EXHIBIT 99.5

BENEFICIAL OWNER ELECTION FORM

The undersigned acknowledge(s) receipt of your letter and the enclosed materials referred to therein relating to the distribution in a rights offering (the “Rights Offering”) by Second Sight Medical Products, Inc. (the “Company”), to the holders of record of its common stock, no par value (the “Common Stock”), as of 5:00 p.m., New York City time, on [January ], 2017, at no charge, of non-transferable subscription rights (the “Rights”) to invest and purchase units (the “Units”) at a subscription price of (i) $2.00 or (ii) the closing price of our Common Stock on its primary exchange on [ ] __, 2017, whichever is lower, per full Unit (the “Subscription Price”). Each such Unit comprised of one share of the Company’s Common Stock, and a warrant to purchase an additional share of Common Stock (the “Warrant”).

Each Right gives the holder thereof the right to invest $0.47 for each share held on the Record Date (the “Basic Subscription Right”). In addition, holders of Rights who purchase all of the Units available to them pursuant to their Basic Subscription Right may also choose to purchase (the “Over-Subscription Privilege”), a portion of any Units that other holders of Rights do not purchase through the exercise of their Basic Subscription Rights (the “Over-Subscription Units”). The number of Units that you will obtain from your subscription will equal the result of the accepted dollar amount of your investment divided by the Subscription Price, rounded down to the nearest Unit. For example, if you invest $470, and if on the Expiration Date the closing price of our common stock as reported by Nasdaq is $2.05 per share, the Subscription Price will be $2.00 (which constitutes lesser of $2.00 or closing price of shares on the Expiration Date), you would receive 235 Units consisting in the aggregate of 235 shares of our common stock and Warrants to purchase 235 shares of our common stock. By way of further illustration, if you invest $470, and on the Expiration Date the closing price of our common stock is $1.53 per share, the Subscription Price will be $1.53 and you would receive a rounded down 307 Units and a refund of $0.29.

With respect to any instructions to exercise (or not to exercise) Rights, the undersigned acknowledges that this form must be completed and returned such that it will actually be received by you by 5:00 p.m., New York City time, on [ ], 2017, the scheduled expiration date of the Rights Offering.

This will instruct you whether to exercise Rights to purchase Units distributed with respect to the shares of Common Stock held by you for the account of the undersigned, pursuant to the terms and subject to the conditions set forth in the Prospectus and the related “Instructions as to Use of Second Sight Medical Products, Inc. Rights Certificates.”

I (we) hereby instruct you as follows:

(CHECK THE APPLICABLE BOXES AND PROVIDE ALL REQUIRED INFORMATION)

Box 1. ¨ Please DO NOT EXERCISE RIGHTS for Units.

Box 2. ¨ Please EXERCISE RIGHTS for Units as set forth below:

Box 3. ¨Payment in the following amount is enclosed: $           

Box 4. ¨ Please deduct payment of $            from the following account maintained by you as follows:

(The total of Box 3 and Box 4 must equal the total payment specified above.)

Type of Account ___________________________

Account No.___________________________

I (we) on my (our) own behalf, or on behalf of any person(s) on whose behalf, or under whose directions, I am (we are) signing this form:

·     irrevocably elect to invest the amount indicated above to purchase Units upon the terms and conditions specified in the prospectus; and

·     agree that if I (we) fail to deliver the amount I (we) have elected to invest, you may exercise any remedies available to you under law.

If you are signing in your capacity as a trustee, executor, administrator, guardian, attorney-in-fact, agent, officer of a corporation or another acting in a fiduciary or representative capacity, please provide the following information: