Assessing the utility of visual acuity measures in visual prostheses

There are presently several ongoing clinical trials to provide usable sight to profoundly visually impaired patients by means of electrical stimulation of the retina. Some of the blind patients implanted with retinal prosthesis reported un-patterned perception and yet benefit from the device in many activities of daily living, seemingly because they adopt active scanning strategies. The aim of the present work is to evaluate if and under what conditions a measured visual acuity level is truly an indication that the brain perceived a patterned image from the electrical stimulation of the visual prosthesis. Sighted subjects used a pixelized simulator in which they perceived either a low resolution sub-sampling of the original image ("normal mode"--patterned vision) or an image that was solely a function of the brightness and size of the original image ("brightness mode"--no patterned vision). Results show that subjects were able to adopt a head scanning strategy that enabled acuity beyond the resolution set by a static view of the stimulus. In brightness mode, i.e. without patterned vision, most subjects achieved a measurable acuity level better than the limit set by the geometrical resolution of the entire array but worse than the limit set by the distance between neighboring simulated pixels. In normal mode all subject achieved acuity level that is better than the geometrical resolution of the simulated pixels. Thus, visual acuity levels comparable with the electrodes/pixels resolution implies that the patient perceives an image with spatial patterns.