The blindsight saga

Is self-awareness necessary to have a theory of mind?

Forty years ago, Gallup proposed that theory of mind presupposes self-awareness. Following Humphrey, his hypothesis was that individuals can infer the mental states of others thanks to the ability to monitor their own mental states in similar circumstances. Since then, advances in several disciplines, such as comparative and developmental psychology, have provided empirical evidence to test Gallup's hypothesis. Herein, we review and discuss this evidence.

The dorsal thalamic lateral geniculate nucleus is required for visual control of head direction cell firing direction in rats

Head direction (HD) neurons, signalling facing direction, generate a signal that is primarily anchored to the outside world by visual inputs. We investigated the route for visual landmark information into the HD system in rats. There are two candidates: an evolutionarily older, larger subcortical retino-tectal pathway and a more recently evolved, smaller cortical retino-geniculo-striate pathway. We disrupted the cortical pathway by lesioning the dorsal lateral geniculate thalamic nuclei bilaterally, and recorded HD cells in the postsubicular cortex as rats foraged in a visual-cue-controlled enclosure. In lesioned rats we found the expected number of postsubicular HD cells. Although directional tuning curves were broader across a trial, this was attributable to the increased instability of otherwise normal-width tuning curves. Tuning curves were also poorly responsive to polarizing visual landmarks and did not distinguish cues based on their visual pattern. Thus, the retino-geniculo-striate pathway is not crucial for the generation of an underlying, tightly tuned directional signal but does provide the main route for vision-based anchoring of the signal to the outside world, even when visual cues are high in contrast and low in detail. KEY POINTS: Head direction (HD) cells indicate the facing direction of the head, using visual landmarks to distinguish directions. In rats, we investigated whether this visual information is routed through the thalamus to the visual cortex or arrives via the superior colliculus, which is a phylogenetically older and (in rodents) larger pathway. We lesioned the thalamic dorsal lateral geniculate nucleus (dLGN) in rats and recorded the responsiveness of cortical HD cells to visual cues. We found that cortical HD cells had normal tuning curves, but these were slightly more unstable during a trial. Most notably, HD cells in dLGN-lesioned animals showed little ability to distinguish highly distinct cues and none to distinguish more similar cues. These results suggest that directional processing of visual landmarks in mammals requires the geniculo-cortical pathway, which raises questions about when and how visual directional landmark processing appeared during evolution.

Conscious vision in blindness: A new perceptual phenomenon implemented on the "wrong" side of the brain

Patients with lesions in the visual cortex are blind in corresponding regions of the visual field, but they still may process visual information, a phenomenon referred to as residual vision or "blindsight". Here we report behavioral and fMRI observations with a patient who reports conscious vision across an extended area of blindness for moving, but not for stationary stimuli. This completion effect is shown to be of perceptual and not of conceptual origin, most likely mediated by spared representations of the visual field in the striate cortex. The neural output to extra-striate areas from regions of the deafferented striate cortex is apparently still intact; this is, for instance, indicated by preserved size constancy of visually completed stimuli. Neural responses as measured with fMRI reveal an activation only for moving stimuli, but importantly on the ipsilateral side of the brain. In a conceptual model this shift of activation to the "wrong" hemisphere is explained on the basis of an imbalance of excitatory and inhibitory interactions within and between the striate cortices due to the brain injury. The observed neuroplasticity indicated by this shift together with the behavioral observations provide important new insights into the functional architecture of the human visual system and provide new insight into the concept of consciousness.

Extrapolating animal consciousness

I argue that the question of animal consciousness is an extrapolation problem and, as such, is best tackled by deploying currently accepted methodology for validating experimental models of a phenomenon of interest. This methodology relies on an assessment of similarities and dissimilarities between experimental models, the partial replication of findings across complementary models, and evidence from the successes and failures of explanations, technologies and medical applications developed by extrapolating and aggregating findings from multiple models. Crucially important, this methodology does not require a commitment to any particular theory or construct of consciousness, thus avoiding theory-biased reinterpretations of empirical findings rampant in the literature.

The redundant target paradigm and its use as a blindsight-test: A meta-analytic study

The redundant target effect (RTE) is the well-known effect whereby a single target is detected faster when a second, redundant target is presented simultaneously. The RTE was shown in different experimental designs and applied in various clinical contexts. However, there are also studies showing non-effects or effects in the opposite direction. Our meta-analysis aims to investigate the replicability of the RTE. Herein, we focused on the clinical context within which the RTE has been applied most often and for which it gained particular prominence: The research on blindsight and other forms of residual vision in patients with damage to the neuronal visual system. The application of the RTE in clinical contexts assumes that whenever vision is present, an RTE will be found. Put differently, the RTE as a tool to uncover residual vision presumes that the RTE is a consistent feature of vision in the healthy population. We found a significant summary effect size of the RTE in healthy participants. The effect size depended on certain experimental features: task type, target configuration in the redundant condition, and how reaction times were computed in the single condition. A specific feature combination is typically used in blindsight research. Analyzing studies with this feature combination revealed a significant summary effect size in healthy participants predicting positive RTEs for future studies. A power-analysis revealed a required sample size of 14 participants to obtain an RTE with high reliability. However, the required sample size is rarely reached in blindsight research. Rather, blindsight research is mostly based on single-case studies. In summary, the RTE is a robust effect on group level but does not occur in every single individual. This means failure to obtain an RTE in a single patient should not be interpreted as evidence for the absence of residual vision in this patient.

Neurologically Healthy Humans' Ability to Make Saccades Toward Unseen Targets

Some patients with a visual field loss due to a lesion in the primary visual cortex (V1) can shift their gaze to stimuli presented in their blind visual field. The extent to which a similar "blindsight" capacity is present in neurologically healthy individuals remains unknown. Using retinotopically navigated transcranial magnetic stimulation (TMS) of V1 (Experiment 1) and metacontrast masking (Experiment 2) to suppress conscious vision, we examined neurologically healthy humans' ability to make saccadic eye movements toward visual targets that they reported not seeing. In the TMS experiment, the participants were more likely to initiate a saccade when a stimulus was presented, and they reported not seeing it, than in trials which no stimulus was presented. However, this happened only in a very small proportion (∼8%) of unseen trials, suggesting that saccadic reactions were largely based on conscious perception. In both experiments, saccade landing location was influenced by unconscious information: When the participants denied seeing the target but made a saccade, the saccade was made toward the correct location (TMS: 68%, metacontrast: 63%) more often than predicted by chance. Signal detection theoretic measures suggested that in the TMS experiment, saccades toward unseen targets may have been based on weak conscious experiences. In both experiments, reduced visibility of the target stimulus was associated with slower and less precise gaze shifts. These results suggest that saccades made by neurologically healthy humans may be influenced by unconscious information, although the initiation of saccades is largely based on conscious vision.

Sensitivity vs. awareness curve: A novel model-based analysis to uncover the processes underlying nonconscious perception

In this study, we present a novel model-based analysis of the association between awareness and perceptual processing based on a multidimensional version of signal detection theory (general recognition theory, or GRT). The analysis fits a GRT model to behavioral data and uses the estimated model to construct a sensitivity versus awareness (SvA) curve, representing sensitivity in the discrimination task at each value of relative likelihood of awareness. This approach treats awareness as a continuum rather than a dichotomy, but also provides an objective benchmark for low likelihood of awareness. In two experiments, we assessed nonconscious facial expression recognition using SvA curves in a condition in which faces (fearful vs. neutral) were rendered invisible using continuous flash suppression (CFS) for 500 and 700 milliseconds. We predicted and found nonconscious processing of face emotion, in the form of higher than chance-level sensitivity in the area of low likelihood of awareness.

How to test blindsight without light-scatter artefacts?

Light-scatter artefacts are a methodological problem in testing residual visual capacities (RVCs), for instance blindsight, in patients with homonymous visual field defects (HVFDs). The term light-scatter artefact describes the phenomenon that light from targets directed towards the HVFD can stray into the sighted visual field. This might enable an observer to respond correctly to information directed at her blind field despite the fact that she is unable to process that information in the blind field itself. In this manuscript, we present a review of the relevance of light-scatter in visual neuroscience, discuss factors that influence the impact of light-scatter and evaluate means to test for light-scatter artefacts. Furthermore, we present findings from an empirical study that was aimed at developing tests for RVCs that are free of light-scatter artefacts. Previous studies on light scatter only used small sample sizes and equipment that is no longer in use. Hence, their results cannot be generalized to future experiments making it necessary to run laborious light-scatter tests for every new study on RVCs. To avoid this, we hereby start a pool of stimuli and paradigms which demonstrably do not elicit light-scatter artefacts. To this end, we investigated 21 healthy young participants in three frequently used RVC-paradigms: (1) temporal 2AFC task, (2) movement direction discrimination, and (3) redundant target paradigm. For each paradigm, we applied the blind-spot method. But first, we had to establish that our testing paradigm was sufficiently sensitive to detect light-scatter artefacts. For this, we used conditions that are known to produce strong light scatter and a paradigm that is very sensitive to such effects. Specifically, we presented white targets on a black background in a dark room. The stimuli were presented to observers' blind spot. To check for light-scatter artefacts, we used a target-detection task in a temporal 2AFC format. We obtained clear light-scatter artefacts. Participants produced reliably above-chance detection performance under these conditions. The other two luminance conditions, measured in an illuminated room, did not produce light-scatter artefacts. Accuracy in the temporal 2AFC task was at chance level for white targets on a grey background at the blind-spot position. Additionally, black targets on a grey background avoided light-scatter artefacts in all three RVC-paradigms. In future, researchers can apply these stimulus and illumination conditions when using one of the three above paradigms in their studies. Using these conditions, they will be able to avoid light-scatter artefacts without having to perform their own blind-spot tests.

The nature of blindsight: implications for current theories of consciousness

Blindsight regroups the different manifestations of preserved discriminatory visual capacities following the damage to the primary visual cortex. Blindsight types differentially impact objective and subjective perception, patients can report having no visual awareness whilst their behaviour suggests visual processing still occurs at some cortical level. This phenomenon hence presents a unique opportunity to study consciousness and perceptual consciousness, and for this reason, it has had an historical importance for the development of this field of research. From these studies, two main opposing models of the underlying mechanisms have been established: (a) blindsight is perception without consciousness or (b) blindsight is in fact degraded vision, two views that mirror more general theoretical options about whether unconscious cognition truly exists or whether it is only a degraded form of conscious processing. In this article, we want to re-examine this debate in the light of recent advances in the characterization of blindsight and associated phenomena. We first provide an in-depth definition of blindsight and its subtypes, mainly blindsight type I, blindsight type II and the more recently described blindsense. We emphasize the necessity of sensitive and robust methodology to uncover the dissociations between perception and awareness that can be observed in brain-damaged patients with visual field defects at different cognitive levels. We discuss these different profiles of dissociation in the light of both contending models. We propose that the different types of dissociations reveal a pattern of relationship between perception, awareness and metacognition that is actually richer than what is proposed by either of the existing models. Finally, we consider this in the framework of current theories of consciousness and touch on the implications the findings of blindsight have on these.

Effects of top-down influence suppression on behavioral and V1 neuronal contrast sensitivity functions in cats

To explore the relative contributions of higher-order and primary visual cortex (V1) to visual perception, we compared cats' behavioral and V1 neuronal contrast sensitivity functions (CSF) and threshold versus external noise contrast (TvC) functions before and after top-down influence of area 7 (A7) was modulated with transcranial direct current stimulation (tDCS). We found that suppressing top-down influence of A7 with cathode-tDCS, but not sham-tDCS, reduced behavioral and neuronal contrast sensitivity in the same range of spatial frequencies and increased behavioral and neuronal contrast thresholds in the same range of external noise levels. The neuronal CSF and TvC functions were highly correlated with their behavioral counterparts both before and after the top-down suppression. Analysis of TvC functions using the Perceptual Template Model (PTM) indicated that top-down influence of A7 increased both behavioral and V1 neuronal contrast sensitivity by reducing internal additive noise and the impact of external noise.

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Top-down suppression lowers both behavioral and V1 neuronal CSF functions

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Top-down suppression raises both behavioral and V1 neuronal TvC functions

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The neuronal CSFs and TvCs are highly correlated with their behavioral counterparts

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Top-down influence lowers internal additive noise and impact of external noise in V1

Rehabilitation of visual perception in cortical blindness

Blindness is a common sequela after stroke affecting the primary visual cortex, presenting as a contralesional, homonymous, visual field cut. This can occur unilaterally or, less commonly, bilaterally. While it has been widely assumed that after a brief period of spontaneous improvement, vision loss becomes stable and permanent, accumulating data show that visual training can recover some of the vision loss, even long after the stroke. Here, we review the different approaches to rehabilitation employed in adult-onset cortical blindness (CB), focusing on visual restoration methods. Most of this work was conducted in chronic stroke patients, partially restoring visual discrimination and luminance detection. However, to achieve this, patients had to train for extended periods (usually many months), and the vision restored was not entirely normal. Several adjuvants to training such as noninvasive, transcranial brain stimulation, and pharmacology are starting to be investigated for their potential to increase the efficacy of training in CB patients. However, these approaches are still exploratory and require considerably more research before being adopted. Nonetheless, having established that the adult visual system retains the capacity for restorative plasticity, attention recently turned toward the subacute poststroke period. Drawing inspiration from sensorimotor stroke rehabilitation, visual training was recently attempted for the first time in subacute poststroke patients. It improved vision faster, over larger portions of the blind field, and for a larger number of visual discrimination abilities than identical training initiated more than 6 months poststroke (i.e., in the chronic period). In conclusion, evidence now suggests that visual neuroplasticity after occipital stroke can be reliably recruited by a range of visual training approaches. In addition, it appears that poststroke visual plasticity is dynamic, with a critical window of opportunity in the early postdamage period to attain more rapid, more extensive recovery of a larger set of visual perceptual abilities.

Transcranial magnetic stimulation (TMS)-induced Blindsight of Orientation is Degraded Conscious Vision

Patients with blindsight are blind due to an early visual cortical lesion, but they can discriminate stimuli presented to the blind visual field better than chance. Studies using transcranial magnetic stimulation (TMS) of early visual cortex have tried to induce blindsight-like behaviour in neurologically healthy individuals, but the studies have yielded varied results. We hypothesized that previous demonstrations of TMS-induced blindsight may result from degraded awareness of the stimuli due to the use of dichotomous visibility scales in measuring awareness. In the present study, TMS was applied to early visual cortex during an orientation discrimination task and the subjective scale measuring awareness was manipulated: The participants reported their conscious perception either using a dichotomous scale or a 4-point Perceptual Awareness Scale. Although the results with the dichotomous scale replicated previous reports of blindsight-like behaviour, there was no evidence of TMS-induced blindsight for orientation when the participants used the lowest rating of the 4-point graded scale to indicate that they were not aware of the presence of the stimulus. Moreover, signal detection analyses indicated that across participants, the individual's sensitivity to consciously discriminate orientation predicted behaviour on reportedly unconscious trials. These results suggest that blindsight-like discrimination of orientation in neurologically healthy individuals does not occur for completely invisible stimuli, that is, when the observers do not report any kind of consciousness of the stimulus. TMS-induced blindsight for orientation is likely degraded conscious vision.

Cortical Visual Impairment in Childhood: 'Blindsight' and the Sprague Effect Revisited

The paper discusses and provides support for diverse processes of brain plasticity in visual function after damage in infancy and childhood in comparison with injury that occurs in the adult brain. We provide support and description of neuroplastic mechanisms in childhood that do not seemingly exist in the same way in the adult brain. Examples include the ability to foster the development of thalamocortical connectivities that can circumvent the lesion and reach their cortical destination in the occipital cortex as the developing brain is more efficient in building new connections. Supporting this claim is the fact that in those with central visual field defects we can note that the extrastriatal visual connectivities are greater when a lesion occurs earlier in life as opposed to in the neurologically mature adult. The result is a significantly more optimized system of visual and spatial exploration within the ‘blind’ field of view. The discussion is provided within the context of “blindsight” and the “Sprague Effect”.

Visual instrumental learning in blindsight monkeys

Blindsight is the residual visuo-motor ability without subjective awareness observed after lesions of the primary visual cortex (V1). Various visual functions are retained, however, instrumental visual associative learning remains to be investigated. Here we examined the secondary reinforcing properties of visual cues presented to the hemianopic field of macaque monkeys with unilateral V1 lesions. Our aim was to test the potential role of visual pathways bypassing V1 in reinforcing visual instrumental learning. When learning the location of a hidden area in an oculomotor search task, conditioned visual cues presented to the lesion-affected hemifield operated as an effective secondary reinforcer. We noted that not only the hidden area location, but also the vector of the saccade entering the target area was reinforced. Importantly, when the visual reinforcement signal was presented in the lesion-affected field, the monkeys continued searching, as opposed to stopping when the cue was presented in the intact field. This suggests the monkeys were less confident that the target location had been discovered when the reinforcement cue was presented in the affected field. These results indicate that the visual signals mediated by the residual visual pathways after V1 lesions can access fundamental reinforcement mechanisms but with impaired visual awareness.

Subliminal perception is continuous with conscious vision and can be predicted from prestimulus electroencephalographic activity

Individuals are able to discriminate visual stimuli they report not consciously seeing. This phenomenon is known as "subliminal perception." Such capacity is often assumed to be relatively automatic in nature and rely on stimulus-driven activity in low-level cortical areas. Instead, here we asked to what extent neural activity before stimulus presentation influences subliminal perception. We asked participants to discriminate the location of a briefly presented low-contrast visual stimulus and then rate how well they saw the stimulus. Consistent with previous studies, participants correctly discriminated with slightly above chance-level accuracy the location of a stimulus they reported not seeing. Signal detection analyses indicated that while subjects categorized their percepts as "unconscious," their capacity to discriminate these stimuli lay on the same continuum as conscious vision. We show that the accuracy of discriminating the location of a subliminal stimulus could be predicted with relatively high accuracy (AUC = 0.70) based on lateralized electroencephalographic (EEG) activity before the stimulus, the hemifield where the stimulus was presented, and the accuracy of previous trial's discrimination response. Altogether, our results suggest that rather than being a separate unconscious capacity, subliminal perception is based on similar processes as conscious vision.

Functional MRI of visual cortex predicts training-induced recovery in stroke patients with homonymous visual field defects

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Damage to the visual brain typically leads to vision loss.

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Vision loss may be partially recovered with visual restitution training (VRT)

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Cortical responses to visual stimulation do not always lead to visual awareness.

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A mismatch between Humphrey and neural perimetry predicts training outcome.

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This finding has important implications for better rehabilitation strategies.

Post-chiasmatic damage to the visual system leads to homonymous visual field defects (HVDs), which can severely interfere with daily life activities. Visual Restitution Training (VRT) can recover parts of the affected visual field in patients with chronic HVDs, but training outcome is variable. An untested hypothesis suggests that training potential may be largest in regions with ‘neural reserve’, where cortical responses to visual stimulation do not lead to visual awareness as assessed by Humphrey perimetry—a standard behavioural visual field test. Here, we tested this hypothesis in a sample of twenty-seven hemianopic stroke patients, who participated in an assiduous 80-hour VRT program. For each patient, we collected Humphrey perimetry and wide-field fMRI-based retinotopic mapping data prior to training. In addition, we used Goal Attainment Scaling to assess whether personal activities in daily living improved. After training, we assessed with a second Humphrey perimetry measurement whether the visual field was improved and evaluated which personal goals were attained. Confirming the hypothesis, we found significantly larger improvements of visual sensitivity at field locations with neural reserve. These visual field improvements implicated both regions in primary visual cortex and higher order visual areas. In addition, improvement in daily life activities correlated with the extent of visual field enlargement. Our findings are an important step toward understanding the mechanisms of visual restitution as well as predicting training efficacy in stroke patients with chronic hemianopia.

Continuous flash suppression: Known and unknowns

Studies utilizing continuous flash suppression (CFS) provide valuable information regarding conscious and nonconscious perception. There are, however, crucial unanswered questions regarding the mechanisms of suppression and the level of visual processing in the absence of consciousness with CFS. Research suggests that the answers to these questions depend on the experimental configuration and how we assess consciousness in these studies. The aim of this review is to evaluate the impact of different experimental configurations and the assessment of consciousness on the results of the previous CFS studies. We review studies that evaluated the influence of different experimental configuration on the depth of suppression with CFS and discuss how different assessments of consciousness may impact the results of CFS studies. Finally, we review behavioral and brain recording studies of CFS. In conclusion, previous studies provide evidence for survival of low-level visual information and complete impairment of high-level visual information under the influence of CFS. That is, studies suggest that nonconscious perception of lower-level visual information happens with CFS, but there is no evidence for nonconscious high-level recognition with CFS.

Singularity and consciousness: A neuropsychological contribution

In common sense experience based on introspection, consciousness is singular. There is only one ‘me’ and that is the one that is conscious. This means that ‘singularity’ is a defining aspect of ‘consciousness’. However, the three main theories of consciousness, Integrated Information, Global Workspace and Recurrent Processing theory, are generally not very clear on this issue. These theories have traditionally relied heavily on neuropsychological observations and have interpreted various disorders, such as anosognosia, neglect and split‐brain as impairments in conscious awareness without any reference to ‘the singularity’. In this review, we will re‐examine the theoretical implications of these impairments in conscious awareness and propose a new way how to conceptualize consciousness of singularity. We will argue that the subjective feeling of singularity can coexist with several disunified conscious experiences. Singularity awareness may only come into existence due to environmental response constraints. That is, perceptual, language, memory, attentional and motor processes may largely proceed unintegrated in parallel, whereas a sense of unity only arises when organisms need to respond coherently constrained by the affordances of the environment. Next, we examine from this perspective psychiatric disorders and psycho‐active drugs. Finally, we present a first attempt to test this hypothesis with a resting state imaging experiment in a split‐brain patient. The results suggest that there is substantial coherence of activation across the two hemispheres. These data show that a complete lesioning of the corpus callosum does not, in general, alter the resting state networks of the brain. Thus, we propose that we have separate systems in the brain that generate distributed conscious. The sense of singularity, the experience of a ‘Me‐ness’, emerges in the interaction between the world and response‐planning systems, and this leads to coherent activation in the different functional networks across the cortex.

Blindsight

For over a century, research has demonstrated that damage to primary visual cortex does not eliminate all capacity for visual processing in the brain. From Riddoch's (1917) early demonstration of intact motion processing for blind field stimuli, to the iconic work of Weiskrantz et al. (1974) showing reliable spatial localization, it is clear that secondary visual pathways that bypass V1 carry information to the visual brain that in turn influences behavior. In this chapter, we briefly outline the history and phenomena associated with blindsight, before discussing the nature of the secondary visual pathways that support residual visual processing in the absence of V1. We finish with some speculation as to the functional characteristics of these secondary pathways.

Dyskinetopsic Palinopsia: Palinopsia Accompanied by Moving Afterimages

Palinopsia refers to the abnormal persistence, or recurrence, of visual images after a visual stimulus has subsided. We describe here a case of palinopsia accompanied by a visual motion perception disorder as manifested by moving afterimages. A 71-year-old man presented to us after having experienced acute-onset, vivid, visual hallucinations for 1 week. A detailed history revealed that he was hallucinating multiple living and nonliving objects. He also complained of a persistence of afterimages, particularly in the left visual field. He reported that, on a few occasions, while sitting by the window in his room, he had seen a moving car on the road; immediately after the car had disappeared from his sight, he had then seen the same car moving backward at almost the same speed-as if the driver had applied the reverse gear. A neuropsychological assessment did not reveal any deficits in attention, language, or episodic memory. Visual field testing by confrontational perimetry suggested left hemianopia. An MRI of the brain revealed an arteriovenous malformation in the medial part of the right occipital lobe, affecting both the lingual gyrus and the inferior occipital gyrus. Palinopsia has generally been described in reference to static afterimages. In our case, not only was the afterimage that was perceived by the patient in motion, but the direction of the movement was also opposite to that of the actual object. We propose the term dyskinetopsic palinopsia, or simply motion-related palinopsia, for this particular condition.

Dimensions of Animal Consciousness

How does consciousness vary across the animal kingdom? Are some animals 'more conscious' than others? This article presents a multidimensional framework for understanding interspecies variation in states of consciousness. The framework distinguishes five key dimensions of variation: perceptual richness, evaluative richness, integration at a time, integration across time, and self-consciousness. For each dimension, existing experiments that bear on it are reviewed and future experiments are suggested. By assessing a given species against each dimension, we can construct a consciousness profile for that species. On this framework, there is no single scale along which species can be ranked as more or less conscious. Rather, each species has its own distinctive consciousness profile.

What cortical areas are responsible for blindsight in hemianopic patients?

The presence of above-chance unconscious behavioral responses following stimulus presentation to the blind hemifield of hemianopic patients (blindsight) is a well-known phenomenon. What is still lacking is a systematic study of the neuroanatomical bases of two distinct aspects of blindsight: the unconscious above chance performance and the phenomenological aspects that may be associated. Here, we tested 17 hemianopic patients in two tasks i.e. movement and orientation discrimination of a visual grating presented to the sighted or blind hemifield. We classified patients in four groups on the basis of the presence of above chance unconscious discrimination without or with perceptual awareness reports for stimulus presentation to the blind hemifield. A fifth group was represented by patients with interruption of the Optic Radiation. In the various groups we carried out analyses of lesion extent of various cortical areas, probabilistic tractography as well as assessment of the cortical thickness of the intact hemisphere. All patients had lesions mainly, but not only, in the occipital lobe and the statistical comparison of their extent provided clues as to the critical anatomical substrate of unconscious above-chance performance and of perceptual awareness reports, respectively. In fact, the two areas that turned out to be critical for above-chance performance in the discrimination of moving versus non-moving visual stimuli were the Precuneus and the Posterior Cingulate Gyrus while for perceptual awareness reports the crucial areas were Intracalcarine, Supracalcarine, Cuneus, and the Posterior Cingulate Gyrus. Interestingly, the proportion of perceptual awareness reports was higher in patients with a spared right hemisphere. As to probabilistic tractography, all pathways examined yielded higher positive values for patients with perceptual awareness reports. Finally, the cortical thickness of the intact hemisphere was greater in patients showing above-chance performance than in those at chance. This effect is likely to be a result of neuroplastic compensatory mechanisms.

Fast and reversible neural inactivation in macaque cortex by optogenetic stimulation of GABAergic neurons

Optogenetic techniques for neural inactivation are valuable for linking neural activity to behavior but they have serious limitations in macaques. To achieve powerful and temporally precise neural inactivation, we used an adeno-associated viral (AAV) vector carrying the channelrhodopsin-2 gene under the control of a Dlx5/6 enhancer, which restricts expression to GABAergic neurons. We tested this approach in the primary visual cortex, an area where neural inactivation leads to interpretable behavioral deficits. Optical stimulation modulated spiking activity and reduced visual sensitivity profoundly in the region of space represented by the stimulated neurons. Rebound firing, which can have unwanted effects on neural circuits following inactivation, was not observed, and the efficacy of the optogenetic manipulation on behavior was maintained across >1000 trials. We conclude that this inhibitory cell-type-specific optogenetic approach is a powerful and spatiotemporally precise neural inactivation tool with broad utility for probing the functional contributions of cortical activity in macaques.

The development of vision between nature and nurture: clinical implications from visual neuroscience

BACKGROUND

Vision is an adaptive function and should be considered a prerequisite for neurodevelopment because it permits the organization and the comprehension of the sensory data collected by the visual system during daily life. For this reason, the influence of visual functions on neuromotor, cognitive, and emotional development has been investigated by several studies that have highlighted how visual functions can drive the organization and maturation of human behavior. Recent studies on animals and human models have indicated that visual functions mature gradually during post-natal life, and its development is closely linked to environment and experience.

DISCUSSION

The role of vision in early brain development and some of the neuroplasticity mechanisms that have been described in the presence of cerebral damage during childhood are analyzed in this review, according to a neurorehabilitation prospective.

A little history goes a long way toward understanding why we study consciousness the way we do today

Consciousness is currently a thriving area of research in psychology and neuroscience. While this is often attributed to events that took place in the early 1990s, consciousness studies today are a continuation of research that started in the late 19th century and that continued throughout the 20th century. From the beginning, the effort built on studies of animals to reveal basic principles of brain organization and function, and of human patients to gain clues about consciousness itself. Particularly important and our focus here is research in the 1950s, 1960s, and 1970s involving three groups of patients-amnesia, split brain, and blindsight. Across all three groups, a similar pattern of results was found-the patients could respond appropriately to stimuli that they denied seeing (or in the case of amnesiacs, having seen before). These studies paved the way for the current wave of research on consciousness. The field is, in fact, still grappling with the implications of the findings showing that the ability to consciously know and report the identity of a visual stimulus can be dissociated in the brain from the mechanisms that underlie the ability to behave in a meaningful way to the same stimulus.

Using superior colliculus principles of multisensory integration to reverse hemianopia

The diversity of our senses conveys many advantages; it enables them to compensate for one another when needed, and the information they provide about a common event can be integrated to facilitate its processing and, ultimately, adaptive responses. These cooperative interactions are produced by multisensory neurons. A well-studied model in this context is the multisensory neuron in the output layers of the superior colliculus (SC). These neurons integrate and amplify their cross-modal (e.g., visual-auditory) inputs, thereby enhancing the physiological salience of the initiating event and the probability that it will elicit SC-mediated detection, localization, and orientation behavior. Repeated experience with the same visual-auditory stimulus can also increase the neuron's sensitivity to these individual inputs. This observation raised the possibility that such plasticity could be engaged to restore visual responsiveness when compromised. For example, unilateral lesions of visual cortex compromise the visual responsiveness of neurons in the multisensory output layers of the ipsilesional SC and produces profound contralesional blindness (hemianopia). The possibility that multisensory plasticity could restore the visual responses of these neurons, and reverse blindness, was tested in the cat model of hemianopia. Hemianopic subjects were repeatedly presented with spatiotemporally congruent visual-auditory stimulus pairs in the blinded hemifield on a daily or weekly basis. After several weeks of this multisensory exposure paradigm, visual responsiveness was restored in SC neurons and behavioral responses were elicited by visual stimuli in the previously blind hemifield. The constraints on the effectiveness of this procedure proved to be the same as those constraining SC multisensory plasticity: whereas repetitions of a congruent visual-auditory stimulus was highly effective, neither exposure to its individual component stimuli, nor to these stimuli in non-congruent configurations was effective. The restored visual responsiveness proved to be robust, highly competitive with that in the intact hemifield, and sufficient to support visual discrimination.

Reversing Hemianopia by Multisensory Training Under Anesthesia

Hemianopia is characterized by blindness in one half of the visual field and is a common consequence of stroke and unilateral injury to the visual cortex. There are few effective rehabilitative strategies that can relieve it. Using the cat as an animal model of hemianopia, we found that blindness induced by lesions targeting all contiguous areas of the visual cortex could be rapidly reversed by a non-invasive, multisensory (auditory-visual) exposure procedure even while animals were anesthetized. Surprisingly few trials were required to reinstate vision in the previously blind hemisphere. That rehabilitation was possible under anesthesia indicates that the visuomotor behaviors commonly believed to be essential are not required for this recovery, nor are factors such as attention, motivation, reward, or the various other cognitive features that are generally thought to facilitate neuro-rehabilitative therapies.

Dissociations between perception and awareness in hemianopia

The most common visual defect to follow a lesion of the retrochiasmal pathways is homonymous hemianopia (HH), whereby patients are blind to the contralesional visual field of each eye. Homonymous hemianopia has been studied in terms of its deleterious consequences on perceptual, cognitive and motor tasks as well as because it represents an interesting model of vision loss after a unilateral lesion of the occipital lobe. From a behavioral perspective, in addition to exhibiting a severe deficit in their contralesional visual field, HH patients can also exhibit dissociations between perception and awareness. Firstly, HH patients suffering from anosognosia may be unaware of their visual field defect. Secondly, HH patients can present with unconscious visual abilities in the blind hemifield, a phenomenon referred to as blindsight. Thirdly, recent reports demonstrate that HH patients can suffer from a subtle deficit in their ipsilesional visual field that they are unaware of, a condition called sightblindness (i.e. the reverse case of 'blindsight'). Finally, HH patients may also exhibit visual hallucinations in their blind field; however, such patients are not systematically aware that their perceptions are unreal. In this review, we provide an overview of the visual-field losses in HH patients after a left or right unilateral occipital lesion. Furthermore, we explore the implications of these four phenomena for models of visual processing and rehabilitation of visual field defects in HH patients. Finally, in contrast to the traditional view that HH is solely a visual-field defect, we discuss why this deficit is an interesting model for studying the dissociation between perception and awareness.

The Evolution of the Pulvinar Complex in Primates and Its Role in the Dorsal and Ventral Streams of Cortical Processing

Current evidence supports the view that the visual pulvinar of primates consists of at least five nuclei, with two large nuclei, lateral pulvinar ventrolateral (PLvl) and central lateral nucleus of the inferior pulvinar (PIcl), contributing mainly to the ventral stream of cortical processing for perception, and three smaller nuclei, posterior nucleus of the inferior pulvinar (PIp), medial nucleus of the inferior pulvinar (PIm), and central medial nucleus of the inferior pulvinar (PIcm), projecting to dorsal stream visual areas for visually directed actions. In primates, both cortical streams are highly dependent on visual information distributed from primary visual cortex (V1). This area is so vital to vision that patients with V1 lesions are considered "cortically blind". When the V1 inputs to dorsal stream area middle temporal visual area (MT) are absent, other dorsal stream areas receive visual information relayed from the superior colliculus via PIp and PIcm, thereby preserving some dorsal stream functions, a phenomenon called "blind sight". Non-primate mammals do not have a dorsal stream area MT with V1 inputs, but superior colliculus inputs to temporal cortex can be more significant and more visual functions are preserved when V1 input is disrupted. The current review will discuss how the different visual streams, especially the dorsal stream, have changed during primate evolution and we propose which features are retained from the common ancestor of primates and their close relatives.

Lesion Studies in Contemporary Neuroscience

Studies of humans with focal brain damage and non-human animals with experimentally induced brain lesions have provided pivotal insights into the neural basis of behavior. As the repertoire of neural manipulation and recording techniques expands, the utility of studying permanent brain lesions bears re-examination. Studies on the effects of permanent lesions provide vital data about brain function that are distinct from those of reversible manipulations. Focusing on work carried out in humans and nonhuman primates, we address the inferential strengths and limitations of lesion studies, recent methodological developments, the integration of this approach with other methods, and the clinical and ecological relevance of this research. We argue that lesion studies are essential to the rigorous assessment of neuroscience theories.

Dissociation between objective and subjective perceptual experiences in a population of hemianopic patients: A new form of blindsight?

After a post-chiasmatic lesion, some patients may retain unconscious visual function, known as blindsight, in their contralesional visual field. Despite the importance of blindsight in the study of consciousness, little is known about the nature of patients' experience in their hemianopic field. To address this knowledge gap, we measured blindsight, and assessed the perceptual experience in the contralesional visual field, of seventeen homonymous hemianopic (HH) patients. To ensure that the stimuli were shown in a "blind" sector of the visual field, we selected a subgroup of eight complete-HH patients, as determined by automatic perimetry. Firstly, we measured blindsight through a forced-choice task in which the patients had to identify letters displayed on a screen. Secondly, we compared the patients' binary responses ("Something was presented" vs "Nothing was presented") to responses on a new, five-level scale, the Sensation Awareness Scale (SAS), which we designed to include visual as well as non-visual answers (e.g., "I felt something"). Interestingly, only one of the eight complete-HH patients met the criteria for blindsight. More importantly, our SAS enabled us to identify a previously unreported dissociation, which we have named blindsense, in four of the eight complete-HH patients. Specifically, these four patients exhibited better-than-chance sensitivity to the presence of a stimulus on the subjective scale, despite being unable to identify the stimulus during the forced-choice task. Our findings highlight the importance of awareness-assessment methods to investigate perceptual experiences in the contralesional visual field and suggest a low incidence of blindsight in post-stroke HH patients.

Preserved extrastriate visual network in a monkey with substantial, naturally occurring damage to primary visual cortex

Lesions of primary visual cortex (V1) lead to loss of conscious visual perception with significant impact on human patients. Understanding the neural consequences of such damage may aid the development of rehabilitation methods. In this rare case of a Rhesus macaque (monkey S), likely born without V1, the animal's in-group behaviour was unremarkable, but visual task training was impaired. With multi-modal magnetic resonance imaging, visual structures outside of the lesion appeared normal. Visual stimulation under anaesthesia with checkerboards activated lateral geniculate nucleus of monkey S, while full-field moving dots activated pulvinar. Visual cortical activation was sparse but included face patches. Consistently across lesion and control monkeys, functional connectivity analysis revealed an intact network of bilateral dorsal visual areas temporally correlated with V5/MT activation, even without V1. Despite robust subcortical responses to visual stimulation, we found little evidence for strengthened subcortical input to V5/MT supporting residual visual function or blindsight-like phenomena.

Visual training in hemianopia alters neural activity in the absence of behavioural improvement: a pilot study

Background

Damage to the primary visual cortex (V1) due to stroke often results in permanent loss of sight affecting one side of the visual field (homonymous hemianopia). Some rehabilitation approaches have shown improvement in visual performance in the blind region, but require a significant time investment.

Methods

Seven patients with cortical damage performed 400 trials of a motion direction discrimination task daily for 5 days. Three patients received anodal transcranial direct current stimulation (tDCS) during training, three received sham stimulation and one had no stimulation. Each patient had an assessment of visual performance and a functional magnetic resonance imaging (fMRI) scan before and after training to measure changes in visual performance and cortical activity.

Results

No patients showed improvement in visual function due to the training protocol, and application of tDCS had no effect on visual performance. However, following training, the neural response in motion area hMT+ to a moving stimulus was altered. When the stimulus was presented to the sighted hemifield, activity decreased in hMT+ of the damaged hemisphere. There was no change in hMT+ response when the stimulus was presented to the impaired hemifield. There was a decrease in activity in the inferior precuneus after training when the stimulus was presented to either the impaired or sighted hemifield. Preliminary analysis of tDCS data suggested that anodal tDCS interacted with the delivered training, modulating the neural response in hMT+ in the healthy side of the brain.

Conclusion

Training can affect the neural responses in hMT+ even in the absence of change in visual performance.

Neuronal mechanisms of motion detection underlying blindsight assessed by functional magnetic resonance imaging (fMRI)

Brain imaging offers a valuable tool to observe functional brain plasticity by showing how sensory inputs reshape cortical activations after a visual impairment. Following a unilateral post-chiasmatic lesion affecting the visual cortex, patients may suffer a contralateral visual loss referred to homonymous hemianopia. Nevertheless, these patients preserve the ability to unconsciously detect, localize and discriminate visual stimuli presented in their impaired visual field. To investigate this paradox, known as blindsight, we conducted a study using functional magnetic resonance imaging (fMRI) to evaluate the structural and functional impact of such lesion in a 33-year old patient (ML), who suffers a complete right hemianopia without macular sparing and showing strong evidences of blindsight. We thus performed whole brain and sliced thalamic fMRI scan sequences during an event-related motion detection task. We provided evidence of the neuronal fingerprint of blindsight by acquiring and associating neural correlates, specific structures and functional networks of the midbrain during blindsight performances which may help to better understand this condition. Accurate performance demonstrated the presence of residual vision and the ability to unconsciously perceive motion presented in the blind hemifield, although her reaction time was significantly higher in her blind-field. When the normal hemifield was stimulated, we observed significant contralateral activations in primary and secondary visual areas as well as motion specific areas, such as the supramarginal gyrus and middle temporal area. We also demonstrated sub-thalamic activations within the superior colliculi (SC) and the pulvinar. These results suggest a role of secondary subcortical structures in normal spontaneous motion detection. In a similar way, when the lesioned hemifield was stimulated, we observed contralateral activity in extrastriate areas with no activation of the primary lesioned visual cortex. Moreover, we observed activations within the SC when the blind hemifield was stimulated. However, we observed unexpected ipsilateral activations within the same motion specific areas, as well as bilateral frontal activations. These results highlight the importance of abnormal secondary pathways bypassing the primary visual area (V1) in residual vision. This reorganization in the structure and function of the visual pathways correlates with behavioral changes, thus offering a plausible explanation for the blindsight phenomenon. Our results may potentially impact the development of rehabilitation strategies to target subcortical pathways.

No Effect of Anodal Transcranial Direct Current Stimulation (tDCS) Over hMT+ on Motion Perception Learning

Background: Human visual cortical area hMT+, like its homolog MT in the macaque monkey, has been shown to be particularly selective to visual motion. After damage to the primary visual cortex (V1), patients often exhibit preserved ability to detect moving stimuli, which is associated with neural activity in area hMT+. As an anatomical substrate that underlies residual function in the absence of V1, promoting functional plasticity within hMT+ could potentially boost visual performance despite primary visual cortical damage.

Objective: To establish in healthy participants whether it is possible to use transcranial direct current stimulation (tDCS) over hMT+ to potentiate learning of visual motion direction discrimination.

Methods: Twenty-one participants were trained daily for 5 days on a visual motion direction discrimination task. Task difficulty was increased as performance improved, by decreasing the proportion of coherently moving dots, such that participants were always performing at psychophysical threshold. tDCS, either anodal or sham, was applied daily during 20 min of training. Task performance was assessed at baseline and at the end of the training period. Performance was also compared with a third group of 10 participants from an earlier study who had undergone the same procedures but without tDCS.

Results: All participants showed improved task performance both during and after training. Contrary to our hypothesis, anodal tDCS did not further improve performance compared to sham stimulation or no stimulation. Bayesian statistics indicated weak evidence in favor of the null hypothesis.

Conclusion: This study found no evidence for a robust effect of anodal tDCS over hMT+ on visual motion direction discrimination learning in the young healthy visual system, although more subtle effects may have been missed in the relatively small sample size.

Neural Restoration Training improves visual functions and expands visual field of patients with homonymous visual field defects

BACKGROUND

In recent years, the introduction of visual rehabilitation for patients with homonymous visual field defects has been met with both enthusiasm and caution. Despite the evidence that restitutive training results in expansion of the visual field, several concerns have been raised.

OBJECTIVE

We tested the effectiveness of a new rehabilitative protocol called "Neuro Restoration Training" (NRT) in reducing visual field defects and in restituting visual functions in the restored hemianopic area.

METHODS

Ten patients with homonymous visual field defects (lesion age >6 months) where trained in detecting low contrast Gabor patches randomly presented in the blind field, which refers to regions of 0 dB sensitivity, and along the hemianopic boundary between absolute (0 dB) and partial blindness (>0 dB). Training included static, drifting, and flickering Gabors in different blocks. Positions along the hemianopic boundary were systematically shifted toward the blind field according to the threshold reduction during the training. Before and after the training, we assessed visual field expansion and improvement in different high-level transfer tasks (i.e., letter identification and shape recognition) performed in the hemianopic boundary and in the blind field.

RESULTS

NRT led to significant visual field enlargement (≈5 deg), as indicated by the conventional Humphrey perimetry, and two custom made evaluations of visual field expansion with eye movement control (one static and one dynamic). The restored area acquired new visual functions such as small letter recognition and perception of moving shapes. Finally, for some patients, NRT also improved detection, either aware or not, of high contrast flickering grating and recognition of geometrical shapes entirely presented within the blind field.

CONCLUSION

These results suggest that NRT may lead to visual field enlargement and translate into untrained visual functions.

Orientation and Contrast Tuning Properties and Temporal Flicker Fusion Characteristics of Primate Superior Colliculus Neurons

The primate superior colliculus is traditionally studied from the perspectives of gaze control, target selection, and selective attention. However, this structure is also visually responsive, and it is the primary visual structure in several species. Thus, understanding the visual tuning properties of the primate superior colliculus is important, especially given that the superior colliculus is part of an alternative visual pathway running in parallel to the predominant geniculo-cortical pathway. In recent previous studies, we have characterized receptive field organization and spatial frequency tuning properties in the primate (rhesus macaque) superior colliculus. Here, we explored additional aspects like orientation tuning, putative center-surround interactions, and temporal frequency tuning characteristics of visually-responsive superior colliculus neurons. We found that orientation tuning exists in the primate superior colliculus, but that such tuning is relatively moderate in strength. We also used stimuli of different sizes to explore contrast sensitivity and center-surround interactions. We found that stimulus size within a visual receptive field primarily affects the slope of contrast sensitivity curves without altering maximal firing rate. Additionally, sustained firing rates, long after stimulus onset, strongly depend on stimulus size, and this is also reflected in local field potentials. This suggests the presence of inhibitory interactions within and around classical receptive fields. Finally, primate superior colliculus neurons exhibit temporal frequency tuning for frequencies lower than 30 Hz, with critical flicker fusion frequencies of <20 Hz. These results support the hypothesis that the primate superior colliculus might contribute to visual performance, likely by mediating coarse, but rapid, object detection and identification capabilities for the purpose of facilitating or inhibiting orienting responses. Such mediation may be particularly amplified in blindsight subjects who lose portions of their primary visual cortex and therefore rely on alternative visual pathways including the pathway through the superior colliculus.

An Argument for Amphetamine-Induced Hallucinations in an Invertebrate

Hallucinations – compelling perceptions of stimuli that aren’t really there – occur in many psychiatric and neurological disorders, and are triggered by certain drugs of abuse. Despite their clinical importance, the neuronal mechanisms giving rise to hallucinations are poorly understood, in large part due to the absence of animal models in which they can be induced, confirmed to be endogenously generated, and objectively analyzed. In humans, amphetamine (AMPH) and related psychostimulants taken in large or repeated doses can induce hallucinations. Here we present evidence for such phenomena in the marine mollusk Tritonia diomedea. Animals injected with AMPH were found to sporadically launch spontaneous escape swims in the absence of eliciting stimuli. Deafferented isolated brains exposed to AMPH, where real stimuli could play no role, generated sporadic, spontaneous swim motor programs. A neurophysiological search of the swim network traced the origin of these drug-induced spontaneous motor programs to spontaneous bursts of firing in the S-cells, the CNS afferent neurons that normally inform the animal of skin contact with its predators and trigger the animal’s escape swim. Further investigation identified AMPH-induced enhanced excitability and plateau potential properties in the S-cells. Taken together, these observations support an argument that Tritonia’s spontaneous AMPH-induced swims are triggered by false perceptions of predator contact – i.e., hallucinations—and illuminate potential cellular mechanisms for such phenomena.

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.