study of Adult Development. He got his M.D. from Harvard Medical School and has published numerous scientific papers he’s a practicing psychiatrist and psychoanalyst, he teaches Harvard medical students, and since that is clearly not enough to keep him busy, he’s also a Zen priest.
His book is a must-read if you’re looking for scientific evidence on how to design your life for more satisfaction so someday in the future you can look back on it without regret, and this episode was an amazing conversation in which Dr. Waldinger breaks down many of the cliches about the good life, making his advice real and tangible. We also get into what he calls “side-by-side” relationships, personality traits for the good life, and the downsides of being too strict about work-life balance.
Show links
- Bob Waldinger
- Waldinger's book, The Good Life: Lessons from the World's Longest Scientific Study of Happiness
- The Harvard Study of Adult Development
- Waldinger's Ted Talk
- Gallup report finding that people with good friends at work have higher engagement with their jobs
- The link between relationships and well-being
- Those with social connections live longer
The Friday Five: A new blood test to detect Alzheimer's
The Friday Five covers five stories in research that you may have missed this week. There are plenty of controversies and troubling ethical issues in science – and we get into many of them in our online magazine – but this news roundup focuses on scientific creativity and progress to give you a therapeutic dose of inspiration headed into the weekend.
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Here are the promising studies covered in this week's Friday Five:
- A blood test to detect Alzheimer's
- War vets can take their psychologist wherever they go
- Does intermittent fasting affect circadian rhythms?
- A new year's resolution for living longer
- 3-D printed eyes?