Visual Field Reconstruction in Hemianopia Using fMRI Based Mapping Techniques.

PURPOSE: A stroke that includes the primary visual cortex unilaterally leads to a loss of visual field (VF) representation in the hemifield contralateral to the damage. While behavioral procedures for measuring the VF, such as perimetry, may indicate that a patient cannot see in a particular area, detailed psychophysical testing often detects the ability to perform detection or discrimination of visual stimuli ("blindsight"). The aim of this study was to determine whether functional magnetic resonance imaging (fMRI) could be used to determine whether perimetrically blind regions of the VF were still represented in VF maps reconstructed on the basis of visually evoked neural activity. METHODS: Thirteen patients with hemianopia and nine control participants were scanned using 3T MRI while presented with visual stimulation. Two runs of a dynamic "wedge and ring" mapping stimulus, totaling approximately 10 min, were performed while participants fixated centrally. Two different analysis approaches were taken: the conventional population receptive field (pRF) analysis and micro-probing (MP). The latter is a variant of the former that makes fewer assumptions when modeling the visually evoked neural activity. Both methods were used to reconstruct the VF by projecting modeled activity back onto the VF. Following a normalization step, these "coverage maps" can be compared to the VF sensitivity plots obtained using perimetry. RESULTS: While both fMRI-based approaches revealed regions of neural activity within the perimetrically "blind" sections of the VF, the MP approach uncovered more voxels in the lesioned hemisphere in which a modest degree of visual sensitivity was retained. Furthermore, MP-based analysis indicated that both early (V1/V2) and extrastriate visual areas contributed equally to the retained sensitivity in both patients and controls. CONCLUSION: In hemianopic patients, fMRI-based approaches for reconstructing the VF can pick up activity in perimetrically blind regions of the VF. Such regions of the VF may be particularly amenable for rehabilitation to regain visual function. Compared to conventional pRF modeling, MP reveals more voxels with retained visual sensitivity, suggesting it is a more sensitive approach for VF reconstruction.

Functional connectivity of the Precuneus reflects effectiveness of visual restitution training in chronic hemianopia.

Visual field defects in chronic hemianopia can improve through visual restitution training, yet not all patients benefit equally from this long and exhaustive procedure. Here, we asked if resting-state functional connectivity prior to visual restitution could predict training success. In two training sessions of eight weeks each, 20 patients with chronic hemianopia performed a visual discrimination task by directing spatial selective attention towards stimuli presented in either hemifield, while suppressing eye movements. We examined two effects: a sensitivity change in the attended (trained) minus the unattended (control) hemifield (i.e., a training-specific improvement), and an overall improvement (i.e., a total change in sensitivity after both sessions). We then identified five visual resting-state networks and evaluated their functional connectivity in relation to both training effects. We found that the functional connectivity strength between the anterior Precuneus and the Occipital Pole Network was positively related to the attention modulated (i.e., training-specific) improvement. No such relationship was found for the overall improvement or for the other visual networks of interest. Our finding suggests that the anterior Precuneus plays a role in attention-modulated visual field improvements. The resting-state functional connectivity between the anterior Precuneus and the Occipital Pole Network may thus serve as an imaging-based biomarker that quantifies a patient's potential capacity to direct spatial attention. This may help to identify hemianopia patients that are most likely to benefit from visual restitution training.

Stimulus- and Neural-Referred Visual Receptive Field Properties following Hemispherectomy: A Case Study Revisited.

Damage to the visual system can result in (a partial) loss of vision, in response to which the visual system may functionally reorganize. Yet the timing, extent, and conditions under which this occurs are not well understood. Hence, studies in individuals with diverse congenital and acquired conditions and using various methods are needed to better understand this. In the present study, we examined the visual system of a young girl who received a hemispherectomy at the age of three and who consequently suffered from hemianopia. We did so by evaluating the corticocortical and retinocortical projections in the visual system of her remaining hemisphere. For the examination of these aspects, we analyzed the characteristics of the connective fields ("neural-referred" receptive fields) based on both resting-state (RS) and retinotopy data. The evaluation of RS data, reflecting brain activity independent from visual stimulation, is of particular interest as it is not biased by the patient's atypical visual percept. We found that, primarily when the patient was at rest, the connective fields between V1 and both early and late visual areas were larger than normal. These abnormally large connective fields could be a sign either of functional reorganization or of unmasked suppressive feedback signals that are normally masked by interhemispheric signals. Furthermore, we confirmed our previous finding of abnormal retinocortical or "stimulus-referred" projections in both early and late visual areas. More specifically, we found an enlarged foveal representation and smaller population receptive fields. These differences could also be a sign of functional reorganization or rather a reflection of the interruption visual information that travels, via the remainder of the visual pathway, from the retina to the visual cortex. To conclude, while we do find indications for relatively subtle changes in visual field map properties, we found no evidence of large-scale reorganization-even though the patient could have benefitted from this. Our work suggests that at a later developmental stage, large-scale reorganization of the visual system no longer occurs, while small-scale properties may still change to facilitate adaptive processing and viewing strategies.