Residual photoreceptors affect the response of a degenerate retina to electrical stimulation

Abstract

Patients with age-related macular degeneration (AMD) implanted with the PRIMA photovoltaic subretinal prosthesis demonstrated letter acuity closely matching the devices 100 {micro}m pixel size. Improving visual acuity requires smaller pixels, which, in turn, require relaxation of electric field confinement to maintain effective stimulation of bipolar cells. Eliminating local return electrodes broadens the electric field but may inadvertently engage residual photoreceptors adjacent to the implant, thereby altering electrically evoked visual percepts. Here we quantify the contribution of residual photoreceptors to electrically evoked retinal responses across various implant configurations. Monopolar photovoltaic arrays with 20 {micro}m pixels and bipolar arrays with 100 {micro}m pixels were implanted subretinally in Long Evans rats, resulting in local degeneration of photoreceptors directly above the device. Responses were compared with those obtained in RCS rats, which lack functional photoreceptors. Implants were activated by patterns of 880 nm laser at pulse durations varying from 0.5 to 10 ms. Visually evoked potentials were measured in scotopic and photopic conditions, with and without the intravitreal application of mGluR6 agonist L-AP4 to block photoreceptor-driven ON pathways. Experimental thresholds were interpreted using a computational model of retinal network activation in distinct electric field geometries. In locally degenerate retina stimulated with monopolar arrays, blocking photoreceptor input yielded a rheobase (0.06 mW/mm{superscript 2}) and chronaxie ([~]3 ms) of the stimulation threshold, matching that measured in fully degenerate RCS retina, indicating direct activation of bipolar cells. In contrast, when photoreceptor input was intact, stimulation thresholds decreased significantly, and dark adaptation further modulated the threshold in a pulse-duration dependent manner. Bipolar arrays provided identical thresholds in locally degenerate and fully degenerate retina (0.2 mW/mm{superscript 2}) when stimulation was confined to the implant center; however, shifting stimulation to the implants edge lowered the thresholds, revealing a contribution from adjacent photoreceptors. These findings demonstrate that residual photoreceptors can substantially influence responses evoked by subretinal prostheses in a degenerate retina, with direct consequences for perceptual uniformity in patients, such as edge brightening. These results provide guidance for design of the next-generation higher-resolution implants, supporting the use of local return electrodes to maximize resolution while minimizing the effect of photoreceptors in clinical applications.