From Personal Experience to Big Picture Perspectives: Dr. Gordon Legge on Low Vision Research and the Bionic Vision Landscape

Dr. Legge, you have had a very impressive career which brought you from MIT to Harvard to Minnesota. What inspired you to dedicate your career to research in low vision, especially with regard to reading?

[Gordon Legge (GL)] I completed my PhD focused on spatial vision, mostly from a psychophysics perspective, which was primarily oriented towards “mainstream” vision science. My work wasn't directly related to low vision at that time. After my PhD, I did a postdoc in England where I was introduced to clinical applications of vision science. There, I encountered an intriguing prototype display called the Beta Graph, which I believed might serve as a beneficial visual display for those with low vision. This piqued my interest in potential video technology for low vision.

Curious, I delved into existing literature to understand the research done on low vision, particularly in reading. Surprisingly, there was a glaring gap, especially in psychophysical studies of low vision reading. When I joined the University of Minnesota as an assistant professor, I continued my research on spatial vision. But I also nurtured a growing interest in low vision reading, exploring fundamental aspects that hadn't been previously investigated.

I took the initiative to submit a grant proposal to NIH focused on low vision and reading. What was remarkable was that not only did they approve the grant, but they also doubled the funding. This was back in the early 1980s. NIH had been looking for research on low vision but hadn't found many researchers in the area. They saw potential in my proposal and decided to fully support and even expand upon my project. That substantial backing from NIH essentially paved the way for my involvement with low vision and reading, which began as a secondary interest but quickly became a focal point of my research.

How do you think that research environments have changed over the years for people with visual impairments, in your experience?

[GL] Going back to the early 1980s, the primary focus in the field of vision impairment was on the diagnosis and treatment of eye diseases. There was limited emphasis on rehabilitation or enhancing the lives of those with impaired vision. However, I, along with others, worked to promote the idea that institutions like the NIH and other government agencies should invest not only in curing eye diseases but also in improving the quality of life for people with visual impairments, be it blindness or low vision. Over time, there's been a shift in research priorities. While it's still a small segment of the overall research effort, there is now a more pronounced effort by organizations, including the NIH, to support rehabilitation and the development of assistive technologies.

The Americans with Disabilities Act (ADA) in the early 1990s also played a pivotal role by raising public awareness about the significance of supporting individuals with visual impairments. Over the past two or three decades, both the research climate and societal perspectives on visual impairment have evolved for the better.

However, challenges remain. The representation of people with disabilities, especially those with vision impairments, in the research community is sparse. Many have had to forge their paths without much mentorship. The research landscape still bears signs of ableism, with many studies and infrastructure assuming able-bodied participants. While there have been efforts to improve the environment for disabled scientists, including grant programs from the NIH to address ableism in science, we face significant hurdles. Things have progressed, but there's still a considerable distance to cover.

What major challenges does the field of bionic vision face today, and what are your hopes for the future innovators and research in the field?

[GL] It's challenging to predict the exact trajectory of bionic vision. Reflecting on its history, Brindley and Lewin in 1968 laid the foundations with their ambitious work and made some pretty bold predictions. Fast-forwarding 50 years, there's undeniable progress, but the advancements have been gradual. For comparison, cochlear implants have set a high standard in their domain. Their widespread use and positive impact have established a benchmark that bionic vision has yet to meet.

The questions surrounding the evolution and potential of bionic vision are vast and intricate. There are underlying scientific inquiries related to the plasticity of the visual system, the adaptability of the visual cortex, especially after early-onset blindness, and the cross-modalization of senses. These scientific curiosities play a crucial role in understanding the broader implications and the potential future of bionic vision.

From a practical perspective, there are concerns regarding the sustainability and scalability of initiatives in this field. Instances like what transpired with Second Sight’s Argus II and Retina Implant’s Alpha-AMS in Europe have left many without support due to the limited scope and scale of the projects. These practical challenges, combined with the scientific ones, make the future of bionic vision both intriguing and demanding."

What advice would you give someone who is just starting out in the field, or is considering a career in vision restoration?

[GL] While I may not be in the best position to offer advice, I believe that both the scientific questions and the aspiration to develop beneficial devices for those with vision impairment are commendable. My suggestion would be to deeply engage with the scientific challenges but to remain cautious about the promises or expectations set for the community. Over the past 50 years, lofty promises have often not been met, leading to skepticism both within the research community and among potential users.

What guidance would you offer to an undergraduate student with visual impairment, specifically someone who is blind, who is beginning their journey in research, whether it be in the field of low vision or any other scientific domain?

[GL] Undoubtedly, pursuing advanced research or enrolling in a Ph.D. program is a significant commitment and presents its challenges. When someone has a disability, like a visual impairment, the challenges can be heightened. But let's remember, everyone faces their own set of challenges, whether they're related to family, geography, or other circumstances.

If you're visually impaired, it's essential to acknowledge the hurdles you might face, but that shouldn't deter you. Everyone should be encouraged to chase their aspirations without limits. If you're passionate about it, pursue it wholeheartedly.

To navigate these challenges, it's beneficial to find a supportive environment. This could be in the form of a mentor, a lab, a university, or a research institute that's welcoming and inclusive. There have been unfortunate instances in the past where individuals with disabilities faced rejection due to an unsupportive environment. Surrounding yourself with receptive colleagues and mentors can make the journey more pleasant and fruitful. So, it's crucial to seek out these positive spaces while acknowledging and preparing for the potential challenges.