Hard vs. soft solutions: the retinal prosthesis

At what point do “soft” solutions (tissue engineering, stem cells, gene therapy, biological manipulation, etc.) begin to make more sense than “hard” biomedical devices (metal electrodes, metal or plastic mechanical structures, electronics, etc) in terms of efficacy, safety, and cost?

Partially inspired by the success of cochlear implants, a research team at MIT has been developing a prosthetic retinal implant using a “hard” approach. Their device consists of a microfabricated grid of electrodes that, when placed against a damaged retina, would be able to stimulate healthy neurons, potentially restoring sight. Sounds fantastic, right? At MIT, there is always someone who can take a fantastic idea and push it even further. A grad student in the group wanted to find a more natural solution and ended up forming his own research initiative using a bio-ionic approach that still uses electronics, but interfaces to the neurons using potassium ions. And the “softest” solution would be to replace the damaged tissue with a functional, natural retina (although this would likely also be the most challenging). What approach will win out in the next ten years? The next twenty years?

“Soft” approaches may initially cost more to develop and take longer to develop than “hard” solutions, which are based on validated medical device methods. But as tissue engineering and biological approaches become more and more sophisticated, will “soft” solutions eventually overtake traditional medical devices ? How soon? What kinds of applications would “soft” vs. “hard” solutions be most suited for? Will the optimal solutions be entirely or mostly tissue-based, or some cyborg combination?

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