SINHA, Pawan  MIT  Blind Children Seeing as Adults  14 Mar 2013

(Pentti Kanerva  seated beside me (old friend from the seventies))

speaker  pronounces first name  pav Ahn...

Paul's intro:  cleric  Molyneaux  posed a problem to John Locke in a letter
330 years ago...  soln depends on rationalist or an empiricist...

he started his careeer at Berkeley:
then to Madison Wisconsin
now at MIT...

Project Prakash...

slide 1:

Y axis billionaire net worth
X axis is  GDP

quite a few billionaires in India  (#5 in the world)
going up quite a bit recently

India, Inc...  BUT...

slide 2

HDI  = human development Index:
size of  disk is proportionate to population

here India is bringing up the rear...

only 1% of GDP is spent on public health in India..

eye health...

1 in every 100 Indians is BLIND !!!!!

but even this might be optimistic  might be 1 in 90

the incid of childhood blindness in India is 3X that in the west...

corneal scarring,  cataracts
retinal dystrophies,
infections,
congenital rubella syndrome...

trrachoma  (He had it in India but  eye drops => cure)

rubella = German Measles  (in mother);

SIA = scheduled immuniz activities...
India does NOT have an immuniz program against rubella  !!!!  til 2009  (> and beyond...

share of global measles deaths in 2010

India  47%
Africa  36%
N America  < 1%

but over   40% of childhood blindness is treatable...

but  the focus in on  adults in India, not on kids

70% of India's blind live in small villages where there are NO ophthalmologists

and there are only  1 in 100,000 ophthalmo

lifespan is  15 years shorter...

childhood mortality is > 50%

over half do not live to see  fifth birthday...

huge humanitarian crisis

  cataracts;  corneal opacities... curable !

dense cataracts... can initiate sight in 1 day...

sci problem... get a window into process of early childhood development:

perfect merger of humanitarian and science

sanskrit for life... PRAKASH
Project Prakash...

past research on recovery after blindness

fine , wandell, maclead  2003  (Brian Wandell is in our aud.)

chselden 1726
von senden 1936
gregory 1964
sacks etc.

he would go to villages outside of Delhi...

Natl eye instit; and private fnds...

project HQ in Delhi...

uses field workers...

he shows video of project:

examines for sensitivity to light  (if no sensit, then not treatable)

can also help kids with low vision...

performed under genl anesthesia...

dense cataract is excised...  put in synthetic intraocular lens in...

rx one eye at a time:

sci Q:  what is the child experiencing...

how does vision develop after onset of sight...  or whether it develops

is brain plastic enough  at age 8 or at age 22????  big Q

vision learning is subject to a critical period...

8 refs...

mitchell  1988  J Physio...  extent of recovery

animal  studies...  suture shut one eye:  it loses  ability to perceive...
and cannot reclaim vision later...

so perhaps surgery late in life is not helpful

(if kitten expt can be extrapolated)

but lit is based on animal studies, monocular depriv,
limited durations of follow-up

so we need data from human S = (subjects).

must get data to explore this...

Prof Brian W  comment:  how abt amblyopia  data?  might also inform this Q...
eg  if leave eye untreated to age 10, then it's a lost cause..
(but this is  only one eye... and a resulting imbalance)

have gotten access to fMRI in Delhi... have done a few analyses...

resting state func connectivity...

do see some correl btwn  some brain regions

he compares  correl  across visual voxels  before and after surg...
before... all the voxels are correl.  but much later  see DE-correl of voxels (they are being patterned)

eg  adaptation and decorrel in cortex :  horace barlow and foldiak  1969...

develop of func specialization

2)  do see  develop of func specializaiton... eg   see  PPA,  FFA  develop
(see this in normal kids  but does it happen in these operated kids)

he shows  data for pt  SC age 21
2 days post-op, then 1 mo, then 4 mo then 10 months post-op

you DO see gradual increase activation in  FFA and PPA

is  it  face vs not face  (at least that)  do not have data to say that they can recognize a partic face

so,  Q1  is brain plastic enough to use this info from eyes late in life??  A  YES

but... can the child actually benefit from the visual info?

he shows a video clip of Soumitra  age 11  presurgery

before surg... find a box of chocolates...  cannot do it... movie...

has only light percept...

now 8 days post surg....  goes  right to it!

A to my Q  (her dx)  was she blind from birth:
prob yes... but v hard to know  extent of deficit
 (detective work to determine that... cuz  many times there are no records)

1)  contrast sensitivity...
get  much improvement in contrast sensitivt  (incr  spatial freq)

Prof Wandell:  comments on pt Mike Nee:
 only 2 cycles per degree  improvement  (not much)

global motion perception:

bill newsome.. motion coherence...

normal sighted controls  threshold is abt  15%

Prakash  perhaps  25% threshold
6 to 24 months  post op:  perhaps  20% threshold...

spatial imagery task...

look at fixation with  this:

look at square  lowest and to the L

then give them instruc... go one up, one to the R etc.

they improve at this...

face/ non-face classification

shows a video  of a young girl...

she gets some right...

they all do improve on face recog  (vs non-face)

fifth task:  maping touch and vision... combining them together...

nature vs nurture

the Molyneux  letter to Locke  1688

man born blind; and the
blind man is  taught
to distinguish cube and sphere by touch..

suppose the blind man be made to see:
query:  whether by sight before he touched them he could now distinguish the cube from the sphere.

touch to vision:  answer is NO  (to Molyneaux Q)  they cannot do this

stars vs  spheres, eg...

cannot do it  within 1 to 2 days  BUT

after 1 week there is a GREAT IMPROVEMENT!!!

NYTimes  april 26 2011  study of vision tackles a philos riddle

YES  they could do it!!!

so,  does the child benefit?  YES!!!

so  rx shud be provided irrespective of age...

Prof Wandell:  some kids  2 cycles per degree but some got more...

further comment:  Brian W:   would expect far more improvement in a 2 month old
than an 8 year old and more than an adult...

he says.. if u only have 1,000 bucks why not spend it on the young ones

can do this surgery for 100 bucks!  total cost = 30M dollars!!!  for all!

Charles Gilbert argues for adult plasticity

Mike Nee says he reasons better abt visual objects...
he is an entrerpreneur

total cost including everything is $400  per eye....

Brian W: suggestion:  put kids in total blindness to try to restore plasticity...

so far have screen 42K kids...

AI  system:  Dylan learns  object recog  unguided...

last slide:  no change in visual actuiy in many of these kids:  challenge of treatment...

we also want to focus on educationfor this children...

want to integrate education with res and with healthcare...

want to build a center...

funds from Simons Fnd;  John Merck Fnd;
James McDonnel Fnd
also NIH/NEI

molecular factors that are expressed in early life may terminate the critical period ofchildhood plasticity...

Dylan  object  concept learning...  take in video...

baby with a video on his head... first 4 weeks of life...

baby can acquite  feeding bottle, face...

needs low level salience....

within a few mins system can pull out a concept  with some  salience feedkbac.

(dinner with Pawan and Paul: see notes)