A Visionary Journey: Prof. Gregg Suaning on Bionic Vision Research in Australia

Prof. Suaning, your career has taken you from semiconductor fabrication via cochlear prostheses to playing a leading role in Bionic Vision Australia. Take us back to those early days - when and how did you decide to make the switch to bionic vision?

[Gregg Suaning (GS)] It goes back to when I worked for Cochlear in Sydney, where I was inspired by its potential. Essentially, people who couldn't hear anything could suddenly hear almost everything with the switch of a device. Initially, the sound processing algorithms weren't the best. However, a discovery in 1994 changed everything. Before this, anyone who could talk on the telephone was a novelty, and we were eager to learn from them. After the discovery, it seemed everyone could use the phone, marking a significant improvement.

Motivated to contribute further, I left Cochlear to pursue a Ph.D., aiming to develop vision prostheses for blind people, inspired by the transformative impact of cochlear implants. I wondered if there could be a breakthrough in visual space similar to the sound processing algorithm that revolutionized hearing aids. Despite the long journey, I believe there's merit in this idea.

After my Ph.D., I sought an academic career, leveraging my industrial experience to secure a tenured position immediately, rather than a typical postdoc. I began my academic career around 2001/2002 and now lead the sydneyBIONICS laboratory within the School of Biomedical Engineering at the University of Sydney. Our focus is on creating implantable devices, as I learned from cochlear implants that without a quality implant, you have nothing. This philosophy guided us to develop a robust implant, providing a platform for new stimulation strategies. Like the advancements in cochlear implants, we aim to enhance these devices through improved algorithms, constantly refining our approach to improve functionality.

Could you elaborate on your involvement with Bionic Vision Australia? Please provide a timeline detailing your contributions from the initial stages to the culmination of the project.

I started my research in vision and vision prostheses in Australia in 1997, initially using parts from broken stereos due to a lack of funding. A subsequent grant of $2,000 allowed us to purchase essential equipment, and a further $20,000 grant enabled us to advance without needing to repurpose parts from cars and stereos. By late 1998, we had secured enough funding to fabricate a chip I had designed, which successfully worked on the first attempt, marking a rare and encouraging milestone.

Our project gained momentum with a significant grant from the Australian Research Council, which was in the $100,000 range, providing much-needed support. The success of Cochlear, known for the bionic ear, had already established a high level of national pride, which our visual system project benefited from, attracting substantial media attention and public interest.

In 2007, during the Australian Prime Minister's 2020 summit, which aimed to shape Australia's future, the development of a bionic eye was identified as a key goal. This led to our team, being the only ones conducting vision prosthesis research, being invited to apply for a $50 million grant in bionic vision around 2009 or 2010. To meet the funding criteria, we collaborated with experts from Melbourne, who had significant experience with cochlear implants.

And hence the Bionic Vision Australia consortium was born. It was meant to unite the University of Melbourne, University of New South Wales, University of Sydney, and other organizations to develop a bionic eye with a $50 million budget. My group received about a quarter of this budget. But despite a shared goal, the sad truth is that there was very little interaction between the research groups in Sydney and Melbourne. So what ended up happening is that everyone just kind of did their own thing, with the Melbourne groups focusing on the first-generation suprachoroidal implant and our group developing Phoenix99.

Is the consortium still active today? What happened after the $50 million grant ended?

[GS]: Following the dissolution of Bionic Vision Australia, efforts in vision restoration continued, particularly in Melbourne with a small clinical trial targeting individuals with retinitis pigmentosa. This trial utilized an active device incorporating cochlear implant technology and an electrode array that was very similar to the one we developed earlier. However, the initial results were not as hoped, with patients reporting seeing only blobs of light, not form vision. So the effort has focused on increasing the number of channels and enhancing the algorithms ever since. Concurrently, the team in Melbourne transitioned into Bionic Vision Technologies, as initially planned, to commercialize the intellectual property we had collectively developed.

Meanwhile, I pursued a different direction in Sydney, focusing on academic research, while Melbourne's efforts became more commercial. In Sydney, we prioritize research and development - we feel that we are not ready to become commercial until we have something that people will actually want. This approach requires patience, as progress in research often unfolds slowly. But, you know, despite the competitive dynamics, our primary objective remains the advancement of vision restoration technologies, albeit from different operational philosophies—Melbourne’s commercial drive versus Sydney’s academic rigor.

How do you evaluate the progress and challenges in the field of vision restoration technologies to date, and what is your outlook on the future of these technologies, especially in terms of overcoming current limitations and attracting investment?

[GS] It’s striking to me that The Eye & The Chip Conference we just attended exclusively focuses on nerve stimulators rather than treatments based on stem cells or gene transfection. Neuroprosthetics, including devices like Argus II, Alpha-AMS, and PRIMA have restored more vision than all other methods combined, leading the field. But, I don't know if they're going to be who's going to be successful. There’s potential in combining technologies, such as channelrhodopsin with electrical stimulation, to enhance effectiveness. But for the most part, these approaches are independent of each other, and one of them is probably going to win. I think it’s a healthy race to have.

My perspective is that genetic therapies may eventually dominate. Reflecting on Cochlear's public offering, we identified potential risks, including revolutionary treatments like a pill for hearing restoration or advancements in stem cells—concerns that remain unresolved since 1996. This ongoing competition to restore vision is likely to continue for years.

Another obstacle is the financial sustainability of companies in this space. Past failures have made investors cautious. Times were different in the mid-2000s, when five or six implants were actively being developed and ultimately implanted, leading to FDA-approved devices in the early 2010s. We need to get back to this level of excitement. More recently, the headlines that have dominated the news are that of bankruptcy and patients being left behind with obsolete technology. I think things are going to idle for a while, until someone proves through hard work and not a lot of money that we’ve got a solution to these problems. And in order to do that we have to do some technological things. I think it's all technological. I don't think it's surgical. I don't think it's anything other than just a new design that is exciting and interesting and effective.

What do you hope will be achieved by the next generation of researchers and developers in this area?

[GS]: I hope the interest in this field doesn't wane, as it's disconcerting to see a decline rather than an increase in the number of researchers. And I don't really know the reason for that. One possibility is the allure of more established fields, like cancer research, where the potential for career success (like a high h-index) may seem greater due to the larger community and higher visibility of one's work. If you’re just starting out and mainly focused on improving your career metrics, then you might not want to get into bionics.

Certainly it's been great for my career! I've loved every minute of it and I still enjoy the work. This field offers not just an engineering challenge but serves a noble purpose—unlike projects aimed at maximizing profit or consumption, which do not inspire me.

My hope is for those of you listening to remain committed to this impactful and exciting field, so it can shape and enhance your careers.