Changes in perilesional V1 underlie training-induced recovery in cortically-blind patients

Damage to the primary visual cortex (V1) causes profound, homonymous visual-field loss termed cortical blindness (CB). Though long considered intractable, multiple studies now show that perceptual training can recover visual functions in chronic CB. A popular hypothesis is that training recruits intact extrageniculostriate pathways. Alternatively, training may induce plastic changes within spared regions of the damaged V1. Here, we linked changes in luminance detection sensitivity with retinotopic fMRI activity in eleven chronic CB patients, before and after extensive visual discrimination training. Our results show that the strength of spared V1 activity representing perimetrically blind-field locations before training predicts the amount of training-induced recovery of luminance detection sensitivity. Additionally, training caused an enlargement of population receptive fields in perilesional V1 cortex, which increased blind-field coverage. These findings uncover fundamental changes in perilesional V1 cortex underlying training-induced restoration of conscious luminance detection sensitivity in cortically-blind patients.