Functional reorganization of visual processing following long-term adaptation to optical defects

How we see is fundamentally limited by the eyes optics, which determine retinal image quality and constrain neural processing. Elucidating how long-term exposure to optical defects alters visual processing is vital for understanding the human brains capacity for and limits of sensory plasticity. Using adaptive optics to bypass the eyes optical aberrations, we assessed changes in visual processing in neurotypically-developed adults with keratoconus (KC)--a corneal disease causing severe optical aberrations during adulthood that cannot be fully corrected using conventional methods. As a result, KC patients are chronically exposed to degraded retinal images in their everyday life, making them an ideal model to understand how prolonged exposure to poor optical quality alters visual processing. Here, we show that when tested under similar fully-corrected optical conditions as neurotypical observers, KC patients exhibited altered contrast sensitivity, with impaired sensitivity for fine spatial details and better sensitivity for coarse spatial details. Both gains and losses in contrast sensitivity were more pronounced in patients with poorer habitual optical quality. Moreover, using an equivalent noise paradigm and a computational model of visual processing, we show that these alterations in visual processing are mediated by changes in signal enhancement of spatial frequency selective mechanisms. The present findings uncover fundamental properties of neural compensation mechanisms in response to long-term exposure to optical defects, which alter sensory processing and limit the benefits of improved optics. The outcome is a large-scale functional reorganization favoring the processing of sensory information less affected by the eyes optics. Significance statementThe eyes optics represent an intrinsic limit to human visual perception, determining the quality of retinal images. Neural adaptation optimizes the brains limited sensory processing capacity to the structure of the degraded retinal inputs, providing an exceptional quality of vision given these optical limitations. Here, we show that prolonged exposure to poor optical quality results in a functional reorganization of visual processing that favors sensory information less affected by the eyes optics. The present study helps elucidate how optical factors shape the way the brain processes visual information. Notably, the resulting adaptive neural plasticity limits the immediate perceptual benefits of optical interventions, a factor that must be taken into consideration when treating the increasing human population affected by optical defects.