 Good good afternoon everybody. Thank you so much for coming today. I'm my name is Susan Goldberg I'm the editor-in-chief of National Geographic magazine, and I'm very honored to be here today to moderate this panel with four of the world's most preeminent experts on blindness. This panel is framed around the question of Can we end or prevent blindness by 2020? And it's partially to raise awareness of this condition which afflicts 40 million people in the world 90% of whom live in the developing world The main the main cause of global blindness is cataracts, which for those of us who you know live in the Developed world seems so tragic and so difficult to hear because as we know cataracts are such a such a generally fixable condition The other main causes of blindness are glaucoma lack of eyeglasses or contact macular degeneration Diabetic retinopathy which is a growing problem With with the rise of diabetes and infectious and infectious diseases. So let's look at what's being done What are the promising pathways and is there a road that we're on in terms of reversing or even? Ending blindness. So let me briefly introduce our our panel here starting at my left Josh Sainz is the director of the Center for Brain Science at Harvard and he does basic research on the billions of neurons That connect with each other in the brain His current focus is on the circuits in the retina that underlie visual perception and that fail in many cases of blindness He says the retinas also are particularly good first target for other brain diseases Well, why is that well for one thing? It's the only part of the brain outside of your skull So Josh has been watching one breakthrough treatment up close and personal and that's for his mother as he says she's stubborn and She refused to see the doctor until the vision in one eye was nearly gone Now for that eye the molecular medicine for macular degeneration came too late But the shots into her better eye. He says were incredibly successful and it really works So his advice get in early. It's hard to get back the things that you lost Next to him, Graciela Pellegrini Stem cell advances are revolutionizing the field of regenerative medicine and that's a field in which Graciela is a distinguished pioneer She is a professor of cell biology at the University of Modena One of her best known achievements may also be among her most satisfying She and her collaborator were the first in the world to develop stem cell therapy to repair damaged corneas They take the stem cells from around the iris and From around the undamaged part of the iris put them back and there then they regenerate Corneal tissues now this treatment has had a 76 percent success rate on 150 patients Some of whom have been followed for more than a decade and some of these people had been blind for 20 years So her team is going to submit data to the FDA this year and launch clinical trials in Europe And as she says you can't imagine the emotion when people can see again Next to her Al summer Al had planned to be a professor specializing in internal medicine along with many many thousands of other students and then he told me one day He fell asleep in the library and when he woke up He saw a book on the state of academic ophthalmology and noticed there were just 12 people in the United States entering this field Maybe I could make a bigger difference. He thought So he was right and thanks to that well-timed nap and fortuitously placed book one of the world's great experts on Public health and blindness found his calling It's estimated that between half a million and a million children every year Do not die or go blind because a breakthrough is made by Al at the CDC and in his work in Indonesia and London He has won every award imaginable in the last 40 years And he's now dean emeritus at the Bloomberg School of Public Health at Johns Hopkins University and Last but certainly not least David Cox David is a neuroscientist and computer scientist at Harvard who's studying the brain and trying to replicate vision in machines So very cutting-edge work. So the way he sees it the eyes retina is the camera The brain is the computer that understands the cameras image But instead of just trying to fix the camera when it's broken He wants to fix the computer by understanding the software of the brain now that kind of understanding would not just help Cure and prevent blindness, but would also have some significant implications for other brain afflictions afflictions such as schizophrenia and autism And he says We don't know the language the brain speaks, but it's when and not if we learn that language This is an alternate future approach to fixing the retina So thank you all for being here today. Like I said, I'm honored to be in your presence. Let me start With a very kind of 30,000 foot question and Al why don't I start with you? So preventing blindness or restoring vision. Where are we making more progress and why well? I I think we're making progress in both areas the restoring vision is in its early stages, so it's people like My colleagues here who are working in the laboratory Trying to understand some of these basic issues My work is primarily at this stage Working with people and looking at the issues of why we can't prevent those things that we already know how to prevent So you already mentioned, you know cataract half of all blindness in the world's cataract We know how to take out cataracts. We can restore perfect vision In that 50% of the people who are blind from cataract the problem is most of those people live in poor countries with very few Facilities very few trained ophthalmic surgeons very little money to support doing what is no more than a hundred dollar 15-minute operation. How do we do that? Two or three of the major causes of blindness that we can now prevent and do largely prevent are the Xerophila that you mentioned the work that I did trachoma and oncocercaiasis and that's why 90% of all the blindness is a developing world because they are not receiving the preventive services that we know how to Provide but simply don't have the resources and the trained Person power to do that and there is a large international effort represented with almost every country in the world called vision 2020 and that's goal is to use the techniques We already know apply them and prevent people from going blind from things They need not go blind from and perhaps find those early Diagnostic techniques for things like glaucoma that we could prevent the blindness in the first place whereas the Real research challenge now is what do you do with people once it down the track of things that we can't reverse? And don't know how to fix well And so Graciela that brings us to you how it's such an incredible thing that you've been able to Restore the vision of some you know a small number, but a very breakthrough research of a small number of people who've had These issues with the cornea. Can you tell us a little more about that? well, yes, we Start many many years ago working in general on stratified epithelia, which are the I mean the cells covering the body and defining what is would belong to us and what is external to us and We found a way to identify in some part of the human eye a Specific area where are localized stem cell of the cornea and the cornea for those of us We are not deep in the field is the transparent membrane which is in front of the collar part of the eye It is transparent that is needed for the vision So it is important to maintain as such and it is one part of the of the body Which is a vascular totally a vascular without vessels in several patients had Coming from different kind of pathology with different problems like post-infective damage Which is quite frequent in especially in very hot countries or in case of contact lens abuse Which is frequent in other part of the world or chemical burns, which are not so unusual in in several jobs Destroy the corneal surface and the stem cell so the cornea cannot be renewed over time and It can cannot be maintained as a transparent membrane so those people lose the vision because the cornea become completely a pack and Vascular rise because the wound is closed by the white part of the eye Which is completely different So analyzing the ocular surface in several parts of the eye We found a specific area where are contain the stem cell powerful cells able to regenerate this transparent membrane of the humans All over their life. So we develop a technology and Being able to isolate from a very small biopsy one millimeter is like a mosquito in the eye very small area from the same patient Having delusion and we isolate the stem cell from this small biopsy We grow them in culture under specific condition or specific career and we reconstruct the tissue of the same patient for transplantation That's just this then was extensively tested at Clinical level on several patient because he's not so a frequent pathology But what I I think is important if is to have understood I mean the mechanism the kind of problems To define all the variables and we have extensively done even because we underwent at the regulatory part from this point of view and I mean this opened the possibility to other treatment once you have understood how it works I mean similar right similar criteria can be applied to other field to other kind of pathology with other and I will I will ask you different condition Thank you, and I will ask you more about that other treatment in a minute But Josh tell us, you know the breakthroughs that are being made in your work Well, my own work is very basic. It's about how the retina works And I'll say a little bit about that and then about breakthroughs that are more clinically relevant The the retina as you yourself said is the most accessible part of the brain. It's outside the skull It's the only part that comes with its own lens So you can look into it in live experimental animals and even live people and methods are improving to look at its individual neurons in life and Follow what happens to them in disease states My own work quickly is on the neural circuits in the retina I think it's going to be the first part of the brain that will be cracked It will really understand in a satisfying way and although David says it's a camera It's a it's actually a camera plus Photoshop. It does a lot of Computation and processing on its own that it then feeds to the brain and these circuits are You know five years ago I would say they were as mysterious as the circuits of the rest of the brain But technology has moved so fast that we can I I think look forward to Understanding how the retina works as a neuronal machine In five years meaning we'll know what all the cell types are. We'll know how they're connected We'll know what their functions are and we'll know what messages they send to the brain Now in terms of how is this going to help cure or prevent blindness I Think it's going to work in conjunction with progress being made in the rest of the brain the main Retinal diseases so-called back-of-the-eye diseases are neurodegenerative diseases So there are diseases not of miss wiring, but diseases where neurons get sick and die and that's what happens in Alzheimer's disease Parkinson's disease Huntington's disease and I think as we move on the progress in neurology and the progress in ophthalmology you're going to feed each other Because they're going to be very very similar mechanisms. They're going to be similar disease targets, and so that's where my hope lies Plus the fact that as new modalities come online gene therapy for example Optogenetics stem cells things we can talk about as we go on My guess is a lot of them will be tested first in the retina retinal diseases Because we know so much about them, and we know how to get into them Maybe the test bed for a lot of therapies Which eventually will be used in the rest of the brain Well now David this brings us to you, you know the description of what you're doing is It sounds so science fiction in a way, you know, but you're Developing mechanisms for machines to be able to see I know that the brain can now control Artificial limbs can we ever get the brain to control an artificial eye? Sure. Yeah, and I mean if you look at vision As an engineer would it's a cascade of Modules and operations so the light has to get through the optics of the eye and if those are damaged You lose sight if the retina the very sophisticated camera. Sorry Josh If that's damaged then the signal doesn't propagate further But ultimately where it's going is to the brain and there are a couple Realizations along the way and the brain that are ultimately responsible for experiencing and understanding what we see and the more We're able to understand how those circuits work the more we can Sort of we can either interface with those so you could imagine Artificial eyes bionic eyes and already you could interface those with the retina or you can increasingly Start to think about interfacing directly with the brain as long as we understand the language of the brain as long as we have the technology to do that interfacing and currently a lot of the technologies we have aren't Aren't ideal for interfacing with their normal tissue So what we end up having to do with current bionic eyes is to actually have quite a bit of computer processing To help you see and sort of meet the brain halfway so there's quite a bit of video processing that goes into Into that that artificial camera the artificial eye that then can interface with the brain To actually give you either the understanding or even a little bit of the experience of seeing well Let me ask all of you. I mean it sounds like we're probably a ways away from having a true bionic eye But what do we think are going to be the breakthroughs that will you know? Be the most prevalent in the next few years things that might be available to consumers That would really allow people to see again who can't see or that would stop a disease in its tracks Kind of like what you said your mother was going through with a macular degeneration Well, there are many things in clinical trials What are the most exciting ones one that I think is exciting if you'll bear with me is what my mom has called wet macular degeneration and That is treated not perfectly, but remarkably well and that itself is a breakthrough of recombinant DNA That is a new sort of a new kind of medication More people have something called dry macular degeneration and for that there is no treatment and Most dry macular degeneration proceeds to what macular degeneration so if you could cure that you'd you'd have the whole thing There's great science recently Suggesting that dry macular degeneration is a disease of what's called the complement system a the bodies Part of the body sort of innate immune system that fights off dangers of all sorts And there's now a couple clinical trials Taking advantage of that knowledge and I emphasize we don't even know if the fundamental insight is right But there's good enough evidence to go in with other sort of molecular medicines recombinant DNA Products to try to Zap the complement system before it leads to dry macular degeneration and then blindness So those trials are I think they're just coming out of phase two. They're starting phase three Which means it'll be quite a while till we know but A I think that's very exciting B It also illustrates the point I made that the retina may be the place to test out Methods to treat other brain diseases So there's a lot of evidence now that Alzheimer's may Involve defects in the complement system So on top of the excitement of being able to fix dry macular degeneration if that works out that could lead to insights They'd be directly applicable to Alzheimer's. That's that would be very exciting indeed Graciella, so you're This the stem cell therapy that that you've been working on this is gonna go to the FDA You're gonna submit some papers to the FDA. What can we expect to see happens next? Well, I cannot say exactly the timing about Possibly submit a possible submission to FDA Now we just obtained the approval from European Medical Agency and we are supposed I mean to to start treating European patient to Multicountry clinical trial and Start in distributing this kind of product at the meantime. We will of course evaluate We'll have some advice at FDA because there are big differences in the regulatory system between different continents we have seen that I mean we have Apparently everybody is concerned about the safety but the vision of safety is deeply different between different in different continents and Everybody has his own criteria and we have to face. What is the I mean the vision of FDA now? We consider at European level mainly Start distributing since in the past We were producing this kind of therapy in Italy and the patient were forced to travel to Italy to have the treatment and This is a strange condition and it's not the best for the patient Especially a blind patient should have the therapy available to him in his country not and so when will people in Europe be able to begin to get that kind of The end of these years will Officially start the clinical trial and but we are starting distribution already in those months To the center that should be qualified there should be certified under the GMP rules. So there is all the Rules all the process of certification which is requested for this kind of therapy So the treatment will become available soon. Are we talking about this being able to Be tested on hundreds of people or thousands of people or I mean We don't have to test now because we had the acknowledgment of our previous trial that were controlled in a retrospective Evaluation by inspectors from European Medicinal agencies. So our previous data were an alleged and considered full compliant We have to increase. I mean the The trial in terms of evaluating for example different medical background All around Europe. How can this different medical background can affect the clinical results of Of the treatment and this was requested by European Medicinal agency and and then I mean once we have the Let's say qualification of the medical doctor for this kind of treatment We we can proceed and treat the patient finally in their respective countries Since it is very easy to to have a small piece of tissue, which is you can imagine is Smaller than the eye traveling all around Europe and it's easier and less expensive that even the patient traveling Yes, so we are going to do of course. We want to ask also the FDA advice since other people even in US was interested in developing this this kind of treatment with stem cell. I think In addition to the importance that we can give to the specific treatment and the specific blindness Which for me was I mean the real motivation for many many years of my life because Looking something that apparently is unaffordable I mean somebody who was blind for 20 years and you can find the solution to the problem is is something Strongly motivating you when you see the smile on the face of that person that recover. I mean the full function is is Something that change your life. I would imagine that would be really really impressive but still We have to consider Many other many other approach and many other things that can in can be improved and I mean with a similar I mean the point is that the first stem cell product was approved This is important because there were many concern toward the stem cell Since the stem cells are considered something that remain in a body for all the life of the per the people so the regulatory authorities was concerned about something remaining forever in the body and once they Set the idea that this can be done and it is a safe procedure because we had a follow-up up to 14 years after transplant This opened the possibility to all the other Specialists all the other cell biologists or gene therapists to proceed on this way That is an especially with the IPS cells with which are all those reprogrammed cells so For those of you who are not deep in the field are all those cells that become again embryonic and This means that we can build tissues with our own cells Sorry our own cells so not giving immunologic rejection So it is important field and the idea that stem cell can be used open even new possibility in this field Especially in Japan where they are very active on this on this part Let me stop you there. Let L, you know if I were sitting in your shoes I would feel somewhat frustrated by this conversation because here's all this amazing stuff that can go on But in the third world, we can't even seem to get you know people eyeglasses or get them cataract operations How do we attack this sort of basic problem? Well, let me bring it to the first world actually So I'm an ophthalmologist and actually the only ophthalmologist amongst this group of very smart people self-excluded So let me tell you about two practical Diseases that we've not talked about And give you an example of that so one is diabetic retinopathy, right? So we're going to wait for our colleagues here on this panel to figure out how we prevent diabetic retinopathy in the first place And diabetic retinopathy is basically the growth of abnormal leaky hemorrhaging vessels in people of diabetes and as you've already mentioned diabetes is a Endemic an epidemic growing around the world as people become more obese They're becoming more sensitive to diabetes more diabetes more diabetic retinopathy now the key to preserving vision and diabetic retinopathy is early treatment primarily Laser therapy, but also a very simple approach to what Josh's mother is going with the intervitual injections, so you have to know when someone is developing diabetic retinopathy now you think that was fairly straightforward everybody more or less knows when they were diabetic at least where they were diabetic severe enough to develop diabetic retinopathy and we Recommend to everybody it's certainly in the developed world that they get an annual dilated eye examination so that we can pick up the earliest manifestations of retinopathy and so we can treat it usually with laser therapy Problem is we there are not enough Themologists in the developed world to in fact examine everybody who has and people don't go for those examinations our Existing recommendation is that every diabetic should have an annual Dilated eye examination so as an experiment we went to the best managed care organizations, you know where people really are doing the right thing and giving the right advice and Looked at how frequently we gave them an extra leeway We said well how what proportion of people with diabetes who should get an annual eye examination even get one Once every two years once every two years we're giving them more you know was it half who's will you have very close? 40% 40% so until we can get people to get now How can they do that we have to stop thinking the way we've always thought so everybody who has Diabetes that's going to put them at risk of retinopathy gets a medication whether it's insulin if they have Insulin-dependent diabetes or they get an oral drug if they don't have that severe that means they have to go to a pharmacist Right, so why don't we put a camera in every? Pharmacist's office that when that pharmacist gives somebody their medication at least once a year Takes a photo of the back of the right we have cameras You don't have to dilate the eye you can get a full picture the back of the eye That gets sent digitally to a reading center although a computer will do most of the reading these days And I'll say this person needs treatment. Well, so what is preventing something in Russia inertia politics, you know each Professions own Interest in what they do. I mean I've been on this theme for 20 years now having Been chair of the National Eye Institute's eye health education program and that seemed to me a reasonable thing to could not get the Organizations together to do that so that that's one side and it's the side of how do we do what we know how to do The other side just to bring in a disease that we've not talked about is open-angle glaucoma very major cause of blindness around the world And actually while everybody's at risk of it African-Americans or Africans or a particularly high risk of it And our approach to glaucoma has been the same for the last hundred years And that's reduced intracula pressure and is no question that if you reduce the intracula pressure enough in People who have very high intracula pressure that you will at least slow the progression if not prevent them from going blind Entirely problem is is that we have since then discovered some of it was my own work that in fact Most people who have open-angle glaucoma go get blind do not have very high pressures and it's just a Dead end trying to reduce intracula pressure because you can't reduce it very much without putting the eye in danger of other diseases So now there's a whole movement to using a totally different approach to the one that we presently use that's in in Clinical trials and in laboratory research that's using chemo protection some way to protect the ganglion cells that make up the optic nerve Which are part of the brain that both David and Josh will tell you So we have to take yet another totally different approach to a very important cause of blindness in the world So is that is glaucoma really one of the most? Stubbornly mysterious diseases it's stubbornly in part because we went down one track and we never considered other tracks And it took some just very straightforward Epidemiology to say well, it's true people with the highest intracula pressures are at the highest risk of going blind But most people don't have very high pressures And in fact therefore even though their individual risk of going blind is lower than that of those who have very high pressures They make up such a large proportion of the populations of the vast majority of people who go blind from glaucoma In fact do it with relatively low pressures, and so we need a different approach Let me ask one more question, and then we'll open it to the audience And I'd also like to introduce somebody in the audience, but if ending blindness in 2020 is Probably not going to happen entirely Given that's only five years away. What is the right year? What is the year that we can say we're going to really be able to Help a lot more people than we're helping now, and I guess I would just ask each of you David Why don't we start with you? So my suspicion is that it's not going to have a single answer And partly because it's hard to define what ending blindness or restoring vision means. Well, how you would define it? Well, so to give you an example, there is a commercially available bionic eye. Yeah, so there's an aparatnol implant With camera that feeds into a processor which then goes to the retina 60 electrodes So what this can basically do is can create 60 points of light that you can see The the the healthy Human eye has one and a half million retinal ganglion cells, so you don't see a lot. You don't see a lot and It's hard to even say Do you it's hard to even put that into terms of 20? Whatever? I mean some of those people say 21,000, but it's a different kind of seeing and you can learn how to use it To do things and that's great, and that makes a big difference in people's quality of life but it's not quite the same thing as as restoring their vision and There's currently a version. It's got 200 electrodes. That's Under that's being tested. There's another effort to pipe directly into the back of the brain Which is much larger area so you can get many more electrodes So it's going to be a gradual process where a lot of people are helped But I think it's going to be very hard to say this is the point at which we're really, you know We've ended blindness. It's going to be a gradual slow gradual slow Josh, what do you think about that? What is what is the timeline? So I think we're going to have the basic knowledge that will help us with things like glaucoma and macular Degeneration and retinitis pigmentosa that we didn't talk about In 10 to 15 years good 2020. Thank you. Graciela. Well from my point of view. I mean ending blindness with being 2020s Unaffordable, but I would be very happy to have if we have a clear idea of The number of hurdles that stop us from giving the solution I mean, there are several kind of several part of science Which are working in different field with different approaches We have shown in this discussion and many other that can provide a solution can provide improvement And sometimes we are slow in producing the solution not only for technical problem But because there are many other things that are not properly working. I mean this kind of Complex task to reach need the multidisciplinary teams. So many people Working together having completely different location different background and those people have to work together and to share results and The interest of their institution. It means that I mean for example having first the education of working in Multidisciplinary team is absolutely needed now to have to reach any difficult task second is Having low that allow to share. Let's say patent to have proper collaboration or Let's say having a private public partnership that allow a better development and more founding and more Advancement in the field and then proper regulation Sometimes I mean the regulation is absolutely needed because humans cannot become like Guinea pigs for experiments but I mean science is evolving very fastly and we need expert in the regulatory panels which are Evoluted with the same speed Otherwise they become a stop instead of being an added value for this technology If we have a list of our problem of our orders within 2020 we know which problem we have to solve in order to speed up the solution of the problem So creating creating the framework by 2020 that gets us part way there All right in the in the developing world just to go back to that for a minute Are we looking at anything near term for really cracking that barrier on fixing cataracts on Figuring out just some way to attack. I think it's important to put in perspective. That's a journey. So in the last 10 years We have stopped people from going blind for vitamin a deficiency river blindness and trochoma So that's a couple million people a year who are no longer going blind. So there's a big impact When are we going to get around to grappling with cataract? That's a social process but progress is being made lots of us have Programs out there trying to see how you organize society to do that And I would think by 2020 will have made a significant impact on that just as in the last 10 years We've made a very significant impact on the other blinding diseases in the developing world Well, thank you all. I do want to open this to questions But first let me introduce somebody in the audience. We have mr. Sandy Greenberg Mr. Greenberg has created a two million dollar prize for whomever can come the closest To a means of helping restore Site by 2020 and I was going to ask him if he could maybe just take a few minutes to explain His his effort to us Thank You Susan. I too am honored to be here. I I I hate to start off the these comments by disagreeing with you Because the prize that my wife Sue and I have created is now three million dollars. Pardon me It's not the worst mistake I've ever For sure. Let's be tied to the Swiss Frank It may become clear that I may be the worst mistake you ever made by but I thank you for the opportunity Sue and I have in fact an October 18th 2012 created a prize as I said Three million dollars in gold to the person or persons who does most or contributes most To ending blindness by 2020 To be precise by December 13th 2020 which is 2,978 days after we began in 2012 The same amount of time it took the United States to reach the moon after President Kennedy announced it so my reasoning which may be flawed is that if we can go to the moon as a civilization and Surely we could end this affliction which has been with All of us and our bipedal ancestors for more than six million years. I Would be remiss if I didn't Speak to the efforts my wife has made to Tolerate me for the past half century and to be with me along all of These steps and finally to say that these conversations began with Professor Schwab in 2008 And that's how we got here and I have to thank in particular Al Somer Josh Sains and our friends Stu Eisenstadt for helping us get here. Thank you Thank you That that is really inspirational. I think we've heard a lot here. That is is quite inspirational as well Let me open it to the audience for questions. I would just ask that you identify yourself, please Jeff Richards a research Institute Davos a Question maybe to Professor Pellegrini at the moment you're culturing your cells in the laboratory for these operations I guess yes When do you see that you'll be able to do this? Interoperative because as soon as you can take such stem cells Interoperatively and put them back. It's much easier on the regulatory conditions. It's much cheaper and yeah Well, if I have to see an evolution of the technology Well, it's not possible to do Interoperatively for a simple reason because we need the time to amplify the culture I mean, we need the time to grow the cells So the cells have their cell cycle they have their time and we have to wait for the time of the cells What can be done that I see as the future of this technology is to have some seal system Because there are some model that can be probably applied to this kind of technology So, I mean all processing can be done almost everywhere with you don't need a specific Facility with a very high level of installation But you can have a seal system or by a processor that can provide The final results without too much manipulation too much cost or too much installation Still the time is needed Because you need to give to the cells the time to proliferate to differentiate to do properly their job If you want to interrupt because that's one concept is to expand the cells Another concept would be instead of putting a large number of stem cells in Would be to put a few stem cells in so if you think of an orchestra and a conductor You put the few stem cells in as the conductor which tell they have a cells what to do Which is I know only a few percent in stem cell work look in this way But this could be possibly done Interoperatively only putting a few cells back in and they then lead the other cells Yeah, yeah, yeah, of course and this approach was used for example in India Where they take a biopsy, which is a little bit bigger and they Cut in very small piece and they put the piece all around the eye I mean if you are in the countryside in India, that's the best thing you can do Because is is impossible to have the installation for culturing cells and making a tissue However, you have to consider that since the cells even in vivo need time You will have the ocular surface not covered by an epithelium Which is absolutely needed for your safety for maintenance for having a Stable carnal surface, which is degraded in absence of epithelium all the time that the cells need to proliferate with our approach we Grow the cells out of the body and the eye is covered by the scar. So is not attacked by microbial Molds or whatever and then when the epithelium is ready You'll go to remove this car and you cover the eye with another barrier new barrier That can protect the eye from any kind of possible adverse event So it's more safe for patient Other questions from the group Yes Yeah, they say said the current approach for using the processor to a camera to do can do like a About 64 I think the resolution But the limitation many it's not because the semiconductor camera is mainly because of the Connection or the process inside so always seeing any major Progress regarding how to find out how to send the signal in because in fact today even with smart phone We have much better camera than what is available now with the eyes and tell us who you are Yeah, when she changed from VR and HTC Okay, let's be clear the the cameras can be brilliantly high resolution The processors can process huge amounts of data It's just just matters how big the computer you're carrying around with you to do the video processing is the limitations currently are on the electrodes so actually the thing that gets implanted into the brain how many electrodes are there available and What these electrodes end up doing is they produce these things called phosphines and so basically a little flash of light And actually one of the biggest limitations is is not even just the density of those electrodes But the fundamental technology of stimulation So as Josh mentioned the retina is a very sophisticated camera It just doesn't just tell you the light level it some cells will tell you that there's a light spot on a dark background And some cells will tell you that there's a dark spot on the light background when you steam it They're right next to each other when you stimulate with an electrode You're hitting both those channels at the same time as many channels in the retina This is also true in in the brain There's cells right next to each other that tell you that you're seeing a little bit of orientation like this and Cell right next to it that's telling you seal edge It's like that when you stimulate with these sort of coarse tools of these stimulating electrodes you hit them all at the same time So it's fundamentally not working the same way that our brain works and that's really the biggest limitation We can put more channels in and actually if you want to look to technology for doing that look to the The brain initiative for instance where there's a huge investment in new technologies And if you look in research labs the kinds of electrode arrays we're able to put in have much higher density Than what's being able to be applied in the clinic? But even there I think we need to move past even just stimulating electrodes because that's one of the fundamental limitations This isn't so different than cochlear implants. So cochlear implants have been around for quite some time There's hundreds of thousands of people who have them fundamentally the same technology Those don't restore hearing per se they give you a new way to hear and you have to learn how to do that and and vision Prosthetics are progressing much the same way they give you something that's a little bit different than than what they're replacing And you can learn to use that But there are technologies potentially on the horizon for much more targeted stimulation where we can stimulate only one type of cell And maybe we could start to think Decades out about actually restoring a much more nuanced much more equivalent Formal vision. It's fascinating Yes, ma'am I'm Nicola von Noterati from Zurich. I'm a medical journalist Something that interests me. Maybe one of you knows about that. Is there any new treatment against short-sightedness? Because in some Asian countries Short-sightedness is something that is really extremely frequent I think the malignant the malignant form is is very bad and can't lead to blindness So maybe any of you know something about that Well, I mean you've talked about this is being so so near-sightedness Essentially what happens is the eye becomes Longer than it should and that's what leads to degeneration in the retina and really very serious problems other than just wearing glasses Like I've done since the fourth grade There are We don't know a lot about what causes it. There are lots of animal models, which we've learned a great deal about There's some epidemiologic data and some trials that have suggested if we took young children and Essentially prevented them from focusing. So, you know, your eye is really quite a wonderful tool You can look at distance and everything is in focus and then you read up close or knit or and you can see that And when you get to my age, you can't do that anymore. You got to wear how many people wear reading glasses. You have to wear So but as you get It is thought that this a what's called accommodation is focusing up close Maybe one of the things that in fact drives the eye to get too long for itself And so some people have demonstrated that if you essentially use a drug atropine or something like that that prevents you from Accommodating reading up close that that makes in fact slow the progression of Nearsightedness also, there's some epidemiologic evidence that when people get more Exposure to sunlight and are outdoors that they in fact slow the progression I've always gone with the thesis that Those of us who are nearsighted couldn't see out of doors and so we didn't you know So I don't really know if it's cause and effect, but there's there's some suggestions Because in effect the problem is is the people really want to have young children not being able to focus up close and having to wear Glasses in order to be able to read and play with their toys and learn their colors and so forth and so on so there's no No absolutely agreed upon certainly no no practical way to prevent it at present But there are things that one can do if I was once going to do an experiment and I actually convinced the commandant of the Naval Academy to prove that this preventing people from Accommodating would in fact prevent them from developing nearsightedness and what you need to know is To enter the Naval Academy the United States probably true at every country you have to have perfect vision without glasses Right by the time they graduate four years late at 25% of them have become nearsighted So they can't be line officers they can work wonderfully on submarines because that's pretty close But they can't be line officers and I actually convinced the commandant to let us Atropinize that is prevent the accommodation for half the incoming class We had to get over who's going to catch the football when army plays Navy and that kind of thing But then they switched commandants on me and as we were just about to launch that project said no No, I'm interested in that we want to win those Navy Army football games and so we're not going to do that So it's a work in progress. There's certainly nothing that's very practical that we can do at this point in time. I can't see behind Yes, ma'am And your Nora, I'm Nora Volkov. I'm a national institutes of drug abuse at the NIH and my question I was taken by your statement that says we're making extraordinary advances in terms of new solutions that are going to be Transformative yet. We already know how to prevent Some of the disorders led lead to blindness and you are some of the ones that are increasing like diabetes retinopathy But so so if we already know we know the pad What are the roadblocks that are not enable us to implement those because otherwise as we can generate more knowledge We cannot solve the implementation. We're not going to solve the problem. What are your thoughts? So I would say there are two things one is we can't stop looking for new innovations Because not only are new innovations allow us to do things we couldn't do before but they often come up with much simpler ways of Doing things that are much more complicated to do now But it may be we could give somebody a drug and they will never get diabetes I mean I said so it's important to continue the innovation process Even if it's things that we already know how to do the other part is organizing humans and their Economic and political system to do the things that they need to do so, you know the United States Well, we have the Affordable Care Act. It's less than perfect, but it's taken 60 years to provide some semblance of Universal health insurance for Americans where most European countries have had these for you know half a century already So like everything else is how do you organize people the money the political processes to put in shape things that are not Rocket science and not what these people do that we know how to do But you've got to put in the right economic stimuli and the right incentives to get people to actually do them It's very frustrating. It's actually easier to do what they're doing Do I see anybody behind me? No, you know one of my big takeaways from this has been in a number of you have mentioned it this connection that I don't think most Non-doctors really make between the health of the eye or understanding the eye and what's going on in the brain And it seems like that is going to be one of the main things that we see In in the years to come, you know the more we know about the eye the more we're going to find out about the brain one of the things I have learned in all of this is Ending blindness Whether it's preventing it from happening or curing it after it does happen is a really terrific story to do for National Geographic Magazine is as what I've decided in talking to all of you over the last few weeks And so we will commence to do that I want to thank everybody for coming and I thank all of our wonderful panelists. Let's give them a round of applause