8.4. Further considerations 8 119 perception. On the other hand, the research and development should not be withheld by an imperfect biological understanding and it is relevant to acknowledge the value of lessfundamental descriptive models. In cases where a complete biological understanding is missing (seeChapter5) it is often still possible to create phenomenologically accurate, descriptive models. In this regard, clinical and simulation research profit from mutual contributions: SPV research can simulate specific clinical observations that can drive patient-centered optimization, while in the meantime further clinical experimentation can help to obtain better biological models of phosphene perception. 8.4. Further considerations What do implant users ‘see’ with phosphene vision The primary focus in this dissertation is put on objective quantification of performance, and only a limited set of subjective outcome measures were used (seeChapters2and6). It is important to acknowledge the value of more qualitative research approaches that focus on subjective measures. In addition to simulation studies, patient reports from first generation implant users can help to better understand what it is like to learn to ‘see’ with phosphene vision. As described in a study byErickson-Davis and Korzybska (2021), phosphene vision is a “highly specific, learned skill-set that combines particular bodily techniques, associative learning and deductive reasoning”. Prosthetic implant users interpret the phosphenes as a “lexicon of flashes” to form an understanding of the environment. While the relative improvements in next generations of visual implants remains to be investigated, it is clear that a natural-like form of bionic vision is not within reach. Taking note of this cognitive process of ‘seeing’ with phosphene vision, opposed to natural vision, can help to identify the key requirements to improve artificial vision. More insight into the practical usefulness on user strategies can be gained both through simulation studies and patient-centered research. A practical approach to phosphene encodings A recurrent topic in this dissertation is the importance of intuitive phosphene representations. Here, it is vital to realize that intuitive phosphene patterns do not necessarily have to be visually similar to the surrounding. In fact, as stated elsewhere (Beyeler& Sanchez-Garcia, 2022), thinking about phosphene vision as a pixelated (‘score board’) representation of the environment can even be misleading or distracting from alternative solutions. Involving patients in the co-design of the stimulus encoding could provide intelligible alternatives of a more practical nature. A smart visual prosthesis will likely contain different modes for different activities (Beyeler & Sanchez-Garcia, 2022; Lozano et al., 2020). The design of practical phosphene encodings together with prospective end-users can help to secure the right priorities from the patient population. The relevance of training and rehabilitation A topic that is not extensively discussed in the current dissertation, is training and rehabilitation. As phosphenes are difficult to detect, interpret and use, the adoption of phosphene vision to support daily living activities will be a process that strongly relies on training. Hence, the progress is often measured in longitudinal studies (e.g., Hoetal., 2015; Stingl et al., 2015). Note that this also holds for some simulation research that
RkJQdWJsaXNoZXIy MTk4NDMw