Visual Plasticity

Even after extended early blindness, visual function can be retained

Deprivation of vision during critical periods of childhood development has long been thought to result in irreversible vision loss. Now, researchers from the Schepens Eye Research Institute/Massachusetts Eye and Ear, Harvard Medical School and MIT have challenged that theory by studying a unique population of pediatric patients who were blind during these critical periods from bilateral cataracts and then had the cataracts removed. The researchers found improvement after sight onset in contrast sensitivity tests, which measure basic visual function and have well understood neural underpinnings.

Their results show that the human visual system can retain plasticity beyond critical periods, even after early and extended blindness. The research has important implications for potential treatments of congenital cataracts, in addition to providing insight into fundamental questions of development and plasticity in neuroscience.

The findings were published in the Proceedings of the National Academy of Sciences USA (PNAS) Early Edition.

Researchers found that children who gained sight after early onset blindness had poor spatial resolution and contrast perception after cataract surgery (left panel depiction). Follow-up assessments revealed enhanced contrast sensitivity (middle panel ). The artist of the painting (right panel) is a child who gained sight after extended blindness. Image: Luis Lesmes, Michael Dorr, Peter Bex, Amy Kalia, Pawan Sinha.


“Our research group has been studying the development of vision in children who were blind from birth because of congenital cataracts. We have been measuring if and how their vision develops after surgery in late childhood and adolescence to remove cataracts, which enables sight for the first time. Our results show remarkable plasticity, and vision continues to improve in many children long after the surgery,” said senior author Peter Bex, HMS associate professor of ophthalmology at Schepens/Mass. Eye and Ear.

The research took place as part of Project Prakash, a joint scientific and humanitarian effort led by Pawan Sinha, professor of vision and computational neuroscience at MIT. The humanitarian part aims to address problems of treatable blindness in India by providing surgeries free of charge to children with cataracts. In the Western world, children born with cataracts typically are treated in the first year of life, but children with this condition in rural India often go untreated because their families lack the necessary financial resources. The project also aims to answer the questions: Can children who suffer from extended congenital blindness develop vision after cataract surgery, and if so, how does this process happen?

The “critical period” or the “critical window” is a traditional concept in the field of neuroscience which suggests that there is plasticity, or potential for development, early in life. But as children grow older ― in the case of vision, past the age of 7 or 8 ― there is less plasticity in the visual system.

The concept of the critical period intersects with clinical care in the practice patterns for children with amblyopia. It was once thought that if amblyopia was not treated before age 8, then the window of opportunity for saving sight was lost.

For patients in this study, one potential justification for not removing the congenital cataracts during their adolescence was that the treatment would not improve vision, and the patients would remain blind because the critical period for developing vision had passed.

The concept of the critical period also intersects with clinical care in the practice patterns for children with other eye disorders, like amblyopia. But, this once-accepted mantra has started to be questioned over the last 10 years, with new insights into plasticity and the potential impact of brain or sensory training following surgery.

The Schepens/Mass. Eye and Ear contribution to Project Prakash was an iPad-based assessment of visual function developed in the Bex Laboratory. Bex’s test measures the minimum contrast required to detect symbols of a range of different sizes: the Contrast Sensitivity Function. This new test is more precise and easier to apply than previous contrast sensitivity assessments.

“Given this background and past research, the most conservative hypothesis for our study would have been that children between 8 and 18 would show no changes in low-level vision, and no changes in their contrast sensitivity functions, when they were tested after their cataract surgery,” said Bex. “With our test (which usually requires specialized laboratory equipment) and some analytics we developed, we showed that some patients developed substantial vision after 15 years of blindness. This visual change could not be accounted for by simple optical factors.”

This work was supported by National Institutes of Health grants R01EY019281 and R01EY20517. 

Adapted from Mass Eye and Ear news release.