Nano Retina, an Israeli startup founded by serial inventor Yossi Gross, participates in the race for more than 45 million blind people worldwide waiting at the finish line: the race of technological development that will allow them to see. And such a race exists.
For years, Raanan Gefen of Nano Retina has been receiving approximately five weekly emails from various places in the world. The content of the mail is similar: Blind people, or relatives of blind people, pleading for any development in the creation of the product Nano Retina has been trying to create – a chip implanted within the eye which will be able to return one’s eyesight. One of the last letters came from an important native American chief who was stricken with blindness at old age. Another letter was from a mother of two: her older child became blind recently and her younger child is exhibiting early symptoms of blindness.
Intially, 49-year-old Gefen would call each of these people but, in a race for time, decided to switch to email correspondences. “Some of them are willing to go far,” he says. “They declare that they can go on a plane, come here and be the first to undergo an implant trial. One of my responsibilities is to bring them back to earth and tell them that we are not yet at that stage.” Gefen knows he’s lucky: The number of companies that have patients requesting to participate in clinical trials is scarce; the period of clinical trials is one of the longest and most expensive periods in the lifespan of any company developing medicine or medical equipment.
“It’s challenging and fun working in a place that develops the most advanced technology and also could help a lot of people,” says Gefen and smiles. “If this succeeds, millions of people will go around with an Israeli chip in their eye.”
The biological photo chip
In recent years, Nano Retina has come to be considered as one of the most promising startups in the world of nano-technology. The challenge of startups in the nano-technology field is how to minimize computer parts to microscopic sizes, so small that they may be utilized in molecular engineering, unique physics trials, as well as in treatment and replacement of tiny organs in the human body.
Gefen, who graduated the prestigious Talpiot track in the Israeli Defense Forces and various research and development units, became acquainted with the field six years ago when he started working with several life sciences entrepreneurial developments. It was then that he met Yossi Gross. Gross is a regular innovator with his name on a record number of patents in Israel – more than 500. He oversees the implementation of his innovations by means of a private foundation called Rainbow Medical. Partners to the foundation include famous businessmen Leon Recanati and Effi Cohen Arazi, who recruited Gefen to the new startup.
Gross and ten of his employees lead a war against blindness out of the small Nano Retina offices in Hertzliya Pituach, Israel. The company is developing an electric chip that will be implanted on the retina of the damaged eye and will be used as an alternate electric retina. The solution is still not perfect: With the chip, people who lost the light source of their eye will be able to look at the world out of an aged computer screen – a thousand pixels in black, white, and grey, that will be arranged into one picture. This partial picture will enable them to read, watch television, and recognize their surroundings.
Only 5 percent of cases of blindness are from birth. For the 40 million people suffering from acquired blindness, the most common type of blindness, such a development is a dream come true. The World Health Organization estimates that in 2020 there will be 75 million blind people in the world and 314 million partially-blind people.
For most of these patients, the problem begins and ends with the retina, the tissue found in the depth of the eyeball. The retina functions as a “film” – absorbing light beams, and converting them into electric signals that go to the brain and are turned into image. The problem for most cases of blindness is concentrated in a sensitive and tiny part of the retina, with a diameter of three millimeters, that is responsible for the eyes’ recognition of most objects.
Retina Nano’s chip is designed to replace this tiny key part, with the chip’s electric components receiving light and converting it into electric signals. One of the unique elements of this chip is that the signals are not translated into computer language, but rather to the “language” used by the eye’s nerves to transmit information to the brain.
The challenge of developing an implant for the retina does not begin and end with the conversion of light into “electric signals,” says Gefen. “The retina is kind of an expansion of the brain, and a large part of image processing occurs there. After all, a healthy eye has 100 million light absorbers, but only a million nerves that go to the brain. Something is taking place there.” When Gefen responds to those contacting him, he explains to them that there is still much more work to be done, and says that the first clinical trial – the implanting of the first of these chips in a human – will only take place in two years. He is not even willing to guess the launching date.
The world in 600 pixels
Nano Retina is not a pioneer in bionic eye development, but it enjoys learning from its competitors’ trials, most of which have ended in unsatisfactory results. Today, the leading company in bionic eye development is the German Retina Implant, which has raised 18 million dollars by last month and has received the permission of the CE, the European counterpart of the FDA, enabling the company to market its implant in Europe. The Retina Implant system includes a chip implanted behind the retina and glasses connected to a tiny battery. The retina receives light waves through the technology, in a manner quite similar to a digital camera, and converts them to electrical stimuli that are transferred to the eye nerves and from there to the brain.
Last November, Retina Implant concluded its first clinical trial, after which it reported that through use of its system, 11 blind people were able to recognize objects in the room in which they were present. Mika Tarho, a 46 year-old blind man from Finland, told the BBC that with the company’s implant, he was able to recognize letters. After a couple of days with the implant, he could recognize his name, correct a spelling mistake purposely inserted in his name, recognize utensils, and read a wall clock. He could do all this with a vision range of only 12 degrees and a total of 60 pixels, in black and white.
Second Sight, a California-based company is also considered today to be one of the leading companies in bionic eye development. The company’s chip is implanted on the eyeball and sends small electrodes to the retina. A tiny video camera placed on a pair of glasses converts the light waves into electric waves, sends them to the chip, and the chip then transfers them to the brain. The acceptable field of vision consists of 16 pixels. Future chips of the company will enable a vision with a resolution of 60 pixels.
At the beginning of the month, Second Sight also reported that it received approval from the CE and that it intends to receive approval from the FDA. As of today, this is the first company in the field of bionic eye development that has declared that its products are out on the market; and toward the end of the year, it will be possible to purchase its implant at hospitals in Paris, Geneva, Manchester and London for $ 100,000.
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Still in the dark
In her lab, Professor Yael Hanin, manager of nerve implants in the Nanotechnology center of electrical engineering at Tel Aviv University, performs the first nerve trials for Nano Retina. As a specialist in human-machine interfacing, she allows herself to be skeptical of the declarations made by Second Sight and Retina Implant. “Both these companies started out as academic research and have years of development and experience, but the solution of each of them is still too limited,” she says.
“Implantating of a retina implant inserted underneath the retina and the ability of this area to receive effective stimulus is limited. Although the implant of Second Sight is placed above the retina, it only enables vision by means of an external camera, a factor which means vision depends upon the movement of the head from side to side. Also, its electrodes create limited resolution. It can be said that perhaps because of its later entry to the market, Nano Retina enjoys the experience gained by its veteran competitors.”
Professor Dave Weinberg, manager of the eye unit in the Rabin Medical Center in Israel, is much more skeptical about the question of how far the field is progressing. “Each time the newspaper writes about this type of success, we are flooded by phone calls from those who assume that the solution to their miseries has come. The expectations are exaggerated in relation to reality. As of today, surgical problems overshadow every existing solution. An implant in the retina must be accepted by the body and not be rejected, and until now every implant that has been performed in the eye has had to be removed. There are no people today with implants in their eyes.”
Weinberg assists Nano Retina in developing surgical methods that will ease the process of inserting the chip into the eye. Currently, the company is building upon a procedure that includes a simple insertion of the implant and its affixation in the center of the field of vision. This procedure would take place over a surgical period of about half a year and under general anesthesia.
An improvement can be seen in existing products, mostly for what we call “ambulatory vision,” says Gefen. “This is the ability to be get by in a space, to know where is the window, the door, to recognize large objects or objects when they are very close to the eye. Most of those receiving implants, have a hard time recognizing faces or reading. You can’t do a lot when you see in 60 pixels.
The mysteries of neuron language
Normal vision is composed of a million pixels, although 1,000 pixels are enough to recognize an image. Nano Retina’s chip, with a size of 43xmm, will provide 600 pixels in its initial version. It will only be planted on one eye, would enable 100 different levels of grey, besides black and white colors, allow the patient to read letters with a length of at least 4 centimers, recognize faces, watch television and perform tasks such as eating with a fork and knife or washing dishes. The second generation of chips will have between 1,200-2,000 pixels, and the goal is to reach 6,000 pixels in color.
The silicon chips will be produced in Tower, the Israeli chip factory of the Ofer Brothers in Migdal Haemeq. Each tiny electrode will represent one pixel in the field of vision and according to Nano Retina’s research, eye nerves will wrap around it following its installation in the retina. Nano Retina has signed an agreement with the largest Nanotechnology company in the United States, Zyvex Labs from Texas. In the framework of the agreement, the American company will use sophisticated technology to develop the tiny electrodes. Zyvex became famous lately by being the first in the world to develop 3-dimensional geometrical structures from lone atoms.
Nano Retina will use sophisticated never-before-used technology to connect the electrode legs to the silicon chip and the chip will transmit electrical signals to the nerves. “We learned to speak a language understood by the brain,” says Gefen. “The brain has its own communication protocols, such as a telephone or cell-phone system. The challenge of translating the light to electronic information by using physiological material is huge. The neuron language in the retina is well defined but mysterious and because it consists of several simultaneous communication channels, it needs to be decoded.
A ray of light is not enough to operate the receptors – energy of about one milowatt per electrode is needed. “This output has not yet been attempted, and when we wanted to conduct a trial we didn’t find any instrument that works at such a low output. Therefore, we must develop such an instrument,” says Gefen. Nano Retina will try to transfer the energy through advanced wireless technology and by means of an infrared light. “Unfortunately, no one has yet discovered how to produce energy from the body’s natural electric output,” says Gefen.
Nano Retina will coat the whole chip with a thin layer of glass, in order to preserve it as a capsule within the eye. For this purpose, Nano Retina turned to the Swiss company CSEM, known for its glass and diamond coating for tiny clock devices.
“I invent all at once”
Yossi Gross is Nano Retina’s spiritual leader. He developed the innovation and through Rainbow Medical, his venture capital fund, is one of its main investors. With considerable enthusiasm, he details his other innovations – some are already reality, some still being developed – they may, eventually, find their way into our bodies and become part of us: a tiny inner-eye telescope developed by the Vision Kar company; the world’s first heart muscle nerve stimulus implant developed by Biocontrol; an artificial pancreas developed by Beta o2, and many other implants that ease the function of the prostates, duodenum, teeth, and heart valves. “Medicines have adverse effects,” he says, “they flow throughout the whole body in an equal manner and are therefore hard to control. On the other hand, in the medical arena, implants are considered a better solution, as they can be controlled by the patient or doctor.”
With his background in aerial engineering and electronics, Gross’s foundation has raised about 40 million dollars so far. From 2007, it has invested in the field of medical equipment in 12 startup companies, 5 of which are already performing trials on humans.