Visual Neurorestoration: An Expert Review of Current Strategies for Restoring Vision in Humans
Abstract
Visual impairment impacts nearly half a billion people globally. Corrective glasses, artificial lens replacement, and medical management have markedly improved the management of diseases inherent to the eye, such as refractive errors, cataracts, and glaucoma. However, therapeutic strategies for retinopathies, optic nerve damage, and distal optic pathways remain limited. The complex optic apparatus comprises multiple neural structures that transmit information from the retina to the diencephalon to the cortex. Over the last few decades, innovations have emerged to address the loss of function at each step of this pathway. Given the retina's lack of regenerative potential, novel treatment options have focused on replacing lost retinal cell types through cellular replacement with stem cells, restoring lost gene function with genetic engineering, and imparting new light sensation capabilities with optogenetics. Additionally, retinal neuroprosthetics have shown efficacy in restoring functional vision, and neuroprosthetic devices targeting the optic nerve, thalamus, and cortex are in early stages of development. Non-invasive neuromodulation has also shown some promise in modulating the visual cortex. Recently, the first in-human whole-eye transplant was performed. While functional vision was not restored, the feasibility of such a transplant with viable tissue graft at one year was demonstrated. Subsequent studies are now focused on guidance cues for axonal regeneration past the…
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