Visions of Tomorrow

Science is constantly pushing the boundaries of what we know and what is possible, but the catalogue of how we would like technology to help us in the future is constantly being filled by the magic of science fiction. Star Trek gave us visions of tablets, cell phones, and replicators – all of which have been (at least somewhat) realized in modern technology. Robocop, Geordi LaForge, and Judge Dredd are among those who have benefited from bionic eyes – and the real-world research into restoring sight through implants and prostheses is being advanced year on year. Additive manufacturing (3D printing) has gone from a fanciful dream for most to a technology that is a one-click delivery away – and won’t (quite) break the bank. Adding to the scene is a plethora of eye-based regenerative medicine that brings the worlds of reality and sci-fi closer than ever (1).

But what role could today’s ophthalmology have in a fictional world of tomorrow? What kind of future do we want – and how do these findings potentially take us there? We asked our contributors how their research could be used in future – in either a realistic application or a fanciful extrapolation of current capabilities. Welcome to eye-fi!

Master of magnetism

In “The Birds Have (Magnetic) Eyes,” we outline the amazing finding that migrating songbirds have a retinal protein that is sensitive to magnetic fields, and therefore may be responsible for the uncanny biological “compass” that guides them from opposite ends of the globe (2).

But how could these magnetic eyes be used in the future? Peter Hore, one of the authors  of the original study, suggests one realistic application: “We could develop man-made magnetic sensing devices using organic spintronics to mimic natural magnetoreception.”

We at The Ophthalmologist wonder if one day this could be applied to survival orientation devices in the harshest environments, maybe using only our handy inbuilt magnetoreceptors? Could we eventually develop a device using these principles to control magnetic fields around us, like a live action Magneto – disabling electronic devices and remotely moving objects? What an X-ceptional idea. 

Let there be light

“Of Mice and Men” looks at the discovery of the focea region in the mouse visual cortex, which performs a similar role to the human fovea in enabling enhanced spatial resolution vision (3). The work shows that mouse vision is much closer to our own than previously realized.

Lead researcher Pieter Roelfsma explains how their lab is using the visual cortex to restore vision – taking a sci-fi concept into a near-future reality. “We are now working on a prosthetic device to restore a rudimentary form of vision in blind individuals,” he says. “Technologies we aim to use for stimulation of the human visual cortex are currently being tested in mice and monkeys in our lab.”

So are we on the cusp of bionic vision to cure blindness? Can we go a couple steps further and enable ourselves to see previously non-visible forms of light? Watch this space.

I, for one, welcome our new robot overlords

David Alais explains the concept of face pareidolia in “Carface” – and his research shows that we emotionally process false faces in the same way as real faces (4). Cars, clocks, and handbags can all look angry, happy, perplexed, and more.

When asked if this could help robots maintain a semblance of normality during a hypothetical machine uprising, he confirmed my fears. “Yes, it would be sensible to make robots with expressions – we know that there is nothing to prevent an object such as a robot from conveying genuine facial emotion.” Moving onto a more realistic perspective of how we design robots for everyday use, he says, “This would clearly be a useful adaptation in our design of robots as we inevitably interact more and more with them. It could even be interactive; the robot could display empathy by using happy and sad templates to determine the emotion of the human they encounter. To display empathy, they merely echo the emotion in the human face by displaying a happy (or sad) face on their video display. This could be helpful in dealing with the mental health consequences of loneliness.” And, if you thought that concept was reserved for the future, you need only walk through a parking lot to see that this is already being put into practice. “Designers know intuitively about emotional response to objects. For example, some motor cars are designed to look like friendly or happy faces; they satisfy the face template with their headlights (eyes), grille (mouth), and badge in the center (nose). This applies to the design of many objects; even if they don’t all look like faces, many are designed to look soft, round, and fleshy, rather than harsh and angular.”

An injection a day keeps blindness away

In “The H Factor,” Simon Clark tells us how his research collaboration led to the discovery of increased factor H-related (FHR) proteins in AMD patients’ blood, the realization that they cause disease-related damage, and the development of a new mass spectrometry-based technique for the simultaneous identification of all seven factor H family members (5).

Clark suggests a sci-fi future where their findings may be used to prevent blindness. “FHR proteins that ultimately lead to vision loss are made in the human liver and we already have techniques to lower gene transcription in the liver – so imagine a world where people have a small injection at breakfast to prevent them from going blind. A daily subcutaneous injection delivering gene-silencing drugs to the liver could reduce FHR protein levels and prevent FHR-mediated inflammation in the back of the eyes. A better alternative to monthly intravitreal injections or surgery!” Perhaps one day soon we will be able to add AMD to the spectrum of “unnecessary blindness.”

Surround sound

Parsin Haji Reza outlined his amazing photoacoustic remote sensing microscopy (PARS) technology in “Structurally Sound.” It enables remarkable structural and functional imaging of the eye without the need for physical contact and can image down to the level of a single capillary or red blood cell (6).

Rich Weinstein of EyeStart says, “In the future, PARS technology will be incorporated into a handheld device and used not only by ophthalmologists, but by all health care professionals as part of a standard medical exam. Imagine being able to scan in real time the anatomy of human tissue to the scale of individual cellular DNA and mitochondria. Instant gene sequencing will allow for truly personalized medicine to go from sci-fi to fact as a broad spectrum of diseases can now be diagnosed and potentially treated prior to the onset of first symptoms. Finally, envision a device that can not only image the cell, but also use a unique algorithm of different light wavelengths as a therapeutic tool for cellular repair. The possibilities are infinite.” There is plenty of scope for future innovation and application for this technology in our world of tomorrow.

Honey, I shrunk the OCT

Sohaib Rufai, author of A Practical Guide For Aspiring Ophthalmologists, gives advice on how to secure an ophthalmic specialist training post in “The Aspiring Ophthalmologist’s Guide to the Galaxy” (7) – along with some inspiring pictures of him conquering the Rocky steps in Philadelphia.

His take on the pioneering sci-fi future of ophthalmology technology centers on the optimization of optical coherence tomography (OCT), which he uses for his neuro-ophthalmological research at Great Ormond Street Hospital and Leicester Royal Infirmary, UK. “Conventional OCT  devices are large and table-mounted, designed mainly for adults and older children – but this technology has since been scaled down and adapted into a futuristic handheld device, enabling gentle non-contact OCT examination in  infants.” He goes on to predict the potential applications of technology miniaturization. “I believe more ophthalmic technology may be scaled down to smaller devices suitable for patients of all ages, possibly even facilitating home-based ophthalmic monitoring.” So expect our eye-fi future to have ophthalmic equipment available in home and travel sizes…

Bionic eye maintenance

Research by Harpreet Kaur, Sarj Athwal, and their team (see “Lifting the Lid on Eye Pressure”) shows that lower lid tightening surgery increases intraocular pressure (IOP) (8) – an important consideration for surgeons when planning procedures such as this in patients with glaucoma. 

But how does this apply to a hypothetical future society where bionic eyes are commonplace? Imagine that implants and upgrades could be integrated onto the surface of the eye to enhance ocular function… Kaur and Athwal have this to say, “these implants could cause an increase in the IOP due to external compression, as demonstrated in our research. So, despite all these technological advances, ophthalmologists of the future will probably still be relied upon to monitor and manage IOP.”

It’s great to see ophthalmologists who are so well prepared for a sci-fi future in ophthalmology!

Brain training

In “Seeing is Believing,” Yair Yahav talks about technology that can not only improve vision in adults with amblyopia, but also enhance anyone’s vision by training the visual cortex (9). The technology combines two Nobel Prize-winning scientific discoveries into a home training program that has helped people to do everything from obtain pilot’s licenses to read TV program titles for the first time.

Yahav says, “The technology is already sci-fi – people are skeptical about how we can improve vision through training the brain, but then they learn how exactly the science works to enable us to work on specific neurons in the cortex – and the clinical results speak for themselves.”

With this development and its applications firmly rooted in science, it’s one for fans of “hard” sci-fi. Could it be used to help super-soldiers improve marksmanship in battle zones – or could it be translated to sporting endeavors, with mandatory vision training to increase athletic performance come game day?

Virtual reality ophthalmologist

In “Equity: Facts and Future,” Tina Felfeli and Yvonne Buys outlined the state of play for male and female ophthalmologists and found the figures wanting (10). Maybe we can reach equity in a non-sci-fi future?

Asked about the future of ophthalmology in relation to sci-fi technology, Buys brought up her involvement in a project that fits the bill. “I am involved in the development of a portable perimeter – which is hard sci-fi, because we have already developed the technology and we’re testing it now.” The device takes eye testing directly to patients’ homes with a virtual reality (VR) headset that hooks up with a smartphone, remote clicker, and control analysis software. “This is something that could significantly change the way we do visual fields,” says Buys. Are we seeing the future of telemedicine – where VR headsets can perform diagnostic testing? Or can the technology even be extended to a device that can deliver procedures from the comfort of the patient’s favorite armchair?

Medic!

In a soon-to-be-published article, Jongmin Kim and Dong-Woo Cho explain how they are using decellularized eye tissue as a bioink to 3D print retinal tissue for research and potentially implantation.

Although 3D printing of human tissue for these purposes is already well within the realms of sci-fi, Kim has a suggestion for a home comfort application. “Imagine that there is a highly advanced 3D cell printing system containing various types of decellularized ECM bioink – and that people have their own stocks of stem cells, such as induced pluripotent stem cells (iPSCs). An injured person could be treated by replacing their damaged organ with a 3D-printed organ using a bioink of dECM and their own iPSCs.” Kim adds, “In a warzone, the army medical officer could carry a hard case with a small 3D cell printing system and bioinks tailored for the soldiers, ready to print replacement tissues when needed. In modern warfare, there are a lot of eye injuries due to shots fired and improvised explosive devices. We hope that our research and future technologies can help soldiers in all military branches who are suffering from eye damage or vision loss.”

Chip-ready vision upgrades

One of our upcoming contributors, Che Connon, will explain his group’s amazing work on engineering human cornea tissue both for research and to meet the growing need for cornea replacements.

His work on bionic corneas fully embraces the intersection of sci-fi and ophthalmology. “A professor of microelectronics and I are working together to embed a microchip within the tissue,” says Connon. Obviously, the translation to reality isn’t quite plug and play. “There are factors we need to consider and overcome – including how to power the chip, how to send and receive signals from a chip embedded in tissue (which has many biomaterial implications in itself), and how to get the chip to integrate in the tissue and avoid rejection issues.” Once microchip technology is successfully integrated into the cornea, the number of potential applications is startling. “The interesting question about integrating electronics into a functional cornea is, ‘What do you want the electronics to do?’ An obvious answer is to monitor IOP for a range of ocular pathologies. But it’s more tempting to think about cameras and things like that; with a camera you can look at all sorts of things – internal monitoring of blood flow, drainage, or anything within the eye; external cameras could be used for vision on a range of wavelengths.” So with a bionic cornea on our sci-fi menu, are we headed for a marvel of medical monitoring – or are we about to crest the horizon of technological espionage seen in the wildest Bond films?

Hollywood meets ophthalmology

Another upcoming article features the work of Qi Cui and team, who are investigating the relationship between a diabetes drug and a reduced risk of glaucoma.

Cui mentioned that the 1966 sci-fi classic Fantastic Voyage reminds her of her own research. “The scene where one of the scientists is eaten by a white blood cell is forever ingrained in my brain! It honestly gave me nightmares for weeks. It’s strangely appropriate because my current research focuses on curbing reactive microglia and macrophages to save neurons in the eye, and that killer white blood cell is just such a reactive macrophage doing what it’s designed to do – to the detriment of poor, villainous Dr. Michaels.” If there is ever a remake, perhaps Cui’s work will ensure that the biological response to human intruders is not only horrific but realistic!

The final frontier

It’s amazing how sci-fi and science can end up interchanging concepts – with sci-fi concepts appearing in labs, and lab research ultimately cameoing in fictional tales. Whether it be revolutionizing eyecare from home, repairing eye trauma in a warzone, or using implanted electronics to restore, monitor, or even improve eyesight, it is clear that ophthalmic research is rapidly progressing beyond what we previously would have deemed  as sci-fi.

As science and technology progresses even further we will have to keep redefining what we put in the respective spaces of science fiction and science fact.