Learning to perceive shape from temporal integration following late emergence from blindness

The Status of Vernier Acuity Following Late Sight Onset

We possess a remarkably acute ability to detect even small misalignments between extended line segments. This "vernier acuity" significantly exceeds our "resolution acuity"-the ability to resolve closely separated stimuli-and is generally considered a "hyperacuity," since the detectable misalignments are markedly finer than the diameter of single retinal cones. Vernier acuity has, thus, often been proposed to reflect spatial organization and multi-unit cortical processing, rendering it an important index of visual function. Notably, vernier acuity exhibits a characteristic developmental signature: it is inferior to resolution acuity early in life but eventually exceeds it by up to one order of magnitude. However, vernier acuity may be disproportionately sensitive to developmental disruptions. Here, we examined the resilience of acquiring this visual proficiency to early-onset, prolonged deprivation by longitudinally tracking vernier and resolution acuities in children with dense congenital cataracts who gained sight late in life as part of Project Prakash. Our data reveal marked longitudinal improvements in both acuity measures and also demonstrate that, like the normally-sighted, late-sighted individuals' vernier acuity exceeds their resolution acuity, thereby rendering it a hyperacuity. However, the extent of this hyperacuity is weaker than observed in normally-sighted controls, pointing to partial limitations in postsurgical skill acquisition. Despite these constraints, our findings point to the feasibility of forming some integrative circuits in the visual system even when inputs are severely compromised, and to the availability of some residual plasticity late in childhood, with implications for the rehabilitation prospects of children following treatment for congenital cataracts.

The development of a wearable goggle echolocation device to support people who are visually impaired with unhindered and unaided movement

The mobility of people with severe visual impairment is limited affecting their comfort and productivity. There are about 45 million people who are blind with global financial burden and annual global cost of productivity estimated to be USD411 billion according to World Health Organization report of 2024. The contributions of the people who are visually impaired to the gross domestic product (GDP) can be enhanced deploying technology. A novel sensory substitution device that enables people who are visually impaired or blind to fairly hear objects in place of seeing objects is proposed. The wearable echolocation device was developed using three ultrasonic sensors, one placed in the right, left, and middle of the goggle with each connected to a buzzer. Audible compass is implemented in the circuitry to guide the user on the direction while walking. In this configuration, the user is guided and alerted of any obstacle within the field of coverage and so can navigate to any desired destination unaided without relying on internet. The developed prototype is easy to use and does not require complex training. The echolocation device was tested by ten enrolled people that are visually impaired or blind who validated its effectiveness and efficiency. The device is comparatively low cost, noninvasive, energy efficient and mass producible.

Object recognition via echoes: quantifying the crossmodal transfer of three-dimensional shape information between echolocation, vision, and haptics

Active echolocation allows blind individuals to explore their surroundings via self-generated sounds, similarly to dolphins and other echolocating animals. Echolocators emit sounds, such as finger snaps or mouth clicks, and parse the returning echoes for information about their surroundings, including the location, size, and material composition of objects. Because a crucial function of perceiving objects is to enable effective interaction with them, it is important to understand the degree to which three-dimensional shape information extracted from object echoes is useful in the context of other modalities such as haptics or vision. Here, we investigated the resolution of crossmodal transfer of object-level information between acoustic echoes and other senses. First, in a delayed match-to-sample task, blind expert echolocators and sighted control participants inspected common (everyday) and novel target objects using echolocation, then distinguished the target object from a distractor using only haptic information. For blind participants, discrimination accuracy was overall above chance and similar for both common and novel objects, whereas as a group, sighted participants performed above chance for the common, but not novel objects, suggesting that some coarse object information (a) is available to both expert blind and novice sighted echolocators, (b) transfers from auditory to haptic modalities, and (c) may be facilitated by prior object familiarity and/or material differences, particularly for novice echolocators. Next, to estimate an equivalent resolution in visual terms, we briefly presented blurred images of the novel stimuli to sighted participants (N = 22), who then performed the same haptic discrimination task. We found that visuo-haptic discrimination performance approximately matched echo-haptic discrimination for a Gaussian blur kernel σ of ~2.5°. In this way, by matching visual and echo-based contributions to object discrimination, we can estimate the quality of echoacoustic information that transfers to other sensory modalities, predict theoretical bounds on perception, and inform the design of assistive techniques and technology available for blind individuals.

Grasping behavior does not recover after sight restoration from congenital blindness

We investigated whether early visual input is essential for establishing the ability to use predictions in the control of actions and for perception. To successfully interact with objects, it is necessary to pre-program bodily actions such as grasping movements (feedforward control). Feedforward control requires a model for making predictions, which is typically shaped by previous sensory experience and interaction with the environment.¹ Vision is the most crucial sense for establishing such predictions.^2,3 We typically rely on visual estimations of the to-be-grasped object's size and weight in order to scale grip force and hand aperture accordingly.^4,5,6 Size-weight expectations play a role also for perception, as evident in the size-weight illusion (SWI), in which the smaller of two equal-weight objects is misjudged to be heavier.^7,8 Here, we investigated predictions for action and perception by testing the development of feedforward controlled grasping and of the SWI in young individuals surgically treated for congenital cataracts several years after birth. Surprisingly, what typically developing individuals do easily within the first years of life, namely to adeptly grasp new objects based on visually predicted properties, cataract-treated individuals did not learn after years of visual experience. Contrary, the SWI exhibited significant development. Even though the two tasks differ in substantial ways, these results may suggest a potential dissociation in using visual experience to make predictions about an object's features for perception or action. What seems a very simple task-picking up small objects-is in truth a highly complex computation that necessitates early structured visual input to develop.

Learning to see after early and extended blindness: A scoping review

Purpose

If an individual has been blind since birth due to a treatable eye condition, ocular treatment is urgent. Even a brief period of visual deprivation can alter the development of the visual system. The goal of our structured scoping review was to understand how we might better support children with delayed access to ocular treatment for blinding conditions.

Method

We searched MEDLINE, Embase and Global Health for peer-reviewed publications that described the impact of early (within the first year) and extended (lasting at least 2 years) bilateral visual deprivation.

Results

Of 551 reports independently screened by two authors, 42 studies met our inclusion criteria. Synthesizing extracted data revealed several trends. The data suggests persistent deficits in visual acuity, contrast sensitivity, global motion, and visual-motor integration, and suspected concerns for understanding complex objects and faces. There is evidence for resilience in color perception, understanding of simple shapes, discriminating between a face and non-face, and the perception of biological motion. There is currently insufficient data about specific (re)habilitation strategies to update low vision services, but there are several insights to guide future research in this domain.

Conclusion

This summary will help guide the research and services provision to help children learn to see after early and extended blindness.

Active vision in sight recovery individuals with a history of long-lasting congenital blindness

What we see is intimately linked to how we actively and systematically explore the world through eye movements. However, it is unknown to what degree visual experience during early development is necessary for such systematic visual exploration to emerge. The present study investigated visual exploration behavior in ten human participants whose sight had been restored only in childhood or adulthood, after a period of congenital blindness due to dense bilateral congenital cataracts. Participants freely explored real-world images while their eye movements were recorded. Despite severe residual visual impairments and gaze instability (nystagmus), visual exploration patterns were preserved in individuals with reversed congenital cataract. Modelling analyses indicated that similar to healthy controls, visual exploration in individuals with reversed congenital cataract was based on the low-level (luminance contrast) and high-level (object components) visual content of the images. Moreover, participants used visual short-term memory representations for narrowing down the exploration space. More systematic visual exploration in individuals with reversed congenital cataract was associated with better object recognition, suggesting that active vision might be a driving force for visual system development and recovery. The present results argue against a sensitive period for the development of neural mechanisms associated with visual exploration.SIGNIFICANCE STATEMENTHumans explore the visual world with systematic patterns of eye movements, but it is unknown whether early visual experience is necessary for the acquisition of visual exploration. Here, we show that sight recovery individuals who had been born blind demonstrate highly systematic eye movements while exploring real-world images, despite visual impairments and pervasive gaze instability. In fact, their eye movement patterns were predicted by those of normally sighted controls and models calculating eye movements based on low- and high-level visual features, and they moreover took memory information into account. Since object recognition performance was associated with systematic visual exploration it was concluded that eye movements might be a driving factor for the development of the visual system.

Human (but not animal) motion can be recognized at first sight - After treatment for congenital blindness

The long-standing nativist vs. empiricist debate asks a foundational question in epistemology - does our knowledge arise through experience or is it available innately? Studies that probe the sensitivity of newborns and patients recovering from congenital blindness are central in informing this dialogue. One of the most robust sensitivities our visual system possesses is to 'biological motion' - the movement patterns of humans and other vertebrates. Various biological motion perception skills (such as distinguishing between movement of human and non-human animals, or between upright and inverted human movement) become evident within the first months of life. The mechanisms of acquiring these capabilities, and specifically the contribution of visual experience to their development, are still under debate. We had the opportunity to directly examine the role of visual experience in biological motion perception, by testing what level of sensitivity is present immediately upon onset of sight following years of congenital visual deprivation. Two congenitally blind patients who underwent sight-restorative cataract-removal surgery late in life (at the ages of 7 and 20 years) were tested before and after sight restoration. The patients were shown displays of walking humans, pigeons, and cats, and asked to describe what they saw. Visual recognition of movement patterns emerged immediately upon eye-opening following surgery, when the patients spontaneously began to identify human, but not animal, biological motion. This recognition ability was evident contemporaneously for upright and inverted human displays. These findings suggest that visual recognition of human motion patterns may not critically depend on visual experience, as it was evident upon first exposure to un-obstructed sight in patients with very limited prior visual exposure, and furthermore, was not limited to the typical (upright) orientation of humans in real-life settings.

Development of multisensory integration following prolonged early-onset visual deprivation

Adult humans make effortless use of multisensory signals and typically integrate them in an optimal fashion.¹ This remarkable ability takes many years for normally sighted children to develop.^2,3 Would individuals born blind or with extremely low vision still be able to develop multisensory integration later in life when surgically treated for sight restoration? Late acquisition of such capability would be a vivid example of the brain's ability to retain high levels of plasticity. We studied the development of multisensory integration in individuals suffering from congenital dense bilateral cataract, surgically treated years after birth. We assessed cataract-treated individuals' reliance on their restored visual abilities when estimating the size of an object simultaneously explored by touch. Within weeks to months after surgery, when combining information from vision and touch, they developed a multisensory weighting behavior similar to matched typically sighted controls. Next, we tested whether cataract-treated individuals benefited from integrating vision with touch by increasing the precision of size estimates, as it occurs when integrating signals in a statistically optimal fashion.¹ For participants retested multiple times, such a benefit developed within months after surgery to levels of precision indistinguishable from optimal behavior. To summarize, the development of multisensory integration does not merely depend on age, but requires extensive multisensory experience with the world, rendered possible by the improved post-surgical visual acuity. We conclude that early exposure to multisensory signals is not essential for the development of multisensory integration, which can still be acquired even after many years of visual deprivation.