Reorganization of early visual cortex functional connectivity following selective peripheral and central visual loss

Neural and Perceptual Adaptations in Bilateral Macular Degeneration: An Integrative Review

Bilateral age-related macular degeneration (AMD) results in central vision loss, affecting the fovea-associated cortical regions. This review examines neuroimaging and psychophysical evidence of spontaneous neural adaptation in acquired bilateral central scotoma. Early visual brain areas show reduced cortical thickness and axonal integrity due to postsynaptic (anterograde) degeneration. Contrary to animal models, evidence for spontaneous adaptation in the primary visual cortex (V1) is limited. Activity in the lesion projection zone (LPZ), previously seen as extensive cortical remapping, may result from non-retinotopic peripheral-to-foveal feedback, sharing substrates with healthy retinal feedforward processes. Preferred retinal loci (PRLs) are influenced more by location and task than by residual vision quality. Reduced lateral masking in the PRL may reflect decreased contrast sensitivity from retinal damage, rather than genuine adaptive mechanisms. Weakened crowding in the PRL is explained by transient adaptation in healthy subjects to artificial scotomas, not by long-term plasticity. Higher visual areas may show compensatory mechanisms enhancing complex tasks like symmetry, face, and motion discrimination. Leveraging spontaneous adaptation through perceptual learning-based treatments can preserve residual visual abilities. Because of limited evidence for spontaneous reorganization in AMD, behavioural training and emerging techniques are crucial for optimal treatment efficacy.

Perceptual learning and neural correlates of virtual navigation in subjective cognitive decline: A pilot study

Spatial navigation deficits in age-related diseases involve brain changes affecting spatial memory and verbal cognition. Studies in blind and blindfolded individuals show that multisensory training can induce neuroplasticity through visual cortex recruitment. This proof-of-concept study introduces a digital navigation training protocol, integrating egocentric and allocentric strategies with multisensory stimulation and visual masking to enhance spatial cognition and brain connectivity in 17 individuals (mean age 57.2 years) with subjective cognitive decline. Results indicate improved spatial memory performance correlated with recruitment of the visual area 6-thalamic pathway and enhanced connectivity between memory, executive frontal areas, and default mode network (DMN) regions. Additionally, increased connectivity between allocentric and egocentric navigation areas via the retrosplenial complex (RSC) hub was observed. These findings suggest that this training has the potential to induce perceptual learning and neuroplasticity through key functional connectivity hubs, offering potential widespread cognitive benefits by enhancing critical brain network functions.

Impact of Deprivation and Preferential Usage on Functional Connectivity Between Early Visual Cortex and Category-Selective Visual Regions

Human behavior can be remarkably shaped by experience, such as the removal of sensory input. Many studies of conditions such as stroke, limb amputation, and vision loss have examined how removal of input changes brain function. However, an important question yet to be answered is: when input is lost, does the brain change its connectivity to preferentially use some remaining inputs over others? In individuals with healthy vision, the central portion of the retina is preferentially used for everyday visual tasks, due to its ability to discriminate fine details. When central vision is lost in conditions like macular degeneration, peripheral vision must be relied upon for those everyday tasks, with some portions receiving "preferential" usage over others. Using resting-state fMRI collected during total darkness, we examined how deprivation and preferential usage influence the intrinsic functional connectivity of sensory cortex by studying individuals with selective vision loss due to late stages of macular degeneration. Specifically, we examined functional connectivity between category-selective visual areas and the cortical representation of three areas of the retina: the lesioned area, a preferentially used region of the intact retina, and a non-preferentially used region. We found that cortical regions representing spared portions of the peripheral retina, regardless of whether they are preferentially used, exhibit plasticity of intrinsic functional connectivity in macular degeneration. Cortical representations of spared peripheral retinal locations showed stronger connectivity to MT, a region involved in processing motion. These results suggest that the long-term loss of central vision can produce widespread effects throughout spared representations in early visual cortex, regardless of whether those representations are preferentially used. These findings support the idea that connections to visual cortex maintain the capacity for change well after critical periods of visual development.

Change in visual acuity over a 12-year period predicts cognitive decline in older adults: identifying social engagement as a potential mediator

OBJECTIVES

Deterioration in vision is an important dementia risk factor yet few studies have examined objectively measured changes in visual acuity over time. Visual decline may also reduce social engagement, highlighting the need to examine visual changes in concert with broader social function.

METHOD

The relationship between change in visual acuity (logMAR) and cognitive decline was examined in 2,281 participants from the PATH study using hierarchical linear regression. Step 2 determined whether social network significantly enhanced model fit. Exploratory mediation analysis examined the indirect effect of vision change on overall cognition via social networks.

RESULTS

Adjusted models showed deterioration in visual acuity significantly predicted poorer cognition across domains (MMSE, β = -0.08, p ≤ 0.001; TMT B-A, β =  0.09, p = 0.004; SDMT, β = -0.07, p ≤ 0.001). Model 2 significantly improved model fit for overall cognition only (MMSE, Fchange(1,1421)= 6.03, p = 0.014). The indirect effect of social network was marginally significant (β = -0.004, SE = 0.002, BCa 95%CI = -0.0088, -0.0002).

CONCLUSION

Deterioration in visual acuity significantly predicted multi-domain cognitive decline highlighting the importance of visual screening and treatment for vision loss. Social engagement partially mediated the relationship between vision change and overall cognition suggesting psychosocial factors may help to reduce the impact of visual decline.

Impact of deprivation and preferential usage on functional connectivity between early visual cortex and category selective visual regions

Human behavior can be remarkably shaped by experience, such as the removal of sensory input. Many studies of conditions such as stroke, limb amputation, and vision loss have examined how the removal of input changes brain function. However, an important question has yet to be answered: when input is lost, does the brain change its connectivity to preferentially use some remaining inputs over others? In individuals with healthy vision, the central portion of the retina is preferentially used for everyday visual tasks, due to its ability to discriminate fine details. However, when central vision is lost in conditions like macular degeneration, peripheral vision must be relied upon for those everyday tasks, with certain portions receiving "preferential" usage over others. Using resting-state fMRI collected during total darkness, we examined how deprivation and preferential usage influence the intrinsic functional connectivity of sensory cortex by studying individuals with selective vision loss due to late stages of macular degeneration. We found that cortical regions representing spared portions of the peripheral retina, regardless of whether they are preferentially used, exhibit plasticity of intrinsic functional connectivity in macular degeneration. Cortical representations of spared peripheral retinal locations showed stronger connectivity to MT, a region involved in processing motion. These results suggest that long-term loss of central vision can produce widespread effects throughout spared representations in early visual cortex, regardless of whether those representations are preferentially used. These findings support the idea that connections to visual cortex maintain the capacity for change well after critical periods of visual development.

Highlights

Portions of early visual cortex representing central vs. peripheral vision exhibit different patterns of connectivity to category-selective visual regions.When central vision is lost, cortical representations of peripheral vision display stronger functional connections to MT than central representations.When central vision is lost, connectivity to regions selective for tasks that involve central vision (FFA and PHA) are not significantly altered.These effects do not depend on which locations of peripheral vision are used more.

Accelerated Brain Atrophy, Microstructural Decline and Connectopathy in Age-Related Macular Degeneration

Age-related macular degeneration (AMD) has recently been linked to cognitive impairment. We hypothesized that AMD modifies the brain aging trajectory, and we conducted a longitudinal diffusion MRI study on 40 participants (20 with AMD and 20 controls) to reveal the location, extent, and dynamics of AMD-related brain changes. Voxel-based analyses at the first visit identified reduced volume in AMD participants in the cuneate gyrus, associated with vision, and the temporal and bilateral cingulate gyrus, linked to higher cognition and memory. The second visit occurred 2 years after the first and revealed that AMD participants had reduced cingulate and superior frontal gyrus volumes, as well as lower fractional anisotropy (FA) for the bilateral occipital lobe, including the visual and the superior frontal cortex. We detected faster rates of volume and FA reduction in AMD participants in the left temporal cortex. We identified inter-lingual and lingual-cerebellar connections as important differentiators in AMD participants. Bundle analyses revealed that the lingual gyrus had a lower streamline length in the AMD participants at the first visit, indicating a connection between retinal and brain health. FA differences in select inter-lingual and lingual cerebellar bundles at the second visit showed downstream effects of vision loss. Our analyses revealed widespread changes in AMD participants, beyond brain networks directly involved in vision processing.

Exposure to written content eliciting weight stigmatization: Neural responses in appetitive and food reward regions

OBJECTIVE

Neural activity in food reward- and appetite-related regions was examined in response to high-calorie (HC), low-calorie, and non-food pictures after exposure to written weight stigma (WS) content. Relationships with eating behavior (by Three-Factor Eating Questionnaire [TFEQ]), blood glucose, and subjective appetite were also explored.

METHODS

Adults with overweight and obesity were randomized to read either a WS (n = 20) or control (n = 20) article and subsequently underwent brain scans while they rated pleasantness of food pictures. Fasting glucose, TFEQ, stigma experiences, and appetite were measured before reading the article, appetite after reading, and glucose and appetite again after the scan.

RESULTS

A priori region of interest analyses revealed significant group differences in activation to HC > low-calorie food cues in the caudate and thalamus whereas exploratory whole-brain analyses suggested significant differences in regions including left insula, left thalamus, left inferior temporal gyrus, right lingual gyrus, and bilateral middle occipital gyrus and superior parietal lobule (p < 0.005 uncorrected, k ≥ 200 m3 ). No significant relationships were observed between the pattern of activation and TFEQ, glucose, or subjective appetite in the WS group.

CONCLUSIONS

Exposure to WS was associated with increased responsiveness to HC food content in the dorsal striatum and thalamus in individuals with overweight and obesity.

Impact of glaucoma on the spatial frequency processing of scenes in central vision

Glaucoma is an eye disease characterized by a progressive vision loss usually starting in peripheral vision. However, a deficit for scene categorization is observed even in the preserved central vision of patients with glaucoma. We assessed the processing and integration of spatial frequencies in the central vision of patients with glaucoma during scene categorization, considering the severity of the disease, in comparison to age-matched controls. In the first session, participants had to categorize scenes filtered in low-spatial frequencies (LSFs) and high-spatial frequencies (HSFs) as a natural or an artificial scene. Results showed that the processing of spatial frequencies was impaired only for patients with severe glaucoma, in particular for HFS scenes. In the light of proactive models of visual perception, we investigated how LSF could guide the processing of HSF in a second session. We presented hybrid scenes (combining LSF and HSF from two scenes belonging to the same or different semantic category). Participants had to categorize the scene filtered in HSF while ignoring the scene filtered in LSF. Surprisingly, results showed that the semantic influence of LSF on HSF was greater for patients with early glaucoma than controls, and then disappeared for the severe cases. This study shows that a progressive destruction of retinal ganglion cells affects the spatial frequency processing in central vision. This deficit may, however, be compensated by increased reliance on predictive mechanisms at early stages of the disease which would however decline in more severe cases.

Sight restoration reverses blindness-induced cross-modal functional connectivity changes between the visual and somatosensory cortex at rest

Resting-state functional connectivity (rsFC) has been used to assess the effect of vision loss on brain plasticity. With the emergence of vision restoration therapies, rsFC analysis provides a means to assess the functional changes following sight restoration. Our study demonstrates a partial reversal of blindness-induced rsFC changes in Argus II retinal prosthesis patients compared to those with severe retinitis pigmentosa (RP). For 10 healthy control (HC), 10 RP, and 7 Argus II subjects, four runs of resting-state functional magnetic resonance imaging (fMRI) per subject were included in our study. rsFC maps were created with the primary visual cortex (V1) as the seed. The rsFC group contrast maps for RP > HC, Argus II > RP, and Argus II > HC revealed regions in the post-central gyrus (PostCG) with significant reduction, significant enhancement, and no significant changes in rsFC to V1 for the three contrasts, respectively. These findings were also confirmed by the respective V1-PostCG ROI-ROI analyses between test groups. Finally, the extent of significant rsFC to V1 in the PostCG region was 5,961 in HC, 0 in RP, and 842 mm3 in Argus II groups. Our results showed a reduction of visual-somatosensory rsFC following blindness, consistent with previous findings. This connectivity was enhanced following sight recovery with Argus II, representing a reversal of changes in cross-modal functional plasticity as manifested during rest, despite the rudimentary vision obtained by Argus II patients. Future investigation with a larger number of test subjects into this rare condition can further unveil the profound ability of our brain to reorganize in response to vision restoration.

Metabolic alterations in the visual pathway of retinitis pigmentosa rats: A longitudinal multimodal magnetic resonance imaging study with histopathological validation

Because retinitis pigmentosa (RP) has been shown to cause degenerative changes in the entire visual pathway, there is an urgent need to perform longitudinal assessments of RP-induced degeneration and identify imaging protocols to detect this degeneration as early as possible. In this study, we assessed a transgenic rat model of RP by using complementary noninvasive magnetic resonance imaging techniques, namely, proton magnetic resonance spectroscopy (¹ H-MRS), to investigate the metabolic changes in RP. Our study demonstrated decreased concentrations and ratios to creatine (Cr) of N-acetylaspartate (NAA), glutamate (Glu), γ-aminobutyric acid (GABA), and taurine (Tau), whereas myo-inositol (Ins) and choline (Cho) were increased in the visual cortex of Royal College of Surgeons (RCS) rats compared with control rats (p < 0.05). Furthermore, with the progression of RP, the concentrations of NAA, Glu, GABA, and Tau, and the ratios of GABA/Cr and Tau/Cr significantly decreased over time, whereas the concentrations of Ins and Cho and the ratio of Ins/Cr significantly increased over time (p < 0.05). In addition, in RCS rats, NAA/Cr decreased significantly from 3 to 4 months postnatal (p < 0.001), and Cho/Cr increased significantly from 4 to 5 months postnatal (p = 0.005). Meanwhile, the ¹ H-MRS indicators in 5-month postnatal RCS rats could be confirmed by immunohistochemical staining. In conclusion, with the progression of RP, the metabolic alterations in the visual cortex indicated progressive reprogramming with the decrease of neurons and axons, accompanied by the proliferation of gliocytes.

Activation of lesion projection zone in primary visual cortex is dependent on bilateral central vision loss in patients with end-stage glaucoma

PURPOSE

To investigate activation of the lesion projection zone (LPZ) in the primary visual cortex during end-stage glaucoma using functional magnetic resonance imaging (fMRI), as well as the relationship between fMRI responses and clinical data.

METHODS

Twelve subjects with bilateral end-stage glaucoma (group A), 12 with unilateral end-stage glaucoma (group B) and 12 healthy controls (group C) were enrolled. fMRI was performed under two testing stimuli conditions: passive viewing of a full-field flickering checkerboard and active viewing of a one-back task with scene images. In fMRI analysis, the primary visual cortex was divided into six regions of interest (ROIs). The beta values of the six ROIs were compared across the three groups using one-way analysis of variance under two viewing conditions. Associations between the fMRI beta value and clinical data including multifocal electroretinogram (mfERG), microperimeter-1 and optical coherence tomography were analysed by Spearman correlation.

RESULTS

The beta values for ROIs 1-3 representing the LPZ were significantly different between the three groups under active viewing conditions, whereas no significant changes were detected under passive viewing. In group A, there were significant differences between all six ROIs for the two viewing conditions, while no significant differences were found in groups B and C. In group A, the P-wave amplitudes of the mfERG was significantly correlated with the beta values of ROIs 1 and 2 under active viewing. In addition, the P-wave latencies of the mfERG were significantly correlated with the beta values for ROIs 2-5. No associations were found between fMRI beta values and clinical data in groups B and C.

CONCLUSIONS

Activation of the LPZ in the primary visual cortex was observed in patients with bilateral end-stage glaucoma under active viewing conditions. These changes were correlated with residual retinal function.

Longitudinal association between visual disability and cognitive function among middle-aged and older adults in China

BACKGROUND/AIMS

To determine the associations between visual disability and cognitive decline in Chinese middle-aged and older adults.

METHODS

A total of 6748 subjects were enrolled into this longitudinal, population-based, nationally representative study from two waves of the China Health and Retirement Longitudinal Study. Lagged dependent variable regression was used to model the independent associations between self-reported visual disability and cognitive function including memory and mental status.

RESULTS

The mean age of the 6748 individuals was 56.33 years, and 3350 (49.6%) were women. The prevalence of visual disability was 3.8%, which increased with age (p<0.001). Both memory and mental status score worsened over time (all p<0.001). After controlling for covariates, lagged dependent variable regression models showed that visual disability at baseline was significantly associated with memory decline after 7 years (β=-0.252, p=0.046). After stratifying by age groups, this association was only significant in the 55-64 age group (β=-0.372, p=0.033). In addition, both memory and mental status in 2011 predicted memory decline over 7 years (p=0.024 and p=0.045, respectively).

CONCLUSIONS

Our results suggest that visual disability may be a risk factor of memory decline, but not mental status among middle-aged and elderly adults in China. Future studies are needed to further corroborate the association between visual disability and cognitive decline and to determine whether interventions to preserve good visual function can prevent cognitive decline.

Perspective on Vision Science-Informed Interventions for Central Vision Loss

Pathologies affecting central vision, and macular degeneration (MD) in particular, represent a growing health concern worldwide, and the leading cause of blindness in the Western World. To cope with the loss of central vision, MD patients often develop compensatory strategies, such as the adoption of a Preferred Retinal Locus (PRL), which they use as a substitute fovea. However, visual acuity and fixation stability in the visual periphery are poorer, leaving many MD patients struggling with tasks such as reading and recognizing faces. Current non-invasive rehabilitative interventions are usually of two types: oculomotor, aiming at training eye movements or teaching patients to use or develop a PRL, or perceptual, with the goal of improving visual abilities in the PRL. These training protocols are usually tested over a series of outcome assessments mainly measuring low-level visual abilities (visual acuity, contrast sensitivity) and reading. However, extant approaches lead to mixed success, and in general have exhibited large individual differences. Recent breakthroughs in vision science have shown that loss of central vision affects not only low-level visual abilities and oculomotor mechanisms, but also higher-level attentional and cognitive processes. We suggest that effective interventions for rehabilitation after central vision loss should then not only integrate low-level vision and oculomotor training, but also take into account higher level attentional and cognitive mechanisms.

Vision Impairment and Adverse Health Conditions in Congolese Older People: A Population-Based Study

INTRODUCTION

In sub-Saharan Africa, many older people experience vision impairment (VI) and its adverse health outcomes. In this study, we examined separately the association between VI and each adverse health conditions (cognitive disorders, vision-related quality of life [VRQoL], and daily functioning interference [DFI]) among Congolese older people. We also explored whether VI had a significant effect on VRQoL components in our population.

METHOD

We performed cross-sectional analyses on data from 660 Congolese people aged ≥65 years who participated in the 2013 survey of the EPIDEMCA population-based cohort study. VI was defined as having a near visual acuity <20/40 (assessed at 30 cm using a Parinaud chart). Cognitive disorders were assessed using neuropsychological tests and neurological examinations. VRQoL was assessed using a reduced version of the National Eye Institute Visual Function Questionnaire (VFQ-22) and DFI using 11 items of participation restrictions and activity limitations. Regarding our main objective, each association was explored separately using multivariable logistic and linear regression models. Additionally, the effects of VI on each VRQoL components were explored using univariable linear regression models.

RESULTS

VI was not associated with cognitive disorders after adjustment for residence area (adjusted odds ratio = 1.7; 95% confidence interval [CI]: 0.6; 4.7), but it was associated with a low VRQoL score (adjusted β = -12.4; 95% CI: -17.5; -7.3) even after controlling for several covariates. An interaction between VI and age (p = 0.007) was identified, and VI was associated with DFI only among people aged >73 years (adjusted β = 0.5; 95% CI: 0.2; 0.8). Our exploratory analysis showed that all components of VRQoL decreased with a decrease in visual acuity (corrected p ≤ 0.05).

CONCLUSION

VI was associated with poor VRQoL and high DFI. Residence area seems to play a confounding role in the association between VI and cognitive disorders. Our findings suggest that targeting interventions on vision could reduce DFI among older people and improve their well-being.

Behavioural Adaptation to Hereditary Macular Dystrophy: A Systematic Review on the Effect of Early Onset Central Field Loss on Peripheral Visual Abilities

Purpose:

Hereditary macular dystrophies (HMD) result in early onset central field loss. Evidence for cortical plasticity has been found in HMD, which may enhance peripheral visual abilities to meet the increased demands and reliance on the peripheral field, as has been found in congenitally deaf adults and habitual action video-game players. This is a qualitative synthesis of the literature on the effect of early onset central field loss on peripheral visual abilities. The knowledge gained may help in developing rehabilitative strategies that enable optimisation of remaining peripheral vision.

Methods:

A systematic search performed on the Web of Science and PubMED databases yielded 728 records published between 1809 to 2020, of which seven case-control studies were eligible for qualitative synthesis.

Results:

The search highlighted an overall paucity of literature, which lacked validity due to small heterogeneous samples and deficiencies in reporting of methods and population characteristics. A range of peripheral visual abilities at different eccentricities were studied. Superior performance of HMD observers in the peripheral field or similarities between the preferred retinal loci (PRL) and normal fovea were observed in four of seven studies. Findings were often based on studies including a single observer. Further larger rigorous studies are required in this area.

Conclusions:

Spontaneous perceptual learning through reliance on and repeated use of the peripheral field and PRL may result in some specific superior peripheral visual abilities. However, worse performance in some tasks could reflect unexpected rod disease, lack of intensive training, or persistent limitations due to the need for cones for specific tasks. Perceptual learning through training regimes could enable patients to optimise use of the PRL and remaining peripheral vision. However, further studies are needed to design optimal training regimes.

Higher Dementia Incidence in Older Adults with Poor Visual Acuity

Background

Longitudinal evidence of poor visual acuity associating with higher risk of incident dementia is mixed. This study aimed to examine if poor visual acuity was associated with higher dementia incidence in a large community cohort of older adults, independent of the possible biases relating to misclassification error, reverse causality, and confounding effects due to health problems and behaviors.

Methods

A total of 15,576 community-living older adults without dementia at baseline were followed for 6 years to the outcome of incident dementia, which was diagnosed according to the ICD-10 or a Clinical Dementia Rating of 1 to 3. Visual acuity was assessed using the Snellen’s chart at baseline and follow-up. Important variables including demographics (age, sex, education, and socioeconomic status), physical and psychiatric comorbidities (cardiovascular risks, ophthalmological conditions, hearing impairment, poor mobility, and depression), and lifestyle behaviors (smoking, diet, physical, intellectual, and social activities) were also assessed.

Results

Over 68,904 person-years of follow-up, 1,349 participants developed dementia. Poorer visual acuity at baseline was associated with higher dementia incidence in 6 years, even after adjusting for demographics, health problems, and lifestyle behaviors, and excluding those who developed dementia within 3 years after baseline. Compared with normal vision, the hazard ratio of dementia was 1.19 (p = .31), 2.09 (p < .001), and 8.66 (p < .001) for mild, moderate, and severe visual impairment, respectively.

Conclusions

Moderate-to-severe visual impairment could be a potential predictor and possibly a risk factor for dementia. From a clinical perspective, older adults with poor visual acuity might warrant further risk assessment for dementia.

Visual Cortex Alterations in Early and Late Blind Subjects During Tactile Perception

Involvement of visual cortex varies during tactile perception tasks in early blind (EB) and late blind (LB) human subjects. This study explored differences in sensory motor networks associated with tactile task in EB and LB subjects and between children and adolescents. A total of 40 EB subjects, 40 LB subjects, and 30 sighted controls were recruited in two subgroups: children (6-12 years) and adolescents (13-19 years). Data were acquired using a 3T MR scanner. Analyses of blood oxygen level dependent (BOLD), functional connectivity (FC), correlation, and post hoc test for multiple comparisons were carried out. Difference in BOLD activity was observed in EB and LB groups in visual cortex during tactile perception, with increased FC of visual with dorsal attention and sensory motor networks in EB. EB adolescents exhibited increased connectivity with default mode and salience networks when compared with LB. Functional results correlated with duration of training, suggestive of better performance in EB. Alteration in sensory and visual networks in EB and LB correlated with duration of tactile training. Age of onset of blindness has an effect in cross-modal reorganization of visual cortex in EB and multimodal in LB in children and adolescents.

Neuroplasticity of the visual cortex: in sickness and in health

Brain plasticity refers to the ability of synaptic connections to adapt their function and structure in response to experience, including environmental changes, sensory deprivation and injuries. Plasticity is a distinctive, but not exclusive, property of the developing nervous system. This review introduces the concept of neuroplasticity and describes classic paradigms to illustrate cellular and molecular mechanisms underlying synapse modifiability. Then, we summarize a growing number of studies showing that the adult cerebral cortex retains a significant degree of plasticity highlighting how the identification of strategies to enhance the plastic potential of the adult brain could pave the way for the development of novel therapeutic approaches aimed at treating amblyopia and other neurodevelopmental disorders. Finally, we analyze how the visual system adjusts to neurodegenerative conditions leading to blindness and we discuss the crucial role of spared plasticity in the visual system for sight recovery.

Visual Cortical Plasticity in Retinitis Pigmentosa

Purpose

Retinitis pigmentosa is a family of genetic diseases inducing progressive photoreceptor degeneration. There is no cure for retinitis pigmentosa, but prospective therapeutic strategies are aimed at restoring or substituting retinal input. Yet, it is unclear whether the visual cortex of retinitis pigmentosa patients retains plasticity to react to the restored visual input.

Methods

To investigate short-term visual cortical plasticity in retinitis pigmentosa, we tested the effect of short-term (2 hours) monocular deprivation on sensory ocular dominance (measured with binocular rivalry) in a group of 14 patients diagnosed with retinitis pigmentosa with a central visual field sparing greater than 20° in diameter.

Results

After deprivation most patients showed a perceptual shift in ocular dominance in favor of the deprived eye (P < 0.001), as did control subjects, indicating a level of visual cortical plasticity in the normal range. The deprivation effect correlated negatively with visual acuity (r = −0.63, P = 0.015), and with the amplitude of the central 18° focal electroretinogram (r = −0.68, P = 0.015) of the deprived eye, revealing that in retinitis pigmentosa stronger visual impairment is associated with higher plasticity.

Conclusions

Our results provide a new tool to assess the ability of retinitis pigmentosa patients to adapt to altered visual inputs, and suggest that in retinitis pigmentosa the adult brain has sufficient short-term plasticity to benefit from prospective therapies.

Enhanced Visual Attentional Modulation in Patients with Inherited Peripheral Retinal Degeneration in the Absence of Cortical Degeneration

The role of attentional mechanisms in peripheral vision loss remains an outstanding question. Our study was aimed at determining the effect of genetically determined peripheral retinal dystrophy caused by Retinitis Pigmentosa (RP) on visual cortical function and tested the recruitment of attentional mechanisms using functional magnetic resonance imaging (fMRI). We included thirteen patients and twenty-two age- and gender-matched controls. We analyzed cortical responses under attentional demands and passive viewing conditions while presenting a visual stimulus covering the central and paracentral visual field. Brain activity was studied in visual areas V1, V2, and V3 as well as in cortical regions of interest corresponding to the preserved and the damaged visual field. The influence of visual field extent and age of disease onset were also investigated. Cortical thickness of visual areas was also measured. We found that cortical visual responses under attentional demands were increased in patients with larger degeneration of visual field, as demonstrated by significant interaction effects between group and task conditions. Moreover, activation during the task condition was increased for patients in two cortical regions of interest corresponding to the preserved and damaged visual field, specifically in patients with severe visual field loss. These findings were observed in the presence of preserved visual cortical structure. We conclude that RP patients have enhanced visual attention recruitment despite their retinal degeneration, while cortical structure and overall response levels remain intact. The unmasking of feedback signals from higher level visual regions involved in attentional processes may explain the increased cortical responses. These findings are relevant for the design of strategies for treating retinal diseases, based on attentional cuing.

Altered intra- and inter-regional functional connectivity of the visual cortex in individuals with peripheral vision loss due to retinitis pigmentosa

This study investigated changes in intra- and inter-regional functional connectivity (FC) in individuals with retinitis pigmentosa (RP) by using regional homogeneity (ReHo) and FC methods. Sixteen RP individuals and 14 healthy controls (HCs) underwent resting-state functional magnetic resonance imaging scans (fMRI). A combined ReHo and FC method was conducted to evaluate synchronization of brain activity. Compared with HCs, RP individuals had significantly lower ReHo values in the bilateral lingual gyrus/cerebellum posterior lobe (LGG/CPL). In FC analysis, the RP group showed decreased positive FC relative to the HC group, from bilateral LGG/CPL to bilateral LGG/cuneus (CUN) and to left postcentral gyrus (PosCG). In contrast, the RP group showed increased negative FC relative to the HC group, from bilateral LGG/CPL to bilateral thalamus, and decreased negative FC from bilateral LGG/CPL to right middle frontal gyrus (MFG), and to left inferior parietal lobule (IPL). Moreover, ReHo values of the bilateral LGG/CPL showed negative correlations with the duration of RP. FC values of the bilateral LGG/CPL-left IPL showed negative correlations with best-corrected visual acuity (BCVA) of the right eye and left eye in RP individuals. Our results reveal reduced synchronicity of neural activity changes in the primary visual area in RP individuals. Moreover, RP individuals showed intrinsic visual network disconnection and reorganization of the retino-thalamocortical pathway and dorsal visual stream, suggesting impaired visuospatial and stereoscopic vision.

Visual brain plasticity induced by central and peripheral visual field loss

Disorders that specifically affect central and peripheral vision constitute invaluable models to study how the human brain adapts to visual deafferentation. We explored cortical changes after the loss of central or peripheral vision. Cortical thickness (CoTks) and resting-state cortical entropy (rs-CoEn), as a surrogate for neural and synaptic complexity, were extracted in 12 Stargardt macular dystrophy, 12 retinitis pigmentosa (tunnel vision stage), and 14 normally sighted subjects. When compared to controls, both groups with visual loss exhibited decreased CoTks in dorsal area V3d. Peripheral visual field loss also showed a specific CoTks decrease in early visual cortex and ventral area V4, while central visual field loss in dorsal area V3A. Only central visual field loss exhibited increased CoEn in LO-2 area and FG1. Current results revealed biomarkers of brain plasticity within the dorsal and the ventral visual streams following central and peripheral visual field defects.