White matter plasticity following cataract surgery in congenitally blind patients

Caterina A. Pedersini, Nathaniel P. Miller, Tapan K. Gandhi, Sharon Gilad-Gutnick, Vidur Mahajan, Pawan Sinha, Bas Rokers

Research output: Contribution to journalArticlepeer-review


The visual system develops abnormally when visual input is absent or degraded during a critical period early in life. Restoration of the visual input later in life is generally thought to have limited benefit because the visual system will lack sufficient plasticity to adapt to and utilize the information from the eyes. Recent evidence, however, shows that congenitally blind adolescents can recover both low-level and higher-level visual function following surgery. In this study, we assessed behavioral performance in both a visual acuity and a face perception task alongside longitudinal structural white matter changes in terms of fractional anisotropy (FA) and mean diffusivity (MD). We studied congenitally blind patients with dense bilateral cataracts, who received cataract surgery at different stages of adolescence. Our goal was to differentiate between age- and surgery-related changes in both behavioral performance and structural measures to identify neural correlates which might contribute to recovery of visual function. We observed surgery-related long-term increases of structural integrity of late-visual pathways connecting the occipital regions with ipsilateral fronto-parieto-temporal regions or homotopic contralateral areas. Comparison to a group of age-matched healthy participants indicated that these improvements went beyond the expected changes in FA and MD based on maturation alone. Finally, we found that the extent of behavioral improvement in face perception was mediated by changes in structural integrity in late visual pathways. Our results suggest that sufficient plasticity remains in adolescence to partially overcome abnormal visual development and help localize the sites of neural change underlying sight recovery.

Original languageEnglish (US)
Article numbere2207025120
JournalProceedings of the National Academy of Sciences of the United States of America
Issue number19
StatePublished - May 9 2023


  • blindness
  • dMRI
  • sight restoration
  • visual pathways
  • white matter plasticity

ASJC Scopus subject areas

  • General


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