Assessing Higher-Order Visual Processing in Cerebral Visual Impairment Using Naturalistic Virtual-Reality-Based Visual Search Tasks

Claire E Manley, Christopher R Bennett, Lotfi B Merabet, Claire E Manley, Christopher R Bennett, Lotfi B Merabet

Abstract

Cerebral visual impairment (CVI) is a brain-based disorder associated with the maldevelopment of central visual pathways. Individuals with CVI often report difficulties with daily visual search tasks such as finding a favorite toy or familiar person in cluttered and crowded scenes. We developed two novel virtual reality (VR)-based visual search tasks combined with eye tracking to objectively assess higher order processing abilities in CVI. The first (virtual toybox) simulates a static object search, while the second (virtual hallway) represents a dynamic human search task. Participants were instructed to search for a preselected target while task demand was manipulated with respect to the presence of surrounding distractors. We found that CVI participants (when compared to age-matched controls) showed an overall impairment with visual search on both tasks and with respect to all gaze metrics. Furthermore, CVI participants showed a trend of worsening performance with increasing task demand. Finally, search performance was also impaired in CVI participants with normal/near normal visual acuity, suggesting that reduced stimulus visibility alone does not account for these observations. This novel approach may have important clinical utility in helping to assess environmental factors related to functional visual processing difficulties observed in CVI.

Keywords: attention; cerebral visual impairment (CVI); eye tracking; higher order visual processing; virtual reality; visual perception; visual search.

Conflict of interest statement

The authors declare no conflict interest.

Figures

Figure 1
Figure 1
Experimental Design. (A) The virtual toybox (static object) visual search task. Prior to data collection, participants were asked to select a target toy from 3 possibilities (a blue truck, yellow duck, or orange basketball; right panel). The selected toy (in this case, a blue truck) was presented in a random location among distractor toys within a 5 × 5 array. Task demand associated with image clutter was manipulated at 3 levels (low, medium, high) corresponding to the number of unique distractor toys in the array (note the total number of the toys were constant across all levels of difficulty). (B) The virtual hallway (dynamic human) visual search task. Participants selected a target (the principal of a fictitious school) from 4 possibilities (balanced by gender and race; right panel). The selected principal (in this case, a Caucasian female) enters the hallway scene from either side and walks toward the observer. Task demand associated with crowd density was manipulated at 3 levels (low, medium, high) corresponding to the number of individuals walking in the hallway.
Figure 2
Figure 2
Group comparisons of performance across visual search outcomes for the (A) virtual toybox and (B) virtual hallway tasks. Comparing group performance revealed that for both tasks, CVI participants were less likely and took longer to find the target as well as had gaze patterns that were less accurate and less precise than controls (as indexed by success rate, reaction time, gaze error, and visual search area, respectively). Results are shown as box plots with interquartile ranges as well as maximum and minimum values (excluding outliers). Individual data (circles) are overlaid with the mean (X) and median value (line) shown. Between group statistical significance levels: *** p < 0.001.
Figure 3
Figure 3
Reaction time performance plotted as a function of task demand for the (A) virtual toybox and (B) virtual hallway tasks. Overall, reaction times were higher for participants with CVI in each condition and in both tasks. For the virtual toybox, reaction times for both CVI participants and controls were significantly higher on the high compared to low task demand conditions. For the virtual hallway, reaction times in CVI as well as control participants were significantly higher on the high compared to low task demand conditions. Note that, in general, reaction times were also slower for both groups on the virtual hallway compared to toybox task. Error bars represent ± SEM. Individual group load effects statistical significance levels: * p < 0.05; ** p < 0.01; *** p < 0.001.
Figure 4
Figure 4
Comparison of visual search performance in CVI participants separated by normal/near normal (20/15 to 20/25 Snellen) to reduced (20/30 to 20/100) visual acuity. (A) In the toybox task, CVI participants with normal/near normal visual acuity showed a significantly lower success rate and longer reaction times when compared to controls. Performance was not significantly different between CVI participants with normal/near normal and impaired visual acuities with respect to success rate. Similarly, reaction times were not significantly slower in the impaired visual acuity CVI group. (B) In the hallway task, CVI participants with normal/near normal visual acuity showed a similar pattern of significantly lower success rate and longer reaction times compared to controls. Performance was not statistically significant between CVI participants with normal/near normal and impaired visual acuities with respect to success rate. Similarly, reaction times were not significantly slower in the impaired visual acuity CVI group. Results are shown as box plots with interquartile ranges as well as maximum and minimum values (excluding outliers). Individual data (circles) are overlaid with the mean (X) and median value (line) shown. Between group statistical significance levels: ** p < 0.01; *** p < 0.001; n.s., not significant.

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