Looking Into the Future

Just two generations ago, the blind were consigned to worlds of darkness, with technology unable to do much to bring them sight. Now, blind men are driving cars -- almost.

"Five, 10, 15 years ago, this was Star Trek or Star Wars technology. Blind men wearing big, stupid visors. We thought no one would be able to do that, at least not in this century," said Dr. Gerald Chader, chief scientific officer of the Foundation Fighting Blindness. "Well, it's looking pretty good, and we may see this come to fruition in our lifetimes."

Of all the fronts scientists are fighting in their war against blindness, the most press has gone to the work of Dr. William Dobelle, a sports-car mechanic-turned-physiologist who may have given a blind man enough vision to steer a car.

"There's no question in my mind that Dobelle is on the right track. It was inspirational," said Dr. Eli A. Friedman, editor of the Journal of the American Society for Artificial Internal Organs and a longtime friend of Dobelle's who witnessed the car driving. "It reminded me of (the books) I read when I first became enchanted with the romance of medicine. As Al Jolson used to say: 'You ain't heard nothing yet.'" Dobelle was unable to comment for this story.

Dobelle's cortical implant does look very much like a cyborg contraption from a science-fiction movie. The device plugs into a hole carved into the back of the patient's skull and connects to a video camera. The camera sends visual information through the device, which stimulates the visual portions of the patient's brain, allowing him to "see" dots of light, or phosphenes. The phosphenes, when arranged properly, could theoretically form crude representations of the real world, allowing the blind to see "maps" of what's in front of them.

"It's not enough resolution to watch TV, but it's enough to ambulate," Friedman said.

But Chader was more cautious about Dobelle's work.

"Dobelle was not really forthright with any scientific disclosures," he said. "He showed a video of one of his patients driving a car in a huge parking lot. Well, blindfold you or me and we could do that. I think the evidence we have is very subjective and not objective, but we're eagerly awaiting Dr. Dobelle to give us more information."

Patricia Strombeck, a master's student at Hunter College in New York who is studying to become a teacher for the blind, said that allowing a once-blind person to see is only the first step in helping them overcome visual impairment.

"There would be some social adjustment period, because as a blind person you develop your own sense of the world," she said. "There is definitely a culture there and some (different) social behaviors for people who are sighted and people who aren't. They are different worlds."

In terms of advances in treatment for blindness, Chader is most enthusiastic about gene therapy for inherited blindness. Testing in dogs with inbred blindness has proven extremely successful.

The poster dog for the disorder, known as Laber's Disease, was born virtually sightless. The dog, Lancelot, bumped into furniture and was unable to recognize humans. Lancelot received gene treatment in one quarter of one eye two and a half years ago. Now he can catch balls.

"A treatment, if not a cure, is in sight for blindness caused by genetic disorders," Chader said.

Other promising areas include drug therapy to reinvigorate ailing neurons and photoreceptors, chips implanted into the brain and in or on the eye, and, to a lesser degree, transplants of photoreceptor cells or other eye tissue. There's even been big strides made in the prevention of certain types of blindness caused by nutritional deficiencies.

But Strombeck warned people from being unrealistically enthusiastic.

"You have to be careful about making sweeping statements about medical treatments that help people regain sight, because they might not always work," she said. "But if it's something that's going to work, it's great."