The blindsight saga

Action blindsight and antipointing in a hemianopic patient

Blindsight refers to the observation of residual visual abilities in the hemianopic field of patients without a functional V1. Given the within- and between-subject variability in the preserved abilities and the phenomenal experience of blindsight patients, the fine-grained description of the phenomenon is still debated. Here we tested a patient with established "perceptual" and "attentional" blindsight (c.f. Danckert and Rossetti, 2005). Using a pointing paradigm patient MS, who suffers from a complete left homonymous hemianopia, showed clear above chance manual localisation of 'unseen' targets. In addition, target presentations in his blind field led MS, on occasion, to spontaneous responses towards his sighted field. Structural and functional magnetic resonance imaging was conducted to evaluate the magnitude of V1 damage. Results revealed the presence of a calcarine sulcus in both hemispheres, yet his right V1 is reduced, structurally disconnected and shows no fMRI response to visual stimuli. Thus, visual stimulation of his blind field can lead to "action blindsight" and spontaneous antipointing, in absence of a functional right V1. With respect to the antipointing, we suggest that MS may have registered the stimulation and subsequently presumes it must have been in his intact half field.

Robust Visual Responses and Normal Retinotopy in Primate Lateral Geniculate Nucleus following Long-term Lesions of Striate Cortex

Lesions of striate cortex (V1) trigger massive retrograde degeneration of neurons in the LGN. In primates, these lesions also lead to scotomas, within which conscious vision is abolished. Mediation of residual visual capacity within these regions (blindsight) has been traditionally attributed to an indirect visual pathway to the extrastriate cortex, which involves the superior colliculus and pulvinar complex. However, recent studies have suggested that preservation of the LGN is critical for behavioral evidence of blindsight, raising the question of what type of visual information is channeled by remaining neurons in this structure. A possible contribution of LGN neurons to blindsight is predicated on two conditions: that the neurons that survive degeneration remain visually responsive, and that their receptive fields continue to represent the region of the visual field inside the scotoma. We tested these conditions in male and female marmoset monkeys (Callithrix jacchus) with partial V1 lesions at three developmental stages (early postnatal life, young adulthood, old age), followed by long recovery periods. In all cases, recordings from the degenerated LGN revealed neurons with well-formed receptive fields throughout the scotoma. The responses were consistent and robust, and followed the expected eye dominance and retinotopy observed in the normal LGN. The responses had short latencies and preceded those of neurons recorded in the extrastriate middle temporal area. These findings suggest that the pathway that links LGN neurons to the extrastriate cortex is physiologically viable and can support residual vision in animals with V1 lesions incurred at various ages.SIGNIFICANCE STATEMENT Patients with a lesion of the primary visual cortex (V1) can retain certain visually mediated behaviors, particularly if the lesion occurs early in life. This phenomenon ("blindsight") not only sheds light on the nature of consciousness, but also has implications for studies of brain circuitry, development, and plasticity. However, the pathways that mediate blindsight have been the subject of debate. Recent studies suggest that projections from the LGN might be critical, but this finding is puzzling given that the lesions causes severe cell death in the LGN. Here we demonstrate in monkeys that the surviving LGN neurons retain a remarkable level of visual function and could therefore be the source of the visual information that supports blindsight.

Probing Human Visual Deficits with Functional Magnetic Resonance Imaging

Much remains to be understood about visual system malfunction following injury. The resulting deficits range from dense, visual field scotomas to mild dysfunction of visual perception. Despite the predictive value of anatomical localization studies, much patient-to-patient variability remains regarding (a) perceptual abilities following injury and (b) the capacity of individual patients for visual rehabilitation. Visual field perimetry is used to characterize the visual field deficits that result from visual system injury. However, standard perimetry mapping does not always precisely correspond to underlying anatomical or functional deficits. Functional magnetic resonance imaging can be used to probe the function of surviving visual circuits, allowing us to classify better how the pattern of injury relates to residual visual perception. Identifying pathways that are potentially modifiable by training may guide the development of improved strategies for visual rehabilitation. This review discusses primary visual cortex lesions, which cause dense contralateral scotomas.

Subcortical pathways to extrastriate visual cortex underlie residual vision following bilateral damage to V1

Residual vision, or blindsight, following damage to the primary visual cortex (V1) has been investigated for almost half a century. While there have been many studies of patients with unilateral damage to V1, far fewer have examined bilateral damage, mainly due to the rarity of such patients. Here we re-examine the residual visual function and underlying pathways of previously studied patient SBR who, as a young adult, suffered bilateral damage restricted to V1 which rendered him cortically blind. While earlier work compared his visual cortex to healthy, sighted participants, here we consider how his visual responses and connections compare to patients with unilateral damage to V1 in addition to sighted participants.

Detection of drifting Gabor patches of different contrasts (1%, 5%, 10%, 50% and 100%) was tested in SBR and a group of eight patients with unilateral damage to V1. Performance was compared to the neural activation in motion area hMT+ measured using functional magnetic resonance imaging. Diffusion tractography was also used to determine the white matter microstructure of the visual pathways in all participants.

Like the patients with unilateral damage, patient SBR showed increased % BOLD signal change to the high contrast stimuli that he could detect compared to the lower contrast stimuli that were not detectable. Diffusion tractography suggests this information is conveyed by a direct pathway between the lateral geniculate nucleus (LGN) and hMT+ since this pathway had microstructure that was comparable to the healthy control group. In contrast, the pathway between LGN and V1 had reduced integrity compared to controls. A further finding of note was that, unlike control participants, SBR showed similar patterns of contralateral and ipsilateral activity in hMT+, in addition to healthy white matter microstructure in the tract connecting hMT+ between the two hemispheres. This raises the possibility of increased connectivity between the two hemispheres in the absence of V1 input.

In conclusion, the pattern of visual function and anatomy in bilateral cortical damage is comparable to that seen in a group of patients with unilateral damage. Thus, while the intact hemisphere may play a role in residual vision in patients with unilateral damage, its influence is not evident with the methodology employed here.

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Bilaterally hemianopic patient SBR has neural patterns like unilateral patients.

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hMT+ activity increases with stimulus contrast and better stimulus detection.

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Like in unilateral patients, the pathway between LGN and hMT+ is intact in SBR.

Unitary and dual models of phenomenal consciousness

There is almost unanimous consensus among the theorists of consciousness that the phenomenal character of a mental state cannot exist without consciousness. We argue for a reappraisal of this consensus. We distinguish two models of phenomenal consciousness: unitary and dual. Unitary model takes the production of a phenomenal quality and it's becoming conscious to be one and the same thing. The dual model, which we advocate in this paper, distinguishes the process in which the phenomenal quality is formed from the process that makes this quality conscious. We put forward a conceptual, methodological, neuropsychological and neural argument for the dual model. These arguments are independent but provide mutual support to each other. Together, they strongly support the dual model of phenomenal consciousness and the concomitant idea of unconscious mental qualities. The dual view is thus, we submit, a hypothesis worthy of further probing and development.

Lights from the Dark: Neural Responses from a Blind Visual Hemifield

Here we present evidence that a hemianopic patient with a lesion of the left primary visual cortex (V1) showed an unconscious above-chance orientation discrimination with moving rather than static visual gratings presented to the blind hemifield. The patient did not report any perceptual experience of the stimulus features except for a feeling that something appeared in the blind hemifield. Interestingly, in the lesioned left hemisphere, following stimulus presentation to the blind hemifield, we found an event-related potential (ERP) N1 component at a post-stimulus onset latency of 180-260 ms and a source generator in the left BA 19. In contrast, we did not find evidence of the early visual components C1 and P1 and of the later component P300. A positive component (P2a) was recorded between 250 and 320 ms after stimulus onset frontally in both hemispheres. Finally, in the time range 320-440 ms there was a negative peak in right posterior electrodes that was present only for the moving condition. In sum, there were two noteworthy results: Behaviorally, we found evidence of above chance unconscious (blindsight) orientation discrimination with moving but not static stimuli. Physiologically, in contrast to previous studies, we found reliable ERP components elicited by stimuli presented to the blind hemifield at various electrode locations and latencies that are likely to index either the perceptual report of the patient (N1 and P2a) or, the above-chance unconscious performance with moving stimuli as is the case of the posterior ERP negative component. This late component can be considered as the neural correlate of a kind of blindsight enabling feature discrimination only when stimuli are moving and that is subserved by the intact right hemisphere through interhemispheric transfer.

Functional reorganization after hemispherectomy in humans and animal models: What can we learn about the brain's resilience to extensive unilateral lesions?

Hemispherectomy (HS) is an effective surgical procedure aimed at managing otherwise intractable epilepsy in cases of diffuse unihemispheric pathologies. Neurological recovery in subjects treated with HS is not limited to seizure reduction, rather, sensory-motor and behavioral improvement is often observed. This outcome highlights the considerable capability of the brain to react to such an extensive lesion, by functionally reorganizing and rewiring the cerebral cortex, especially early in life. In this narrative review, we summarize the animal studies as well as the human neurophysiological and neuroimaging studies dealing with the reorganizational processes that occur after HS. These topics are of particular interest in understanding mechanisms of functional recovery after brain injury. HS offers the chance to investigate contralesional hemisphere activity in controlling ipsilateral limb movements, and the role of transcallosal interactions, before and after the surgical procedure. These post-injury neuroplastic phenomena actually differ from those observed after less extensive brain damage. Therefore, they illustrate how different lesions could lead the contralesional hemisphere to play the "good" or "bad" role in functional recovery. These issues may have clinical implications and could inform rehabilitation strategies aiming to improve functional recovery following unilateral hemispheric lesions. Future studies, involving large cohorts of hemispherectomized patients, will be necessary in order to obtain a greater understanding of how cerebral reorganization can contribute to residual sensorimotor, visual and auditory functions.

Blindsight and Unconscious Vision: What They Teach Us about the Human Visual System

Damage to the primary visual cortex removes the major input from the eyes to the brain, causing significant visual loss as patients are unable to perceive the side of the world contralateral to the damage. Some patients, however, retain the ability to detect visual information within this blind region; this is known as blindsight. By studying the visual pathways that underlie this residual vision in patients, we can uncover additional aspects of the human visual system that likely contribute to normal visual function but cannot be revealed under physiological conditions. In this review, we discuss the residual abilities and neural activity that have been described in blindsight and the implications of these findings for understanding the intact system.

Neuro-visual rehabilitation

Despite the fact that almost one-third of patients suffer from visual deficits following brain damage; neuro-visual rehabilitation to compensate for visual field deficits is relatively neglected in the clinical setting. This is in contrast to physio and speech therapies, which are the bread and butter of rehabilitative programs. Likewise, programs that address coping with dementia usually concentrate on language, memory and cognitive skills, but often fail to address the deficits experienced by the subset of patients suffering from progressive cortico-visual dysfunction. Herein, we will review the different approaches to neuro-visual rehabilitation, mainly concentrating on restorative and compensatory treatments. While the first claims to restore vision in the blind visual field, the latter attempts to improve the use of the remaining intact field. These approaches differ in their premise regarding the ability of the adult human brain to adapt following damage, reflecting different attitudes toward the presumed treatment target organ. While restorative therapies claim to reactivate inactive neurons within or around the damaged cortices, compensatory approaches aim to improve voluntary eye movements to compensate the visual loss. We will also briefly discuss the use of optical devices for bypassing the visual deficit as well as the use of the blind-sight phenomena to convert non-conscious visual abilities in the blind visual field into awareness. The various therapeutic approaches will be discussed in the context of patients suffering from hemianopsia and in patients suffering from posterior cortical atrophy. We will argue that of all, the compensatory strategies have shown the most promising results.

Visual Confidence

Visual confidence refers to an observer's ability to judge the accuracy of her perceptual decisions. Even though confidence judgments have been recorded since the early days of psychophysics, only recently have they been recognized as essential for a deeper understanding of visual perception. The reluctance to study visual confidence may have come in part from obtaining convincing experimental evidence in favor of metacognitive abilities rather than just perceptual sensitivity. Some effort has thus been dedicated to offer different experimental paradigms to study visual confidence in humans and nonhuman animals. To understand the origins of confidence judgments, investigators have developed two competing frameworks. The approach based on signal decision theory is popular but fails to account for response times. In contrast, the approach based on accumulation of evidence models naturally includes the dynamics of perceptual decisions. These models can explain a range of results, including the apparently paradoxical dissociation between performance and confidence that is sometimes observed.

Behavioral Consequences and Cortical Reorganization in Homonymous Hemianopia

The most common visual defect to follow a lesion of the retrochiasmal pathways is homonymous hemianopia (HH), whereby, in each eye, patients are blind to the contralesional visual field. From a behavioral perspective, in addition to exhibiting a severe deficit in their contralesional visual field, hemianopic patients can also present implicit residual capacities, now usually referred to collectively as blindsight. It was recently demonstrated that HH patients can also suffer from a subtle deficit in their ipsilesional visual field, called sightblindness (the reverse case of blindsight). Furthermore, the nature of the visual deficit in the contralesional and ipsilesional visual fields, as well as the pattern of functional reorganization in the occipital lobe of HH patients after stroke, all appear to depend on the lesion side. In addition to their contralesional and ipsilesional visual deficits, and to their residual capacities, HH patients can also experience visual hallucinations in their blind field, the physiopathological mechanisms of which remain poorly understood. Herein we review blindsight in terms of its better-known aspects as well as its less-studied clinical signs such as sightblindness, hemispheric specialization and visual hallucinations. We also discuss the implications of recent experimental findings for rehabilitation of visual field defects in hemianopic patients.

Visual Rehabilitation in Chronic Cerebral Blindness: A Randomized Controlled Crossover Study

The treatment of patients suffering from cerebral blindness following stroke is a topic of much recent interest. Several types of treatment are under investigation, such as substitution with prisms and compensation training of saccades. A third approach, aimed at vision restitution is controversial, as a proper controlled study design is missing. In the current study, 27 chronic stroke patients with homonymous visual field defects were trained at home with a visual training device. We used a discrimination task for two types of stimuli: a static point stimulus and a new optic flow-discontinuity stimulus. Using a randomized controlled crossover design, each patient received two successive training rounds, one with high contrast stimuli in their affected hemifield (test) and one round with low-contrast stimuli in their intact hemifield (control). Goldmann and Humphrey perimetry were performed at the start of the study and following each training round. In addition, reading performance was measured. Goldmann perimetry revealed a statistically significant reduction of the visual field defect after the test training, but not after the control training or after no intervention. For both training rounds combined, Humphrey perimetry revealed that the effect of a directed training (sensitivity change in trained hemifield) exceeded that of an undirected training (sensitivity change in untrained hemifield). The interaction between trained and tested hemifield was just above the threshold of significance (p = 0.058). Interestingly, reduction of the field defect assessed by Goldmann perimetry increases with the difference between defect size as measured by Humphrey and Goldmann perimetry prior to training. Moreover, improvement of visual sensitivity measured by Humphrey perimetry increases with the fraction of non-responsive elements (i.e., more relative field loss) in Humphrey perimetry prior to training. Reading speed revealed a significant improvement after training. Our findings demonstrate that our training can result in reduction of the visual field. Improved reading performance after defect training further supports the significance of our training for improvement in daily life activities.

Blind-Sight vs. Degraded-Sight: Different Measures Tell a Different Story

Blindsight patients can detect, localize, and discriminate visual stimuli in their blind field, despite denying being able to see the stimuli. However, the literature documents the cases of blindsight patients who demonstrated a preserved degree of awareness in their impaired visual field. The aim of this study is to investigate the nature of visual processing within the impaired visual field and to ask whether it reflects pure unconscious behavior or conscious, yet degraded, vision. A hemianopic patient (SL) with a complete lesion to the left primary visual cortex was tested. SL was asked to discriminate several stimulus features (orientation, color, contrast, and motion) presented in her impaired visual field in a two-alternative forced-choice task. SL had to report her subjective experience: in the first experiment as “seen” or “guessed,” whereas in the second experiment as the degree of clarity of her experience according to the perceptual awareness scale. In the first experiment, SL demonstrated a performance above-chance in the discrimination task for “guessed” trials, thus showing type 1 blindsight. In the second experiment, however, SL showed above-chance performance only when she reported a certain degree of awareness, thus showing that SL’s preserved discrimination ability relies on conscious vision. These data show that graded measures to assess awareness, which can better tap on the complexity of conscious experience, need to be used in order to differentiate genuine forms of blindsight from degraded conscious vision.

Lost in dissociation: The main paradigms in unconscious cognition

Contemporary studies in unconscious cognition are essentially founded on dissociation, i.e., on how it dissociates with respect to conscious mental processes and representations. This is claimed to be in so many and diverse ways that one is often lost in dissociation. In order to reduce this state of confusion we here carry out two major tasks: based on the central distinction between cognitive processes and representations, we identify and isolate the main dissociation paradigms; we then critically analyze their key tenets and reported findings.

Here, there and everywhere: higher visual function and the dorsal visual stream

The dorsal visual stream, often referred to as the 'where' stream, represents the pathway taken by visual information from the primary visual cortex to the posterior parietal lobe and onwards. It partners the ventral or 'what' stream, the subject of a previous review and largely a temporal-based system. Here, we consider the dorsal stream disorders of perception (simultanagnosia, akinetopsia) along with their consequences on action (eg, optic ataxia and oculomotor apraxia, along with Balint's syndrome). The role of the dorsal stream in blindsight and hemispatial neglect is also considered.

Relearning to See in Cortical Blindness

The incidence of cortically induced blindness is increasing as our population ages. The major cause of cortically induced blindness is stroke affecting the primary visual cortex. While the impact of this form of vision loss is devastating to quality of life, the development of principled, effective rehabilitation strategies for this condition lags far behind those used to treat motor stroke victims. Here we summarize recent developments in the still emerging field of visual restitution therapy, and compare the relative effectiveness of different approaches. We also draw insights into the properties of recovered vision, its limitations and likely neural substrates. We hope that these insights will guide future research and bring us closer to the goal of providing much-needed rehabilitation solutions for this patient population.

Human blindsight is mediated by an intact geniculo-extrastriate pathway

Although damage to the primary visual cortex (V1) causes hemianopia, many patients retain some residual vision; known as blindsight. We show that blindsight may be facilitated by an intact white-matter pathway between the lateral geniculate nucleus and motion area hMT+. Visual psychophysics, diffusion-weighted magnetic resonance imaging and fibre tractography were applied in 17 patients with V1 damage acquired during adulthood and 9 age-matched controls. Individuals with V1 damage were subdivided into blindsight positive (preserved residual vision) and negative (no residual vision) according to psychophysical performance. All blindsight positive individuals showed intact geniculo-hMT+ pathways, while this pathway was significantly impaired or not measurable in blindsight negative individuals. Two white matter pathways previously implicated in blindsight: (i) superior colliculus to hMT+ and (ii) between hMT+ in each hemisphere were not consistently present in blindsight positive cases. Understanding the visual pathways crucial for residual vision may direct future rehabilitation strategies for hemianopia patients.

DOI:http://dx.doi.org/10.7554/eLife.08935.001

Visual information from our eyes projects to a region at the back of the brain called the primary visual cortex, which is where the information is processed to allow us to see the world around us. If a person suffers a stroke that affects this primary visual cortex, he or she can become blind on one side. However, some people can still detect images within this ‘blind’ area, even if they are not consciously aware of it. This phenomenon is known as ‘blindsight’, but it remains unclear which pathways and structures in the brain might allow this information to be detected.

Ajina et al. have now examined the brains of a large group of patients with damage to the visual cortex. The results for the patients with blindsight were compared to those without, and to a group of sighted control participants. This analysis identified a pathway that seems to underlie blindsight. This pathway (which runs between an area of the brain called the lateral geniculate nucleus and another called the motion area hMT+) was present in all patients with blindsight, but was missing or disrupted in those patients without blindsight.

Ajina et al. then examined other pathways that had previously been suggested to support blindsight and revealed that they were unlikely to do so. This is because the suggested connections were not identifiable in all patients with blindsight, and were often intact in those patients without blindsight.

So far, this work has addressed the structure of the pathways rather than their activity. Future work will attempt to determine whether it is possible to strengthen such pathways to improve visual ability.

DOI:http://dx.doi.org/10.7554/eLife.08935.002

Facial blindsight

Blindsight denotes unconscious residual visual capacities in the context of an inability to consciously recollect or identify visual information. It has been described for color and shape discrimination, movement or facial emotion recognition. The present study investigates a patient suffering from cortical blindness whilst maintaining select residual abilities in face detection. Our patient presented the capacity to distinguish between jumbled/normal faces, known/unknown faces or famous people's categories although he failed to explicitly recognize or describe them. Conversely, performance was at chance level when asked to categorize non-facial stimuli. Our results provide clinical evidence for the notion that some aspects of facial processing can occur without perceptual awareness, possibly using direct tracts from the thalamus to associative visual cortex, bypassing the primary visual cortex.

Making eye contact without awareness

Direct gaze is a potent non-verbal signal that establishes a communicative connection between two individuals, setting the course for further interactions. Although consciously perceived faces with direct gaze have been shown to capture attention, it is unknown whether an attentional preference for these socially meaningful stimuli exists even in the absence of awareness. In two experiments, we recorded participants' eye movements while they were exposed to faces with direct and averted gaze rendered invisible by interocular suppression. Participants' inability to correctly guess the occurrence of the faces in a manual forced-choice task demonstrated complete unawareness of the faces. However, eye movements were preferentially directed towards faces with direct compared to averted gaze, indicating a specific sensitivity to others' gaze directions even without awareness. This oculomotor preference suggests that a rapid and automatic establishment of mutual eye contact constitutes a biological advantage, which could be mediated by fast subcortical pathways in the human brain.

Involvement of the Extrageniculate System in the Perception of Optical Illusions: A Functional Magnetic Resonance Imaging Study

Research on the neural processing of optical illusions can provide clues for understanding the neural mechanisms underlying visual perception. Previous studies have shown that some visual areas contribute to the perception of optical illusions such as the Kanizsa triangle and Müller-Lyer figure; however, the neural mechanisms underlying the processing of these and other optical illusions have not been clearly identified. Using functional magnetic resonance imaging (fMRI), we determined which brain regions are active during the perception of optical illusions. For our study, we enrolled 18 participants. The illusory optical stimuli consisted of many kana letters, which are Japanese phonograms. During the shape task, participants stated aloud whether they perceived the shapes of two optical illusions as being the same or not. During the word task, participants read aloud the kana letters in the stimuli. A direct comparison between the shape and word tasks showed activation of the right inferior frontal gyrus, left medial frontal gyrus, and right pulvinar. It is well known that there are two visual pathways, the geniculate and extrageniculate systems, which belong to the higher-level and primary visual systems, respectively. The pulvinar belongs to the latter system, and the findings of the present study suggest that the extrageniculate system is involved in the cognitive processing of optical illusions.

Multisensory training reverses midbrain lesion-induced changes and ameliorates haemianopia

Failure to attend to visual cues is a common consequence of visual cortex injury. Here, we report on a behavioural strategy whereby cross-modal (auditory-visual) training reinstates visuomotor competencies in animals rendered haemianopic by complete unilateral visual cortex ablation. The re-emergence of visual behaviours is correlated with the reinstatement of visual responsiveness in deep layer neurons of the ipsilesional superior colliculus (SC). This functional recovery is produced by training-induced alterations in descending influences from association cortex that allowed these midbrain neurons to once again transform visual cues into appropriate orientation behaviours. The findings underscore the inherent plasticity and functional breadth of phylogenetically older visuomotor circuits that can express visual capabilities thought to have been subsumed by more recently evolved brain regions. These observations suggest the need for reevaluating current concepts of functional segregation in the visual system and have important implications for strategies aimed at ameliorating trauma-induced visual deficits in humans.

Hemisphere-dependent ipsilesional deficits in hemianopia: Sightblindness in the 'intact' visual field

OBJECTIVES

In addition to exhibiting a severe contralesional deficit, hemianopic patients may also show a subtle ipsilesional visual deficit, called sightblindness (the reverse case of 'blindsight). We have tested for the presence, nature and extent of such an ipsilesional visual field (IVF) deficit in hemianopic patients that we assigned to perform two visual tasks. Namely, we aimed to ascertain any links between this ipsilesional deficit, the lesion side, and the tasks performed or the stimuli used.

METHODS

We tested left and right homonymous hemianopic (right brain-damaged RBD and left brain-damaged LBD, respectively) patients and healthy controls. Natural-scene images, either non-filtered or filtered in low or high spatial frequency (LSF or HSF, respectively) were presented in the IVF of each subject. For the two tasks, detection ("Is an image present?") and categorization ("Is the image of a forest or a city?"), accuracy and response time were recorded.

RESULTS

In the IVF the RBD (left hemianopes) patients made more errors on the categorization task than did their matched controls, regardless of image type. In contrast, the only task in which the LBD (right hemianopes) patients made more errors than did the controls was the HSF-images task. Furthermore, in both tasks (detection and categorization), the RBD patients performed worse than did the LBD patients.

DISCUSSION

Homonymous hemianopic patients do indeed exhibit a specific visual deficit in their IVF, which was previously thought to be unaffected. We have demonstrated that the nature and severity of this ipsilesional deficit is determined by the side of the occipital lesion as well as by the tasks and the stimuli. Our findings corroborate the idea of hemispheric specialization at the occipital level, which might determine the nature and severity of ipsilesional deficits in hemianopic patients.

There are things that we know that we know, and there are things that we do not know we do not know: Confidence in decision-making

Metacognition, the ability to think about our own thoughts, is a fundamental component of our mental life and is involved in memory, learning, planning and decision-making. Here we focus on one aspect of metacognition, namely confidence in perceptual decisions. We review the literature in psychophysics, neuropsychology and neuroscience. Although still a very new field, several recent studies suggest there are specific brain circuits devoted to monitoring and reporting confidence, whereas others suggest that confidence information is encoded within decision-making circuits. We provide suggestions, based on interdisciplinary research, to disentangle these disparate results.

Area V5-a microcosm of the visual brain

Area V5 of the visual brain, first identified anatomically in 1969 as a separate visual area, is critical for the perception of visual motion. As one of the most intensively studied parts of the visual brain, it has yielded many insights into how the visual brain operates. Among these are: the diversity of signals that determine the functional capacities of a visual area; the relationship between single cell activity in a specialized visual area and perception of, and preference for, attributes of a visual stimulus; the multiple asynchronous inputs into, and outputs from, an area as well as the multiple operations that it undertakes asynchronously; the relationship between activity at given, specialized, areas of the visual brain and conscious awareness; and the mechanisms used to “bind” signals from one area with those from another, with a different specialization, to give us our unitary perception of the visual world. Hence V5 is, in a sense, a microcosm of the visual world and its study gives important insights into how the whole visual brain is organized—anatomically, functionally and perceptually.

Subcortical functional reorganization due to early blindness

Lack of visual input early in life results in occipital cortical responses to auditory and tactile stimuli. However, it remains unclear whether cross-modal plasticity also occurs in subcortical pathways. With the use of functional magnetic resonance imaging, auditory responses were compared across individuals with congenital anophthalmia (absence of eyes), those with early onset (in the first few years of life) blindness, and normally sighted individuals. We find that the superior colliculus, a "visual" subcortical structure, is recruited by the auditory system in congenital and early onset blindness. Additionally, auditory subcortical responses to monaural stimuli were altered as a result of blindness. Specifically, responses in the auditory thalamus were equally strong to contralateral and ipsilateral stimulation in both groups of blind subjects, whereas sighted controls showed stronger responses to contralateral stimulation. These findings suggest that early blindness results in substantial reorganization of subcortical auditory responses.

Distinct representation and distribution of visual information by specific cell types in mouse superficial superior colliculus

The superficial superior colliculus (sSC) occupies a critical node in the mammalian visual system; it is one of two major retinorecipient areas, receives visual cortical input, and innervates visual thalamocortical circuits. Nonetheless, the contribution of sSC neurons to downstream neural activity and visually guided behavior is unknown and frequently neglected. Here we identified the visual stimuli to which specific classes of sSC neurons respond, the downstream regions they target, and transgenic mice enabling class-specific manipulations. One class responds to small, slowly moving stimuli and projects exclusively to lateral posterior thalamus; another, comprising GABAergic neurons, responds to the sudden appearance or rapid movement of large stimuli and projects to multiple areas, including the lateral geniculate nucleus. A third class exhibits direction-selective responses and targets deeper SC layers. Together, our results show how specific sSC neurons represent and distribute diverse information and enable direct tests of their functional role.

Behavioral and electrophysiological evidence for fast emergence of visual consciousness

A fundamental unsettled dispute concerns how fast the brain generates subjective visual experiences. Both early visual cortical activation and later activity in fronto-parietal global neuronal workspace correlate with conscious vision, but resolving which of the correlates causally triggers conscious vision has proved a methodological impasse. We show that participants can report whether or not they consciously perceived a stimulus in just over 200 ms. These fast consciousness reports were extremely reliable, and did not include reflexive, unconscious responses. The neural events that causally generate conscious vision must have occurred before these behavioral reports. Analyses on single-trial neural correlates of consciousness revealed that the late cortical processing in fronto-parietal global neuronal workspace (∼300 ms) started after the fastest consciousness reports, ruling out the possibility that this late activity directly reflects the emergence of visual consciousness. The consciousness reports were preceded by a negative amplitude difference (∼160-220 ms) that spread from occipital to frontal cortex, suggesting that this correlate underlies the emergence of conscious vision.

Motion area V5/MT+ response to global motion in the absence of V1 resembles early visual cortex

Motion area V5/MT+ shows a variety of characteristic visual responses, often linked to perception, which are heavily influenced by its rich connectivity with the primary visual cortex (V1). This human motion area also receives a number of inputs from other visual regions, including direct subcortical connections and callosal connections with the contralateral hemisphere. Little is currently known about such alternative inputs to V5/MT+ and how they may drive and influence its activity. Using functional magnetic resonance imaging, the response of human V5/MT+ to increasing the proportion of coherent motion was measured in seven patients with unilateral V1 damage acquired during adulthood, and a group of healthy age-matched controls. When V1 was damaged, the typical V5/MT+ response to increasing coherence was lost. Rather, V5/MT+ in patients showed a negative trend with coherence that was similar to coherence-related activity in V1 of healthy control subjects. This shift to a response-pattern more typical of early visual cortex suggests that in the absence of V1, V5/MT+ activity may be shaped by similar direct subcortical input. This is likely to reflect intact residual pathways rather than a change in connectivity, and has important implications for blindsight function. It also confirms predictions that V1 is critically involved in normal V5/MT+ global motion processing, consistent with a convergent model of V1 input to V5/MT+. Historically, most attempts to model cortical visual responses do not consider the contribution of direct subcortical inputs that may bypass striate cortex, such as input to V5/MT+. We have shown that the signal change driven by these non-striate pathways can be measured, and suggest that models of the intact visual system may benefit from considering their contribution.

The case for characterising type-2 blindsight as a genuinely visual phenomenon

Type-2 blindsight is often characterised as involving a non-visual form of awareness that blindsight subjects experience under certain presentation conditions. This paper evaluates the claim that type-2 awareness is non-visual and the proposal that it is a cognitive form of awareness. It is argued that, contrary to the standard account, type-2 awareness is best characterised as visual both because it satisfies certain criteria for being visual and because it can accommodate facts about the phenomenon that the cognitive account cannot. The conclusion is made that type-2 blindsight is best characterised as involving a form of abnormal, degraded visual awareness.

Rehabilitation of homonymous hemianopia: insight into blindsight

Strong evidence of considerable plasticity in primary sensory areas in the adult cortex, and of dramatic cross-modal reorganization in visual areas, after short- or long-term visual deprivation has recently been reported. In the context of patient rehabilitation, this scientifically challenging topic takes on urgent clinical relevance, especially given the lack of information about the role of such reorganization on spared or newly emerged visual performance. Amongst the most common visual field defects found upon unilateral occipital damage of the primary visual cortex is homonymous hemianopia (HH), a perfectly symmetric loss of vision in both eyes. Traditionally, geniculostriate lesions were considered to result in complete and permanent visual loss in the topographically related area of the visual field (Huber, 1992). However, numerous studies in monkeys, and later, in humans, have demonstrated that despite destruction of the striate cortex, or even following a hemispherectomy, some patients retain a certain degree of unconscious visual function, known as blindsight. Accordingly, there have recently been attempts to restore visual function in patients by stimulating unconscious preserved blindsight capacities. Herein we review different visual rehabilitation techniques designed for brain-damaged patients with visual field loss. We discuss the hypothesis that explicit (conscious) visual detection can be restored in the blind visual field by harnessing implicit (unconscious) visual capacities. The results that we summarize here underline the need for early diagnosis of cortical visual impairment (CVI), and the urgency in rehabilitating such deficits, in these patients. Based on the research precedent, we explore the link between implicit (unconscious) vision and conscious perception and discuss possible mechanisms of adaptation and plasticity in the visual cortex.

Is primary visual cortex necessary for visual awareness?

Influential models propose that conscious experience of extrastriate activity requires the integrity of primary visual cortex (V1). A new study challenges this view by demonstrating that when V1 is lesioned, visual qualia can be induced when transcranial magnetic stimulation (TMS) is applied over the patients' ipsilesional hemisphere.

Why is "blindsight" blind? A new perspective on primary visual cortex, recurrent activity and visual awareness

The neuropsychological phenomenon of blindsight has been taken to suggest that the primary visual cortex (V1) plays a unique role in visual awareness, and that extrastriate activation needs to be fed back to V1 in order for the content of that activation to be consciously perceived. The aim of this review is to evaluate this theoretical framework and to revisit its key tenets. Firstly, is blindsight truly a dissociation of awareness and visual detection? Secondly, is there sufficient evidence to rule out the possibility that the loss of awareness resulting from a V1 lesion simply reflects reduced extrastriate responsiveness, rather than a unique role of V1 in conscious experience? Evaluation of these arguments and the empirical evidence leads to the conclusion that the loss of phenomenal awareness in blindsight may not be due to feedback activity in V1 being the hallmark awareness. On the basis of existing literature, an alternative explanation of blindsight is proposed. In this view, visual awareness is a "global" cognitive function as its hallmark is the availability of information to a large number of perceptual and cognitive systems; this requires inter-areal long-range synchronous oscillatory activity. For these oscillations to arise, a specific temporal profile of neuronal activity is required, which is established through recurrent feedback activity involving V1 and the extrastriate cortex. When V1 is lesioned, the loss of recurrent activity prevents inter-areal networks on the basis of oscillatory activity. However, as limited amount of input can reach extrastriate cortex and some extrastriate neuronal selectivity is preserved, computations involving comparison of neural firing rates within a cortical area remain possible. This enables "local" read-out from specific brain regions, allowing for the detection and discrimination of basic visual attributes. Thus blindsight is blind due to lack of "global" long-range synchrony, and it functions via "local" neural readout from extrastriate areas.

Reconciling current approaches to blindsight

After decades of research, blindsight is still a mysterious and controversial topic in consciousness research. Currently, many researchers tend to think of it as an ideal phenomenon to investigate neural correlates of consciousness, whereas others believe that blindsight is in fact a kind of degraded vision rather than "truly blind". This article considers both perspectives and finds that both have difficulties understanding all existing evidence about blindsight. In order to reconcile the perspectives, we suggest two specific criteria for a good model of blindsight, able to encompass all evidence. We propose that the REF-CON model (Overgaard & Mogensen, 2014) may work as such a model.

Elucidating unconscious processing with instrumental hypnosis

Most researchers leverage bottom-up suppression to unlock the underlying mechanisms of unconscious processing. However, a top-down approach - for example via hypnotic suggestion - paves the road to experimental innovation and complementary data that afford new scientific insights concerning attention and the unconscious. Drawing from a reliable taxonomy that differentiates subliminal and preconscious processing, we outline how an experimental trajectory that champions top-down suppression techniques, such as those practiced in hypnosis, is uniquely poised to further contextualize and refine our scientific understanding of unconscious processing. Examining subliminal and preconscious methods, we demonstrate how instrumental hypnosis provides a reliable adjunct that supplements contemporary approaches. Specifically, we provide an integrative synthesis of the advantages and shortcomings that accompany a top-down approach to probe the unconscious mind. Our account provides a larger framework for complementing the results from core studies involving prevailing subliminal and preconscious techniques.

The Timing and Neuroanatomy of Conscious Vision as Revealed by TMS-induced Blindsight

Following damage to the primary visual cortex, some patients exhibit “blindsight,” where they report a loss of awareness while retaining the ability to discriminate visual stimuli above chance. Transient disruption of occipital regions with TMS can produce a similar dissociation, known as TMS-induced blindsight. The neural basis of this residual vision is controversial, with some studies attributing it to the retinotectal pathway via the superior colliculus whereas others implicate spared projections that originate predominantly from the LGN. Here we contrasted these accounts by combining TMS with visual stimuli that either activate or bypass the retinotectal and magnocellular (R/M) pathways. We found that the residual capacity of TMS-induced blindsight occurs for stimuli that bypass the R/M pathways, indicating that such pathways, which include those to the superior colliculus, are not critical. We also found that the modulation of conscious vision was time and pathway dependent. TMS applied either early (0–40 msec) or late (280–320 msec) after stimulus onset modulated detection of stimuli that did not bypass R/M pathways, whereas during an intermediate period (90–130 msec) the effect was pathway independent. Our findings thus suggest a prominent role for the R/M pathways in supporting both the preparatory and later stages of conscious vision. This may help resolve apparent conflict in previous literature by demonstrating that the roles of the retinotectal and geniculate pathways are likely to be more nuanced than simply corresponding to the unconscious/conscious dichotomy.

S-cone Visual Stimuli Activate Superior Colliculus Neurons in Old World Monkeys: Implications for Understanding Blindsight

The superior colliculus (SC) is thought to be unresponsive to stimuli that activate only short wavelength-sensitive cones (S-cones) in the retina. The apparent lack of S-cone input to the SC was recognized by Sumner et al. [Sumner, P., Adamjee, T., & Mollon, J. D. Signals invisible to the collicular and magnocellular pathways can capture visual attention. Current Biology, 12, 1312–1316, 2002] as an opportunity to test SC function. The idea is that visual behavior dependent on the SC should be impaired when S-cone stimuli are used because they are invisible to the SC. The SC plays a critical role in blindsight. If the SC is insensitive to S-cone stimuli blindsight behavior should be impaired when S-cone stimuli are used. Many clinical and behavioral studies have been based on the assumption that S-cone-specific stimuli do not activate neurons in the SC. Our goal was to test whether single neurons in macaque SC respond to stimuli that activate only S-cones. Stimuli were calibrated psychophysically in each animal and at each individual spatial location used in experimental testing [Hall, N. J., & Colby, C. L. Psychophysical definition of S-cone stimuli in the macaque. Journal of Vision, 13, 2013]. We recorded from 178 visually responsive neurons in two awake, behaving rhesus monkeys. Contrary to the prevailing view, we found that nearly all visual SC neurons can be activated by S-cone-specific visual stimuli. Most of these neurons were sensitive to the degree of S-cone contrast. Of 178 visual SC neurons, 155 (87%) had stronger responses to a high than to a low S-cone contrast. Many of these neurons' responses (56/178 or 31%) significantly distinguished between the high and low S-cone contrast stimuli. The latency and amplitude of responses depended on S-cone contrast. These findings indicate that stimuli that activate only S-cones cannot be used to diagnose collicular mediation.

The coupling of vision with locomotion in cortical blindness

Maintaining or modifying the speed and direction of locomotion requires the coupling of the locomotion with the retinal optic flow that it generates. It is shown that this essential behavioral capability, which requires on-line neural control, is preserved in the cortically blind hemifield of a hemianope. In experiments, optic flow stimuli were presented to either the normal or blind hemifield while the patient was walking on a treadmill. Little difference was found between the hemifields with respect to the coupling (i.e. co-dependency) of optic flow detection with locomotion. Even in the cortically blind hemifield, faster walking resulted in the perceptual slowing of detected optic flow, and self-selected locomotion speeds demonstrated behavioral discrimination between different optic flow speeds. The results indicate that the processing of optic flow, and thereby on-line visuo-locomotor coupling, can take place along neural pathways that function without processing in Area V1, and thus in the absence of conscious intervention. These and earlier findings suggest that optic flow and object motion are processed in parallel along with correlated non-visual locomotion signals. Extrastriate interactions may be responsible for discounting the optical effects of locomotion on the perceived direction of object motion, and maintaining visually guided self-motion.

A model of subjective report and objective discrimination as categorical decisions in a vast representational space

Subliminal perception studies have shown that one can objectively discriminate a stimulus without subjectively perceiving it. We show how a minimalist framework based on Signal Detection Theory and Bayesian inference can account for this dissociation, by describing subjective and objective tasks with similar decision-theoretic mechanisms. Each of these tasks relies on distinct response classes, and therefore distinct priors and decision boundaries. As a result, they may reach different conclusions. By formalizing, within the same framework, forced-choice discrimination responses, subjective visibility reports and confidence ratings, we show that this decision model suffices to account for several classical characteristics of conscious and unconscious perception. Furthermore, the model provides a set of original predictions on the nonlinear profiles of discrimination performance obtained at various levels of visibility. We successfully test one such prediction in a novel experiment: when varying continuously the degree of perceptual ambiguity between two visual symbols presented at perceptual threshold, identification performance varies quasi-linearly when the stimulus is unseen and in an 'all-or-none' manner when it is seen. The present model highlights how conscious and non-conscious decisions may correspond to distinct categorizations of the same stimulus encoded by a high-dimensional neuronal population vector.