Restoring Vision

The Real Bionic Woman
After losing her vision for 30 years, Lisa Kulik finds hope in the Argus II, the world’s first commercially available device to restore sight to the blind. By Adam Smith When Lisa and Ed Kulik graduated Hollywood High School in 1977, Lindsay Wagner was America’s only “Bionic Woman.” Thirty-seven years later, bionic women aren’t relegated to Wednesdays on ABC. In fact, in Ed’s case, he may have married one. They were strangers in high school, and likely would have remained that way if some guy hadn’t shoved a fish into his pocket. Witness the scene: Two years after graduation, Lisa and Ed were at a party in the Hollywood Hills. Ed was a young marine, recently returned from Camp Pendleton. He drove a red ’68 Camaro, but he preferred his previous ride: “deuce and a half with a 50-caliber machine gun.” Lisa was a happy-go-lucky veterinary technician. At the party, one of their former classmates, “Crazy Larry,” had also taken a keen interest in the animal kingdom. Reaching into a fish tank, he deposited a hapless goldfish into his pocket. He turned to Lisa and Ed: “Wanna see my fish?” It was not a high point in the annals of ichthyology, but as parties go it was a decent icebreaker. They both laughed over it. Two years later they were married. Twenty-one was a big year for Lisa: marriage, baby Joey on the way—and the first time she learned about a strange “night blindness” and spots on her retina. It would be five more years before she would be formally diagnosed with retinitis pigmentosa (RP). Over the next 30 years, like fragmentary missing pixels on a TV screen, Lisa’s vision deteriorated. In 1986, she was heartbroken when she could no longer drive. In 2000, she formed her last strong memories of her sons: 6-foot Joey holding his diploma from Thousand Oaks High School, and blue-eyed Danny’s thrilling 9th-inning RBI in the season’s final elimination game. She had never seen her grandkids, and she never really saw her sons as adults. In some respects, Lisa Kulik, 55, was a prisoner of her ranch-style house on Clara Lane. Her “jailer” was retinitis pigmentosa. Her own damaged photoreceptors, robbed of the rods and cones we take for granted, made the outside world dark, confusing, even dangerous. “My house is one of the few places I can move around on my own,” said Lisa. “But outside, I can barely walk to get the trashcan off the driveway. If I ever needed to run to the neighbors’, I couldn’t do it. At least with the driveway, I can feel the rocks on the side. But just keeping on the sidewalk without falling off the curb—I don’t think I can do it.” Fridays are the best, she said, when Ed is home and the couple normally heads to their cabin on the Colorado River. In the mornings, the river is as smooth as glass, and they slide out on a red and white Sport Nautique ski boat called Wet Dreams. Later in the day, at 115 degrees, Arizona becomes the sun’s anvil, but, wakeboarding or waterskiing on the Colorado, this is Lisa’s time. She rides the water until her hips get sore and she can feel the breath of places as far away as the Rockies or the canyon lands of Utah wash over her. “We like to go against the current,” said Lisa. “It’s like freedom.” A New Hope “The doctors told me there was no cure for RP,” Lisa said. For 30 years, she had to be satisfied with that answer. In the fall of 2012, Ed was reading science news stories on his iPhone. “Fox News had a story about help for retinitis pigmentosa,” Ed said. “I told Lisa, ‘You gotta call about this.’” The technology was the Argus II Retinal Prosthesis System, often referred to as an artificial retina or the “the world’s first bionic eye.” Co-invented and co-developed over a period of 25 years by Professor Mark Humayun, a USC ophthalmologist and biomedical engineer, the device offers partial restoration of vision to people with RP. Now commercialized by Second Sight Medical Products in Sylmar, California, the Argus II received FDA approval in March 2013 and Medicare approval seven months later. To date, it is the first prosthetic device for the blind available in the United States. When she was a kid, Lisa used to watch “Romper Room,” the long-running children’s series. “Every episode used to end with the lady looking into her magic mirror and ‘seeing’ all the children around the world,” Lisa said. “I used to think she could see me too. “I thought this might be like my magic mirror.” Having developed the technology, USC was designated one of 13 approved surgery centers in the United States. Lisa first came to USC in July 2013, meeting with Dr. Lisa Olmos de Koo of the Keck School of Medicine of USC. Olmos determined her to be a perfect candidate. “They told us [the surgery] might be able to happen in a couple weeks,” Lisa said. Yet by the end of 2013, no surgery date had been set. Even though Medicare had approved the surgery in October, the Kuliks still needed their private insurer, CIGNA, to sign off on it. “CIGNA fought us tooth and nail,” said Ed. But by mid-May 2014, nearly a year after the initial visit, the surgery was approved. “I had the woman on the phone read the approval letter to me word for word because I didn’t believe her,” Lisa said. June 2, 2014, the day of the surgery, was Lisa’s Cecil B. DeMille moment. After facing the assembled press and cameras, she smiled. “I was more nervous for this than I am for the surgery,” she said. As she was wheeled into the USC Eye Institute’s OR, the word “yes” was written over her left eye, denoting which eye would receive the artificial retina. Lisa marveled that in age of bionic eyes and cochlear implants, sometimes the best tool for the job is a black Sharpie. For five hours, Ed waited. After a while, he fled to a grassy spot on the USC Health Sciences Campus, smoking La Gloria Cubanas, trying not to think about all the possible complications. Lisa, of course, has no memory of those hours, nor how this marvel of engineering and surgical precision found its way into and around her eye. How her eyeball was exposed in all its extra-ocular glory, how an exquisitely crafted circuit and receiver were tied around that eyeball like a silicon belt buckle. How Olmos made a 5-millimeter incision into the sclera (the white part of her eye) to slide a 60-electrode array inside and tack it oh-so-carefully to the macula, the retina’s yellow oval for central vision. “The most critical step,” observed Humayun, “is to make sure the array is very flat on the retina.” That’s the very delicate interface, where 21st-century microelectronics talk directly to 200,000-year-old Homo sapiens brains. After leading the development of the Argus II system, USC had pioneered the initial clinical trials. Now, the USC Eye Institute was the second successful commercial surgery site in the United States, and Lisa Kulik was its first patient. Magic Mirror— Activate! The Argus II is not human vision—it’s computer vision. A video camera mounted on the Argus II glasses sees the world. That black-and-white, 320 x 240 pixel camera image of the world travels down a wire to a video processing unit worn at the waist. The VPU translates that video into 60 electrical pulses, one for each electrode nestled against Lisa’s retina. These electrical pulses pass through the optic nerve to the brain, allowing the sensation of light. That’s what patients like Lisa learn to interpret as visual patterns. Lisa’s new world is essentially a 6-by-10 grid of light. But unlike the old Lite-Brite toy, it requires a great deal more rehab and training to discern an image. It took a week before she could activate the camera for the first time. They say that when Balboa first saw the Pacific Ocean, he had just scaled the summit of a mountain in Panama. When Yuri Gagarin first saw the planet Earth from space, he was crammed inside a tiny Vostok 1 spacecraft. When Lisa Kulik first saw the world through her new bionic vision, she was in a tiny room on the fourth floor of the USC Eye Institute. James Weiland, USC professor of ophthalmology and biomedical engineering, sat opposite Lisa, his laptop depicting the grid of 60 electrodes. He’s been collaborating with Humayun since nearly the beginning, and in fact Weiland was sitting opposite Harold Churchey in 2002 when Churchey, the first recipient of an artificial retina, saw light for the first time in 50 years. There was a sudden beep. “It said hello,” Weiland said. “The processor is talking to the implant in your eye.” Lisa was given a video game joystick, not unlike an Xbox controller. “Hit right for when you see the flash of light, left for when you don’t see it,” said Weiland, indicating the controller. “We’re stimulating the electrodes in your eye. We want to know the minimum amount of electricity for you to see something.” A few minutes later, Lisa noted, “It was a quick flash, more of a straight line to the left. It went from here over to here. Like a snake, kind of.” “You’re seeing snakes?” Ed laughed. Weiland, the team from Second Sight, and Lan Yue, a postdoctoral researcher in the Humayun-Weiland lab, were pleased. Lisa’s first “fitting” session of the Argus II—like tuning a guitar, each of the 60 electrodes must be “tuned” to find the right amount of current that will stimulate Lisa’s dormant retinal cells—was a success. Initially, Weiland was unsure how valuable 60 electrodes might be for the blind. But after seeing the results of dozens of patients, Weiland has become a believer: “A little bit of vision goes a really long way.” Their last Friday in Los Angeles, Lisa and Ed went for a walk. Standing outside the USC Eye Institute, Lisa tested the Argus II glasses for the first time. Ed stood next to her, holding her arm, as he always does. Suddenly, he let go. “No,” Ed said, “you need to try it on your own.” This was not her home on Clara Lane. It was a busy university campus, with buses, shuttles, cars, students and patients. Her only guide was her “magic mirror” and the seldom-used image-processing power of her own brain. On the VPU at her waist, Lisa toggled between the Argus II’s four settings: bright light conditions, lower light with shadows, enhanced borders and edge detection, and inverse contrast for dusk or no light conditions. She noticed the contrast of the dark asphalt on the street and the lighter pavement of the sidewalk. She noticed the dark interruption of a bush in the midst of the sidewalk itself. She saw the white lines of the crosswalk. Slowly, Lisa stepped out into the California sunshine. That night, on Humayun’s advice, Lisa saw the moon for the first time in 25 years. It was Friday the 13th and Lisa couldn’t help herself: She howled at the moon.