The Beginning of the Artificial Eye Program

Governor Rampton stuck out his hand “Welcome to Utah. If I can help you, let me know.” The President of the University, Fletcher (later head of NASA), said “Welcome to Utah and if you want to set up your own company, we will help you.” I had called a friend, Dr. C. William Hall, who worked with Dr. DeBakey in Houston, TX. “Where is the best regional medical program in the U.S.?” Answer: “In Salt Lake City.” Three days later, I was called by Dr. Keith Reemstma, head of the Department of Surgery of the University of Utah. He invited me over. I was 56 years old and it was April of 1967. The sun shone on the mountains. New snow covered the foothills. Clear water in large amounts rushed down Main Street. A few days later my wife, Janke, found a house overlooking the intermountain valley. We bought it before I had a contract. The University of Utah had no money but they would help me to bring in the money. My plan for an institute of artificial organs listed: artificial kidney heart lung machine artificial heart artificial eye artificial ear artificial arm etc. I went to Mt. Sinai Hospital in Cleveland to learn the new cost analysis program that estimated every sponge, every needle, and every bottle of saline. It was horrible, but I wrote a contract proposal for the Public Health Service. It featured a wind–it–yourself artificial kidney with which a patient could do home dialysis; all expenses for a 3 month period, including a Maytag washing machine, would be $263. We got the contract. That established the dialysis center in Utah. I wrote a grant proposal to build new types of artificial kidneys that established my laboratory in the Merrill Engineering Building at the University of Utah. (A young student, looking up at me said “This is the first time that I do something that I really like.”) I got an extension of 1 year for my artificial heart grant, and then William Dobelle stepped into my office. He wanted to work on an artificial eye and travelled through the U.S. to find the most promising place to do it. He travelled on, but some time later came back and was given wooden barracks #518 next to my wooden barracks #512. (They were World War I barracks.) Brindley in 1968 in England proved that electrical stimulation of the occipital lobe of the brain could produce the sensation of seeing a point of light, even in people who were totally blind and without eyes. The House brothers of California stimulated the accoustic nerve in the cochlea of the ear and caused hearing sensation in totally deaf people. These observations formed the scientific background of our work. Dobelle and I planned to make seeing and hearing prostheses that would be useful. From a panel of 24 blind people, we tried to find out what blind people really wanted: very little interest in reading except for the little sign that says “Men” or “Women.” They want to be able to walk around without bumping into other people; other people become unfriendly when bumped into. This was the time that the still young microcircuit industry changed from 3″ wafers to 5″ wafers. Dobelle and I visited the chairman of General Instruments Inc. which owned a complete 3″ wafer microcircuits laboratory between State and Main Street at 19 East Oakland Avenue in Salt Lake City. Dobelle proved to the chairman of G.I. that it would be financially better for the company if he donated the entire facility to the University of Utah and got a tax deduction, than what he would get if he sold it. I suddenly found myself the director of a complete microcircuit laboratory, of which I knew nothing. The manager of this laboratory, when it was owned by General Instruments, Dr. Bob Huber, was persuaded to stay on when I guaranteed his salary for 2 years. The laboratory flourished. Dobelle went to San Francisco, rented a room in a hotel, put in an advertisement in some newspapers for additional scientific personnel and hired them (one was Dr. Hanson). We greatly expanded the laboratory with other donations. General Instruments needed microcircuits and our laboratory made them. At that time we made a chip with 36,000 bits, which was the largest in the industry. Thus, we had the ability to build the electronics required for the artificial eye and the artificial ear. We then simplified the technique greatly by abandoning radio transfer into the skull and by adopting direct wiring via a pedestal. An array of 65 electrodes was built of multiple layers of teflon, roughly following the contour of the occipital lobe of the brain where the visual cortex is located. Platinum wires with small balls at the end were melted in the teflon, insulated and bundled, and brought to the pedestal that was screwed to the bone and came out through the skin. I want to regress to the earliest experiments in humans. Dobelle contacted nearly every neurosurgical unit in the U.S. and Canada. Traveling to them, he did 39 experiments. He induced United Airlines to ship the equipment wherever needed. He needed a patient to be operated on the occipital lobe of the brain under local anesthesia. These are few and far between. He and his co–workers, Mladejowski and others, would set up the equipment in the operating room and hope that the patient, whose cooperation had been assured, could indeed cooperate and would see a point of light when his cortex was stimulated. I often encouraged or consoled Mladejowski, who had his office near mine, when he was near desperation trying to disentangle the visual records from the stimulation. Indeed, Brindley’s (1968) findings were confirmed and further expanded, but it became obvious that we needed blind volunteers with more durable implants. We needed money and I became the principal investigator for an NIH contract that I could not have written without the help of Dobelle. We got the contract, but from the onset were in conflict with that branch of the NIH. They wanted us to use the technique that we all know in small hotels. A nice lady sits at a pegboard and plugs in the connector to your room telephone. Dobelle had other ideas. We did not have a grant but we had a contract. If you do not perform on a contract, the government can make you pay it back. It fell upon me to appease Washington. We wrote an application to the IRB (Institutional Review Board for Research on Human Subjects). We wanted to implant an array of electrodes on the visual cortex of a totally blind volunteer. Finding volunteers was no problem. There were many. I will never forget that meeting with the IRB. One of the members fell asleep during Dobelle’s presentation. Permission was denied. I will, to the end of my days, be grateful to the chairman of the IRB, Dr. Athens, who tabled the refusal and did not publish it. As I wrote earlier, Dobelle had visited most of the neurosurgical units in the U.S. and Canada. In his experience, Dr. Girvin in London, Ontario offered the best possibility for cooperation. So we all went to London, Ontario, with all of our equipment and all of our personnel. When the first blind man reported that indeed, he saw light, it was a profound emotional experience, not just for him but for all of us who were present. Some of us, including myself, cried. Dobelle, Mladejowski, and co-workers have described the results of these experiments in numerous publications. * The amount of data obtained in this and subsequent long-term experiments was so enormous that we abandoned the data obtained with the hand-held electrodes that we had collected as a traveling team, because it was not worth the trouble to decipher them anymore. Optimal mode of stimulation, mapping of the electrodes in the visual field, persistence of this map, and acceptability and durability of the implant were all determined. The distance between the electrodes had to be 3 mm or you got cross talk. With no more money from the NIH, how could we finance this work? The microcircuit laboratory became very prosperous, so much so that President Emmery of the University of the Utah feared it would lose its tax exempt status. The University of Utah, therefore, decided to take the microcircuit laboratory away from my Institute of Artificial Organs and give it to the Research Institute. The artificial ear is another story. Here we stimulate the accoustic nerve, which is neatly arranged in the cochlea. Sixty percent of totally deaf people can now use the telephone. None of the 66 patients wanted to give it up. “It is not just that we can communicate, we are also delivered from the totally silent world.” A Baptist minister flushed a toilet 10 times because he was so elated by the sound of the rushing water. On the 22nd of September, 1999, Dr. William Dobelle demonstrated in Dr. Eli Friedman’s department at the State University of New York at Brooklyn a blind man with an artificial eye. The last of four arrays with 65 electrodes that were made in Salt Lake City had been implanted 31 years ago in this blind volunteer at Columbia University and it is still working. Dr. Dobelle has reduced the desk size electronic stimulating equipment to a small unit the size of a book. Experiments to use it as a mobility prosthesis are now under way. The blind man found his way between some tables and chairs that were put there to block him. This reopens the artificial eye program that was started in 1967.

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