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.

Réadaptation et performance visuelle chez la personne hémianopsique : une étude de cas portant sur les saccades oculaires et le blindsight.

But: La perte unilatérale du cortex visuel postérieur engendre une cécité corticale controlatérale à la lésion, qu’on appelle hémianopsie homonyme (HH). Celle-ci est notamment accompagnée de problèmes d’exploration visuelle dans l’hémichamp aveugle dus à des stratégies oculaires déficitaires, qui ont été la cible des thérapies de compensation. Or, cette perte de vision peut s’accompagner d’une perception visuelle inconsciente, appelée blindsight. Notre hypothèse propose que le blindsight soit médié par la voie rétino-colliculaire extrastriée, recrutant le colliculus supérieur (CS), une structure multisensorielle. Notre programme a pour objectif d’évaluer l’impact d’un entraînement multisensoriel (audiovisuel) sur la performance visuelle inconsciente des personnes hémianopsiques et les stratégies oculaires. Nous essayons, ainsi, de démontrer l’implication du CS dans le phénomène de blindsight et la pertinence de la technique de compensation multisensorielle comme thérapie de réadaptation. Méthode: Notre participante, ML, atteinte d’une HH droite a effectué un entraînement d’intégration audiovisuel pour une période de 10 jours. Nous avons évalué la performance visuelle en localisation et en détection ainsi que les stratégies oculaires selon trois comparaisons principales : (1) entre l’hémichamp normal et l’hémichamp aveugle; (2) entre la condition visuelle et les conditions audiovisuelles; (3) entre les sessions de pré-entraînement, post-entraînement et 3 mois post-entraînement. Résultats: Nous avons démontré que (1) les caractéristiques des saccades et des fixations sont déficitaires dans l’hémichamp aveugle; (2) les stratégies saccadiques diffèrent selon les excentricités et les conditions de stimulations; (3) une adaptation saccadique à long terme est possible dans l’hémichamp aveugle si l’on considère le bon cadre de référence; (4) l’amélioration des mouvements oculaires est liée au blindsight. Conclusion(s): L’entraînement multisensoriel conduit à une amélioration de la performance visuelle pour des cibles non perçues, tant en localisation qu’en détection, ce qui est possiblement induit par le développement de la performance oculomotrice.

Is blindsight like normal, near-threshold vision?

Blindsight is the rare and paradoxical ability of some human subjects with occipital lobe brain damage to discriminate unseen stimuli in their clinically blind field defects when forced-choice procedures are used, implying that lesions of striate cortex produce a sharp dissociation between visual performance and visual awareness. Skeptics have argued that this is no different from the behavior of normal subjects at the lower limits of conscious vision, at which such dissociations could arise trivially by using different response criteria during clinical and forced-choice tests. We tested this claim explicitly by measuring the sensitivity of a hemianopic patient independently of his response criterion in yes-no and forced-choice detection tasks with the same stimulus and found that, unlike normal controls, his sensitivity was significantly higher during the forced-choice task. Thus, the dissociation by which blindsight is defined is not simply due to a difference in the patients’ response bias between the two paradigms. This result implies that blindsight is unlike normal, near-threshold vision and that information about the stimulus is processed in blindsighted patients in an unusual way.

Localization of visual stimuli after striate cortex damage in monkeys: parallels with human blindsight.

Blindsight is a phenomenon in which human patients with damage to striate cortex deny any visual sensation in the resultant visual field defect but can nonetheless detect and localize stimuli when persuaded to guess. Although monkeys with striate lesions have also been shown to exhibit some residual vision, it is not yet clear to what extent the residual capacities in monkeys parallel the phenomenon of human blindsight. To clarify this issue, we trained two monkeys with unilateral lesions of striate cortex to make saccadic eye movements to visual targets in both hemifields under two conditions. In the condition analogous to clinical perimetry, they failed to initiate saccades to targets presented in the contralateral hemifield and thus appeared "blind." Only in the condition where the fixation point was turned off simultaneously with the onset of the target--signaling the animal to respond at the appropriate time--were monkeys able to localize targets contralateral to the striate lesion. These results indicate that the conditions under which residual vision is demonstrable are similar for monkeys with striate cortex damage and humans with blindsight.

Réadaptation et performance visuelle chez la personne hémianopsique : une étude de cas portant sur les saccades oculaires et le blindsight

But: La perte unilatérale du cortex visuel postérieur engendre une cécité corticale controlatérale à la lésion, qu’on appelle hémianopsie homonyme (HH). Celle-ci est notamment accompagnée de problèmes d’exploration visuelle dans l’hémichamp aveugle dus à des stratégies oculaires déficitaires, qui ont été la cible des thérapies de compensation. Or, cette perte de vision peut s’accompagner d’une perception visuelle inconsciente, appelée blindsight. Notre hypothèse propose que le blindsight soit médié par la voie rétino-colliculaire extrastriée, recrutant le colliculus supérieur (CS), une structure multisensorielle. Notre programme a pour objectif d’évaluer l’impact d’un entraînement multisensoriel (audiovisuel) sur la performance visuelle inconsciente des personnes hémianopsiques et les stratégies oculaires. Nous essayons, ainsi, de démontrer l’implication du CS dans le phénomène de blindsight et la pertinence de la technique de compensation multisensorielle comme thérapie de réadaptation. Méthode: Notre participante, ML, atteinte d’une HH droite a effectué un entraînement d’intégration audiovisuel pour une période de 10 jours. Nous avons évalué la performance visuelle en localisation et en détection ainsi que les stratégies oculaires selon trois comparaisons principales : (1) entre l’hémichamp normal et l’hémichamp aveugle; (2) entre la condition visuelle et les conditions audiovisuelles; (3) entre les sessions de pré-entraînement, post-entraînement et 3 mois post-entraînement. Résultats: Nous avons démontré que (1) les caractéristiques des saccades et des fixations sont déficitaires dans l’hémichamp aveugle; (2) les stratégies saccadiques diffèrent selon les excentricités et les conditions de stimulations; (3) une adaptation saccadique à long terme est possible dans l’hémichamp aveugle si l’on considère le bon cadre de référence; (4) l’amélioration des mouvements oculaires est liée au blindsight. Conclusion(s): L’entraînement multisensoriel conduit à une amélioration de la performance visuelle pour des cibles non perçues, tant en localisation qu’en détection, ce qui est possiblement induit par le développement de la performance oculomotrice.

Estudios en visión ciega (Blindsight): aportes fundamentales en la neurociencia y su proyección hasta nuestros días

Se denomina visión ciega (Blindsight) al fenómeno tradicionalmente estudiado en pacientes con lesiones en su córtex visual primario (V1), quienes logran discriminar estímulos visuales pese a no tener consciencia de haberlos percibido. A partir de una revisión de literatura del área se exponen hitos del desarrollo del estudio de Blindsight como paradigma de investigación en neurociencias, sus aportes fundamentales, y controversias conceptuales y metodológicas. Se exponen además datos surgidos de la investigación reciente en el área, la cual plantea un énfasis en explicar el fenómeno asociado a sus correlatos neuroanatómicos, existiendo hallazgos recurrentes respecto a un rol central del colículo superior. Se concluye que el estudio del blindsight como paradigma de investigación se encuentra actualmente en un proceso de replanteamiento tanto de carácter metodológico como conceptual.

N-methyl-D-aspartate channel and consciousness: From signal coincidence detection to quantum computing

Research on Blindsight, Neglect/Extinction and Phantom limb syndromes, as well as electrical measurements of mammalian brain activity, have suggested the dependence of vivid perception on both incoming sensory information at primary sensory cortex and reentrant information from associative cortex. Coherence between incoming and reentrant signals seems to be a necessary condition for (conscious) perception. General reticular activating system and local electrical synchronization are some of the tools used by the brain to establish coarse coherence at the sensory cortex, upon which biochemical processes are coordinated. Besides electrical synchrony and chemical modulation at the synapse, a central mechanism supporting such a coherence is the N-methyl-D-aspartate channel, working as a 'coincidence detector' for an incoming signal causing the depolarization necessary to remove Mg 2+, and reentrant information releasing the glutamate that finally prompts Ca 2+ entry. We propose that a signal transduction pathway activated by Ca 2+ entry into cortical neurons is in charge of triggering a quantum computational process that accelerates inter-neuronal communication, thus solving systemic conflict and supporting the unity of consciousness. © 2001 Elsevier Science Ltd.

Neural basis of visual deficits recovery: visual residual functions and multisensory integration.

The ability of integrating into a unified percept sensory inputs deriving from different sensory modalities, but related to the same external event, is called multisensory integration and might represent an efficient mechanism of sensory compensation when a sensory modality is damaged by a cortical lesion. This hypothesis has been discussed in the present dissertation. Experiment 1 explored the role of superior colliculus (SC) in multisensory integration, testing patients with collicular lesions, patients with subcortical lesions not involving the SC and healthy control subjects in a multisensory task. The results revealed that patients with collicular lesions, paralleling the evidence of animal studies, demonstrated a loss of multisensory enhancement, in contrast with control subjects, providing the first lesional evidence in humans of the essential role of SC in mediating audio-visual integration. Experiment 2 investigated the role of cortex in mediating multisensory integrative effects, inducing virtual lesions by inhibitory theta-burst stimulation on temporo-parietal cortex, occipital cortex and posterior parietal cortex, demonstrating that only temporo-parietal cortex was causally involved in modulating the integration of audio-visual stimuli at the same spatial location. Given the involvement of the retino-colliculo-extrastriate pathway in mediating audio-visual integration, the functional sparing of this circuit in hemianopic patients is extremely relevant in the perspective of a multisensory-based approach to the recovery of unisensory defects. Experiment 3 demonstrated the spared functional activity of this circuit in a group of hemianopic patients, revealing the presence of implicit recognition of the fearful content of unseen visual stimuli (i.e. affective blindsight), an ability mediated by the retino-colliculo-extrastriate pathway and its connections with amygdala. Finally, Experiment 4 provided evidence that a systematic audio-visual stimulation is effective in inducing long-lasting clinical improvements in patients with visual field defect and revealed that the activity of the spared retino-colliculo-extrastriate pathway is responsible of the observed clinical amelioration, as suggested by the greater improvement observed in patients with cortical lesions limited to the occipital cortex, compared to patients with lesions extending to other cortical areas, found in tasks high demanding in terms of spatial orienting. Overall, the present results indicated that multisensory integration is mediated by the retino-colliculo-extrastriate pathway and that a systematic audio-visual stimulation, activating this spared neural circuit, is able to affect orientation towards the blind field in hemianopic patients and, therefore, might constitute an effective and innovative approach for the rehabilitation of unisensory visual impairments.

Residual visual processing following real or virtual lesions to primary visual pathways

Lesions to the primary geniculo-striate visual pathway cause blindness in the contralesional visual field. Nevertheless, previous studies have suggested that patients with visual field defects may still be able to implicitly process the affective valence of unseen emotional stimuli (affective blindsight) through alternative visual pathways bypassing the striate cortex. These alternative pathways may also allow exploitation of multisensory (audio-visual) integration mechanisms, such that auditory stimulation can enhance visual detection of stimuli which would otherwise be undetected when presented alone (crossmodal blindsight). The present dissertation investigated implicit emotional processing and multisensory integration when conscious visual processing is prevented by real or virtual lesions to the geniculo-striate pathway, in order to further clarify both the nature of these residual processes and the functional aspects of the underlying neural pathways. The present experimental evidence demonstrates that alternative subcortical visual pathways allow implicit processing of the emotional content of facial expressions in the absence of cortical processing. However, this residual ability is limited to fearful expressions. This finding suggests the existence of a subcortical system specialised in detecting danger signals based on coarse visual cues, therefore allowing the early recruitment of flight-or-fight behavioural responses even before conscious and detailed recognition of potential threats can take place. Moreover, the present dissertation extends the knowledge about crossmodal blindsight phenomena by showing that, unlike with visual detection, sound cannot crossmodally enhance visual orientation discrimination in the absence of functional striate cortex. This finding demonstrates, on the one hand, that the striate cortex plays a causative role in crossmodally enhancing visual orientation sensitivity and, on the other hand, that subcortical visual pathways bypassing the striate cortex, despite affording audio-visual integration processes leading to the improvement of simple visual abilities such as detection, cannot mediate multisensory enhancement of more complex visual functions, such as orientation discrimination.

Parameters affecting conscious versus unconscious visual discrimination with damage to the visual cortex (V1).

When the visual (striate) cortex (V1) is damaged in human subjects, cortical blindness results in the contralateral visual half field. Nevertheless, under some experimental conditions, subjects demonstrate a capacity to make visual discriminations in the blind hemifield (blindsight), even though they have no phenomenal experience of seeing. This capacity must, therefore, be mediated by parallel projections to other brain areas. It is also the case that some subjects have conscious residual vision in response to fast moving stimuli or sudden changes in light flux level presented to the blind hemifield, characterized by a contentless kind of awareness, a feeling of something happening, albeit not normal seeing. The relationship between these two modes of discrimination has never been studied systematically. We examine, in the same experiment, both the unconscious discrimination and the conscious visual awareness of moving stimuli in a subject with unilateral damage to V1. The results demonstrate an excellent capacity to discriminate motion direction and orientation in the absence of acknowledged perceptual awareness. Discrimination of the stimulus parameters for acknowledged awareness apparently follows a different functional relationship with respect to stimulus speed, displacement, and stimulus contrast. As performance in the two modes can be quantitatively matched, the findings suggest that it should be possible to image brain activity and to identify the active areas involved in the same subject performing the same discrimination task, both with and without conscious awareness, and hence to determine whether any structures contribute uniquely to conscious perception.

Inefficient search strategies in simulated hemianopia

Acknowledgements Anna Nowakowska is supported by an ESRC doctoral studentship. A James S McDonnell scholar award to Amelia R. Hunt also provided financial support. We are grateful to Edvinas Pilipavicius and Juraj Sikra for data collection. We also wish to thank W. Joseph MacInnes for help with programming the experiment and Paul Hibbard for help with filtering the faces.