Doctors Who Make a Difference in Hawai‘i
Meet five Hawai‘i physicians that are doing important work in our local communities.
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Seeing the Light
Ending blindness via an implanted computer chip and video-cam eyeglasses.
By Don Wallace
Dr. Gregg Kokame performed the first bionic-eye implant in the Pacific Rim.
Photos: Olivier Koning
A HONOLULU WOMAN IN HER 60s, who lost her hearing as a child and later, as a grandmother, her sight, is quietly making Hawai‘i medical history with a bionic eye and high-tech eyeglasses.
It started when a hereditary genetic condition called retinitis pigmentosa began narrowing her vision. Then, two years ago, her world went black—robbing her not just of her sight but her ability to communicate easily with family and friends.
Enter ophthalmologist Dr. Gregg Kokame, director of Retina Consultants of Hawai‘i, who has been studying the disease for decades. He saw potential for a device he’d been watching develop, a type of bionic eye.
Officially, it’s the ARGUS II Retinal Prosthesis, which consists of a pair of video-camera eyeglasses that send images to a video-processing unit worn on a belt, which transmits wireless signals to a chip—the “eye”—that has been implanted on top of the retina.
It was 20 years in development by Dr. Mark Humayun of the USC Eye Institute, and Kokame had been following its path since 2008, when he’d invited Humayun to Hawai‘i to speak about his work.
Kokame, 58, was born in New Orleans, the son of a surgeon from Kaua‘i. His dad moved the family home to Hawai‘i when Gregg was 10 years old. After schooling at ‘Iolani, Pomona College and UCLA medical school, Kokame got inspired by the science of the eye.
A retinal chip relays signals from video-glasses to the optic nerve.
Once FDA approval was granted in 2013 for the retinal prosthesis, Kokame started planning. “The first thing is finding a patient,” he says. “They have to have had vision so they know how to interpret sight. You want to make sure they’re motivated, that they want to go through training before and retraining after.” He had a patient in mind, one who, when informed that she would be the first person in Hawai‘i and Asia to receive the bionic eye, showed no hesitation. “She is a sweet old lady who was able to adjust to losing her sight. But she was very interested in being part of the process, and her family also was very involved.”
A YEAR BEFORE SURGERY, Kokame flew out to meet with the company founded to produce the device, Second Sight, in California. Then, Kokame explains, “We developed a research center at Pali Momi, worked to create a surgical suite at the Eye Surgery Center and started training people to perform the surgery.”
Humayun himself flew out to observe the four-hour surgery, which seemed successful. But they wouldn’t know for sure until two to three weeks had passed and the eye had healed. “There is no ability in the (retinitis-pigmentosa-afflicted) retina to receive light,” says Kokame. “We’ve replaced the input of light with the signals of a video camera, sent wirelessly. The glasses have a transmitting device, and the eye has a receiving device. That’s the amazing thing.”
Only when Kokame threw the switch would there be light.
Kokame recalls the scene when the new eye went on: “The room was filled with about 20 people, including family, medical residents, people from the research group.” A bioengineer began by fitting the eyeglasses to the patient’s face and plugging in the video processor. The next move—testing each of the 60 microelectrodes inside up to 80 times in sequence to ensure they were all responding to the retina—required the camera to be switched on. From that point, says Kokame, “The patient would receive impulses and the patient would gradually start to perceive things.”
The switch flipped, video signals stimulated the retina and the array triggered electrical impulses to the brain via the optic nerve. “You could see it in her face,” Kokame recalls. “In the smile on her face. Once the device was turned on, when she initially saw the light, that was one of the most touching moments.”
Next Kokame stood across the room and pointed a flashlight in her face. “‘Walk toward the light,’ I said. And she was able to actually walk all the way toward me, toward the light.”
The room broke into applause, as well as tears.
While ARGUS II is inarguably a breakthrough, the early results are modest. The recipient doesn’t see color, the resolution is extremely fuzzy. “You see light intensity versus dark intensity,” says Kokame. “But, with the implant in place, all the processing technology can be upgraded over time without surgery. And the technology is going to evolve.” Continuing research is expected to enhance the experience so that patients will eventually see detail and color.
The technology behind the ARGUS II shows promise for the relief of symptoms of other eye diseases, including macular degeneration, which affects 11 million Americans.
As for Hawai‘i’s first patient, the dramatic moment of seeing her first light in two years had barely passed when she opened her purse and began handing out hand-crocheted gifts she’d made without sight. She has since, Kokame reports, gone back with new enthusiasm to one of her favorite pastimes, making lei.
“Before, she would just make lei and not understand what was dark lei and what was light lei. Now she can differentiate between the flowers.”