Vision after 53 years of blindness

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.

Does Vergence Affect Perceived Size?

Since Kepler (1604) and Descartes (1637), it has been suggested that 'vergence' (the angular rotation of the eyes) plays a key role in size constancy. However, this has never been tested divorced from confounding cues such as changes in the retinal image. In our experiment, participants viewed a target which grew or shrank in size over 5 s. At the same time, the fixation distance specified by vergence was reduced from 50 to 25 cm. The question was whether this change in vergence affected the participants' judgements of whether the target grew or shrank in size? We found no evidence of any effect, and therefore no evidence that eye movements affect perceived size. If this is correct, then our finding has three implications. First, perceived size is much more reliant on cognitive influences than previously thought. This is consistent with the argument that visual scale is purely cognitive in nature (Linton, 2017; 2018). Second, it leads us to question whether the vergence modulation of V1 contributes to size constancy. Third, given the interaction between vergence, proprioception, and the retinal image in the Taylor illusion, it leads us to ask whether this cognitive approach could also be applied to multisensory integration.

Advances in Neuroscience, Not Devices, Will Determine the Effectiveness of Visual Prostheses

Background: Innovations in engineering and neuroscience have enabled the development of sophisticated visual prosthetic devices. In clinical trials, these devices have provided visual acuities as high as 20/460, enabled coarse navigation, and even allowed for reading of short words. However, long-term commercial viability arguably rests on attaining even better vision and more definitive improvements in tasks of daily living and quality of life. Purpose: Here we review technological and biological obstacles in the implementation of visual prosthetics. Conclusions: Research in the visual prosthetic field has tackled significant technical challenges, including biocompatibility, signal spread through neural tissue, and inadvertent activation of passing axons; however, significant gaps in knowledge remain in the realm of neuroscience, including the neural code of vision and visual plasticity. We assert that further optimization of prosthetic devices alone will not provide markedly improved visual outcomes without significant advances in our understanding of neuroscience.

Themes of advanced information processing in the primate brain

Here is a review of several empirical examples of information processing that occur in the primate cerebral cortex. These include visual processing, object identification and perception, information encoding, and memory. Also, there is a discussion of the higher scale neural organization, mainly theoretical, which suggests hypotheses on how the brain internally represents objects. Altogether they support the general attributes of the mechanisms of brain computation, such as efficiency, resiliency, data compression, and a modularization of neural function and their pathways. Moreover, the specific neural encoding schemes are expectedly stochastic, abstract and not easily decoded by theoretical or empirical approaches.

Learning to see again: biological constraints on cortical plasticity and the implications for sight restoration technologies

The 'bionic eye'-so long a dream of the future-is finally becoming a reality with retinal prostheses available to patients in both the US and Europe. However, clinical experience with these implants has made it apparent that the visual information provided by these devices differs substantially from normal sight. Consequently, the ability of patients to learn to make use of this abnormal retinal input plays a critical role in whether or not some functional vision is successfully regained. The goal of the present review is to summarize the vast basic science literature on developmental and adult cortical plasticity with an emphasis on how this literature might relate to the field of prosthetic vision. We begin with describing the distortion and information loss likely to be experienced by visual prosthesis users. We then define cortical plasticity and perceptual learning, and describe what is known, and what is unknown, about visual plasticity across the hierarchy of brain regions involved in visual processing, and across different stages of life. We close by discussing what is known about brain plasticity in sight restoration patients and discuss biological mechanisms that might eventually be harnessed to improve visual learning in these patients.

Resting-State Retinotopic Organization in the Absence of Retinal Input and Visual Experience

Early visual areas have neuronal receptive fields that form a sampling mosaic of visual space, resulting in a series of retinotopic maps in which the same region of space is represented in multiple visual areas. It is not clear to what extent the development and maintenance of this retinotopic organization in humans depend on retinal waves and/or visual experience. We examined the corticocortical receptive field organization of resting-state BOLD data in normally sighted, early blind, and anophthalmic (in which both eyes fail to develop) individuals and found that resting-state correlations between V1 and V2/V3 were retinotopically organized for all subject groups. These results show that the gross retinotopic pattern of resting-state connectivity across V1-V3 requires neither retinal waves nor visual experience to develop and persist into adulthood. Significance statement: Evidence from resting-state BOLD data suggests that the connections between early visual areas develop and are maintained even in the absence of retinal waves and visual experience.

A lack of experience-dependent plasticity after more than a decade of recovered sight

In 2000, monocular vision was restored to M. M., who had been blind between the ages of 3 and 46 years. Tests carried out over 2 years following the surgery revealed impairments of 3-D form, object, and face processing and an absence of object- and face-selective blood-oxygen-level-dependent responses in ventral visual cortex. In the present research, we reexamined M. M. to test for experience-dependent recovery of visual function. Behaviorally, M. M. remains impaired in 3-D form, object, and face processing. Accordingly, we found little to no evidence of the category-selective organization within ventral visual cortex typically associated with face, body, scene, or object processing. We did observe remarkably normal object selectivity within lateral occipital cortex, consistent with M. M.'s previously reported shape-discrimination performance. Together, these findings provide little evidence for recovery of high-level visual function after more than a decade of visual experience in adulthood.

Development of pattern vision following early and extended blindness

Visual plasticity peaks during early critical periods of normal visual development. Studies in animals and humans provide converging evidence that gains in visual function are minimal and deficits are most severe when visual deprivation persists beyond the critical period. Here we demonstrate visual development in a unique sample of patients who experienced extended early-onset blindness (beginning before 1 y of age and lasting 8-17 y) before removal of bilateral cataracts. These patients show surprising improvements in contrast sensitivity, an assay of basic spatial vision. We find that contrast sensitivity development is independent of the age of sight onset and that individual rates of improvement can exceed those exhibited by normally developing infants. These results reveal that the visual system can retain considerable plasticity, even after early blindness that extends beyond critical periods.