Procedure for bionic eye surgery

Question

So there's this guy called Joel who suffers from a case of bad luck. You see, Joel was just minding his own business (in a war zone) when a grenade decided to introduce itself to his face (we all have been there). So Joel's face was cut to ribbons; he suffered major damage to the face, neck and lost both eyes. A black site operative was in the area collecting (unwilling) test subjects for some cybernetic experiments and chanced upon him. So he took Joel back with him to turn him into a mindless killer cyborg (still better than the health care).

So the problem is: I have no idea how they would install a Bionic Eye. It just seems much harder than, say, a hand or leg. In fact, check out my question about a cybernetic arm I did a while ago: same story, different character.

I'm just saying: I know how the basics work, but haven't figured out how they would do it with the eyes. I think it would be very different from, say, connecting a nerve to a cybernetic arm to get movement than relaying an advanced image in real time into your brain. the Bionic Eye should be better then the old eyes and not some basic tech device you have to hit to get color like an old TV. I just want to use realistic surgery for my book and I’m far from a medical student, so any info would help a lot.

So my question is this: What would be the Procedure for Bionic Eye Surgery?

My idea (once the problem is solved) would be installing a holding socket inside the eye where it was connected to the brain so they could just screw in any Bionic Eye they wanted like a light bulb (but I’m very open to different ideas).

Joel's new Bionic Eyes (and soon to be body) are not for free, he will be used as a military asset (he will be classified as a weapon of the state). so the Bionic Eyes should be combat capable (not a blind mans helper) hence the screw in eyes for different uses in the field. cybernetics is out on the open market but military powers are working on new and improved way to use them in warfare (some are not so legal)

And just for the people that haven't figured this out yet: This is a hundred years in the future with an advanced tech level

Answer 1

You need to remove the original, damaged eyes and let the sockets heal. If the facial bones have been damaged, you need to fix those too.

Then you need to measure the socket interior and 3D-print an eyeball to match. The exact internals of the artificial eye are up to you. The most complicated detaild are, in order of complexity:

• Connecting the bionic eye interface to the optic nerve. You will have to connect electronic bits to tips of neurons individually if you wish to get eyesight at least as good as the original capacity the cyborg had.

• Training. The cyborg's brain will not understand the signals coming in as soon as the eyes are activated. Neural networks, even natural ones, need training. This may take anywhere from days to months. The eyes may stream 4K video to a computer but the cyborg will only see static, then blotches, then blurry images until his brain gets used to the eye's signals.

• Focusing and adjusting for darkness. Our eyes are not just passive cameras on a single configuration. We can move small parts to adjust focus and to allow more or less light to come in. This is done by muscles. The artificial eye will need servomotors for that, or in the very least solid state electronics that will take input from cyborg's nerves and do the equivalent of what a pupil and the lens would do. The cyborg will need neural network training for those too.

• Self cleaning. Eyes are cleansed by the immunological system and the flow of acquous humor on the inside, and tears on the outside. Maybe you can reuse the tear ducts for the outside, but inside maintainance is on the bionic eye engineer.

• And finally, make the eye out of a material that does not cause rejection. But it's the future, so maybe that is already solved.

Answer 2

What would be the Procedure for Bionic Eye Surgery?

I assume you don't want to publish the detailed surgical protocol on some high impact score journal, but rather give some plausible explanation on how the thing might work.

Thus:

• CCD like device to translate a light signal into an electric signal (roughly what the retina does)
• suitable interface between the CCD and the optical nerve, so that the electric signal are transmitted to the brain
• suitable training for the brain to learn to process the received signals.

Answer 3

The cyber socket indeed needs to be connected to the optical nerve, and possibly to the nerves that go / went to the muscles controlling the eyeball (this could be monitored through myoelectricity sensors or active electrodes).

As its the advanced future, you can either have:

• the cyber-socket talking the same protocol as the biological eye and muscle

• another implant directly in the vision center of the brain receiving data from the socket.

Avoiding the eye connecting directly to the optical nerve sounds like a good idea.

If your eye-bulbs are mobile, they could be actuated through mems / ultrasonic transducers like the focus motors in camera objectives, or be fixed like insects and having the software part of the eyesocket change the focus zone that is fed to the optical nerve. Or just feed all the field of view data to the brain through the nerve and have your cyborg learn to deal with it.

You eyesocket can be a passive component like an eye socket providing just plug and control functionality, or an active component that transform all the eye-bulbs in the same vision protocol.

Or have the assist mode be the socket doing some simplification of the data and have an advanced mode where the eyebulb feed the data directly to the optical nerve with only protocol translation and no filtering or dumbing down.

Answer 4

Another possibility to consider is that only the anterior segment of the eye is damaged: no lens, no iris, no cornea, no vitreous. No worries! Here's the procedure as I see it.

We have the funds. . . We have the technology. . . We can rebuild!

Since we're 200 years in the future, I'll posit some things a little in advance of what we can do now.

Introduction

Due to advances in bio-mechanical material & artificial tissue science, we're able to coat a technological device with a kind of immune-transparent tissue, composed of lab-grown and host-derived components. Rejection is impossible. The implant is secured within a bony~cartilagenous~connective tissue matrix that effectively seals and secures it within the host's body.

The implant itself is based on centuries old technologies, applied in a new way: lasers, the IMT & the IOL, the latter two of which serve to replace the biological lens as a light focusing device. Our device, the INTROCULUS ITVS (the Intraocular Total Vision System) comprises three essential functions and several variable ancillary functions.

Of course, central vision & peripheral vision are keys. Much like the IOLs of old, the ITVS focuses incoming light onto the biological retina, allowing the Cyborg to "see normally". In addition to normal colour vision, the ordinary lens system allows for "normal" low light vision. What distinguished the ITVS from the competition is the rest of the story: we've known for centuries that, apart from standard colour vision, humans are able to see and process UV and IR light as well. ITVS takes advantage of this ability: when the Cyborg engages IR-Vision, incoming IR radiation is translated into ultra rapid IR laser bursts that the retina can see; when the Cyborg engages UV-Vision, the nano-computer shunts the UV light signals to predetermined parts of the retina in succession, allowing the Cyborg full UV vision without the side effects encountered by unaltered humans.

Procedure

Preparation, Phase I: Neuro-Ophthalmology team will address the remaining portions of the globe and prepare them for implantation. Remaining vitreous & any foreign bodies are removed; ocular muscles are disinserted; edge of the globe is prepared by excising non-viable tissue and repairing tears with standard adhesive techniques; the retina and inner surfaces of the globe are scanned and measured in the minutest detail, down to the atomic level in the case of the nerve receptors within the retina; finally a biopatch device, which is basically a biological bandaid, is trimmed and secured to the globe-stump.

Preparation, Phase II: Cranio-Maxillo-Facial team will address all aspects of repairing facial fractures, in consultation with Plastic-Reconstructive team. Particular attention will be paid to the preparation of the orbital bone structures. CMF team will take 3D measurements of the bony orbit and surrounding bony tissues. Plastics will secure tissue samples for Rapid Growth Autoreimplantation. (Basically, they'll take some skin and connective tissue & fat cells for directed cloning & tissue development: the Cyborg will end up with a natural appearing face, eye lid, etc.

Preparation, Phase III: Neuro-Ophtho team in conjunction with CMF will review the gathered measurements and begin the process of 3D tissue extrusion of the ITVS skeleton. The ITVS skeleton is the latticework into which the non-biological device will be housed. Precise measurement are required in order to calibrate & aim the data stream from the device to the retina. Measurements will be sent to the Introculus.co labs where bespoke devices will be built to the CyberForce general command's specifications for this unit. Each device is tailor made for an individual cyborg, with tolerances of less than .001mm (physical dimensions) and 1:1 concatenation between device signal output device and its designated array of biological optic nerves.

Implantation: Once all the devices, Introculus Bio-Skeletons and tissue packs are ready, all teams will converge for implantation.

Plastics will open the face and remove the external tissue bandages. CMF will prepare the orbital bone for the skeleton implant while N-O connects the device to its biological housing. Preparation of the orbit involves precise alignment of the Introculus Drill Gantry, a device that bores all fastener holes and reams out all areas of native bone where the implanted Skeleton will reside. They will also reserve the removed bone dust & blood for use later.

N-O will now remove the biopatch device from the prepared edge of the globe and secure the exterior of the globe to the first part of the Skeleton. This is a simple 3D extruded bio-lattice that, with "bioglue technology" supports & holds the soft globe in a predetermined attitude and position, based on measurements taken earlier. The posterior portions of this bio-lattice will be filled by Plastics with lab generated orbital fat tissues which will, as with the original human tissue, serve to protect the remaining globe of the eye and the optic nerve. It also serves to "fill up the space" in the orbit. N-O will come in again to prepare the power filaments: fine bio-neutral wires that will convert physical movement (whether from facial muscle movement to the rhythmic motion of the tiniest of arterioles) into electrical energy and thence convey that energy to the ITVS device, which will then be fully powered.

Once the bio-lattice Skeleton is in place, N-O will simply slide into place the ITVS device within its housing. Again, bioglue technology will be used to seal the two halves of the Bio-Skeleton together: the engineered tissue surrounding the housing & device will bond seamlessly with the tissue of the retina. The seal will allow NuVit, an optically enhanced clear fluid vitreous humour replacement system, to fill the space that was once the man's posterior chamber.

Once the device is placed, Plastics will once again take over. The once barbaric procedure known to history as the "microsurgical free flap" is now perfected in the form of a nano-surgical autologous facial flap. Essentially, the man's own tissues have been rapidly engineered to replace the temporary "bandaid" tissues. Nano-lasers and microscopically controlled instrumentation assures that an adequate blood supply is routed to the new tissue. Bioglues and tissue regeneration techniques allow for the flap to be perfectly trimmed & inset within two hours and initial tissue fusion to occur within the first post-operative day.

Conclusion

Post-Operative Healing: Various modern techniques are used to ensure rapid and biologically integral healing of tissues & bonding with bio-engineered components. Continuous monitoring of blood levels of oxygenation & tissue regeneration factors (both systemically & locally at the flap locations) alert Nursing & Medical well in advance of a crisis. Flap death is now a very rare artifact, with incidence less than 0.5% Of more concern is the mental state of the host as his levels of consciousness waxes and wanes after surgery.

Post-Operative Therapy: As with any bio-technological implant, a Cyborg must undergo a rigorous programme of post-operative training and therapy. In many cases, such as with the implantation of so-called "bionic arms" and "legs", where neuro-pathways have been utterly destroyed, this regimen may last many weeks or months as the brain, which already "knows" where it wants the hand or foot to go must relearn how to get that message across to the hand or foot.

With Introculus's hemi-ocular salvage technique, much of the retraining regimen required by the older "whole eye" bionic replacement process, is made moot. Because the retina and optic nerve remain intact and active, the training regimen immediately proceeds on to the final stages: device calibration, facial muscle to device movement exercise and most importantly, device-retina training.

This concludes our presentation on the implantation procedure for the Introculus ITVS Device. Thank you for considering Introculus for all your CyberForce's vision needs!

Answer 5

One of the things that none of the answers preceding this one has addressed is the issue that this is post-trauma replacement, not simply a matter of replacing existing good eyes with better ones, or even replacing blind but intact eyes with functional ones. You have major trauma here, and nerves tend not to react too well to trauma at the best of times.

A nerve bundle is not a bunch of short cells connected in series and multiplexed in parallel, they are typically bundles of single very long cells.

A neuron has a cell body, a number of shortish "receiver" branches called dendrites, and a single long axon that goes to wherever the output signal is required. This means that the neuron's body is typically quite close to the source of its signal(s).

In the case of trauma as severe as this, it is quite likely that optic neurons' dendrites and bodies would be damaged or destroyed. Should that be the case, while the neurons' severed axons would still be present, they would be like a stick cut from a tree - not capable of surviving in isolation, let alone functioning. This is a roundabout way of saying that you are highly likely to have nerve mortality all the way from the eye to the sub-cerebral optical ganglion.

In order to be profitable - and prostheses like these would be made to be a source of profit for their manufacturer - a therapy must be as broadly applicable as possible, not limited to a narrow range of edge cases like damage to only the front of the eye, that leaves the retina (a very fragile structure) completely intact.

This leaves us with three possible ways of integrating the inorganic hardware with the biological wetware. In all 3 cases, the facial trauma must be repaired and sockets for the inorganic optics implanted, but the process of making the data connection differs:

1. The lowest-tech option is to run electrical cables from the eyes to the optical cortex at yhe back of the brain, where the cables would terminate at the neural bodies of each of the optical cortex's neurons. There is a reasonably simple physical mapping between the visual field and the arrangement of the optival cortex's neurons, so once the connections had been made, it would be a one-off process to fine-tune the mapping so that no relearning would have to take place.

2. The intermediate tech option would be to use nanotech assemblers to assemble new cable to replace the optic nerve bundle all the way to the sub-cerebral ganglion, and then as in 1, map cerebral cortical neurons to hardware pixels. This would be a little more difficult, as deriving an approximate preliminary mapping would be more difficult, but not impossible.

3. The highest tech option would be to not to map the optical image received by the hardware to the optical cortex at all, but to process the incoming data in the hardware and pass the output deeper into the brain, bypassing the optical cortex almost entirely, so, instead of showing the brain an image, the hardware would be telling the brain what it sees more directly.

Of the three approaches, #1 is the most invasive, requiring opening the cranium and running cabling through the skull, and #2 is the least invasive, with nanoassemblers removing only dying severed axons and replacing them with microscopic wires.

So, why would we even consider option #3, considering that it would involve making connections to many, if not the majority of the neurons in the brain?

Consider this: with a mapping made between the pixels of the prosthetic eye and the optical cortical neurons, we can duplicate the pre-existing visual capabilities - and no more. Sure, the manufactured prostheses could have perfect vision, but the system is limited by the number of neurons in the optical cortex. You simply cannot increase the resolving power of the eye without having to downsample the input in order to send it to the brain. Only RGB output from the eye would be 'native', and any other output would have to be substituted or overlaid onto the optical field. While the initial training is not training the human to accept incorrect signals, but rather training the hardware to produce an output acceptable to the patient, the human brain did not evolve to process all the extra layers of data that the manufactured optics can generate, so learning to interpret the different modes of operation would still be time consuming.

With the third option, the optical hardware does the image processing and interpretation, and passes the interpretation to the patient's brain. With the correct connections, the eyes would not need any artificial separation of display modes,the interpretation of all available modes would be passed simultaneously, and they would seem completly normal to the user - the optical processing system in the eyes would present the data in such a way that its output would not be so much seen as experienced, and its higher resolution, broader spectrum and other capabilities would be presented in such a way that it would seem as natural as the user's former wetware human Mk1 eyeballs' output. Once the patient's brain had been mapped and the neural lace grown inside the brain, the eyes would be pretty much plug and play. The neural lace would also have the side advantage of reinforcing the whole brain against impact damage.

So, what would we be able to achieve in 100 years? Option #1, almost certainly, Option #2 is a strong possibility, and Option #3 would be dependent upon AI-led and conducted research over this timeframe, as it would most likely take an intelligence without human limitations to understand the inner workings of the human brain to the degree required.