Colenbrander August
Rehabilitation Engineering Research Center, Smith-Kettlewell Eye Research Institute, San Francisco, California.
Ophthalmol Sci. 2024 Apr 18;4(6):100532. doi: 10.1016/j.xops.2024.100532. eCollection 2024 Nov-Dec.
Vision is the most powerful sense guiding our interaction with the environment. Its process starts with the retinal image as input and results in visually guided behaviors as output. This paper summarizes insights I gained over >40 years dealing with clinical ophthalmology, visual science, and vision rehabilitation, disciplines that all involve vision, but from different points of view. The retinal image contains 2-dimensional forms that have no inherent meaning. The brain matches this input to stored concepts, to create a Mental Model that is filled with 3-dimensional objects that are meaningful and linked to other senses. Ultimately this leads to the output of goal-directed visually guided behavior. The processes involved are too complex to be covered by a single practitioner. Optimal vision rehabilitation requires teamwork that includes contributions from various professions. It also requires an understanding, as well as possible, of the cerebral processes involved. The visual sciences study mostly the input-driven process from retinal image to visual percepts. Their studies deal mostly with groups and group averages and only occasionally with individual disease conditions. Clinical ophthalmology deals mostly with individuals, rather than group averages. The motto of the American Academy of Ophthalmology reminds us that the end point of patient care goes beyond "preserving sight." It also includes "empowering lives" by creating the conditions for goal-directed interaction with the environment through visually directed behavior. Traditionally, the study of vision has mainly involved the conscious part of vision, handled mostly in the ventral stream. However, the subconscious part of vision, handled mostly in the dorsal stream must also be considered. This is further stimulated by the demands of computer vision, image processing, and artificial intelligence. Vision rehabilitation traditionally deals with the input side through better illumination and various magnification devices. This is the domain of low vision aids. Increasingly, however, it must also address the output side, and the involvement of other senses (braille, long cane, and talking books). This requires better understanding of the goal-directed higher visual processes. The supplemental material covers the development of numerical scales to quantify not only visual acuity but also visual abilities, and the use of different tests.
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
视觉是引导我们与环境互动的最强大的感官。其过程始于视网膜图像作为输入，并以视觉引导行为作为输出。本文总结了我在40多年处理临床眼科、视觉科学和视力康复方面所获得的见解，这些学科都涉及视觉，但角度不同。视网膜图像包含没有内在意义的二维形式。大脑将此输入与存储的概念相匹配，以创建一个心理模型，该模型充满了有意义且与其他感官相关联的三维物体。最终，这导致了目标导向的视觉引导行为的输出。所涉及的过程过于复杂，无法由单一从业者涵盖。最佳的视力康复需要团队合作，包括来自各个专业的贡献。它还需要尽可能地理解所涉及的大脑过程。视觉科学主要研究从视网膜图像到视觉感知的输入驱动过程。他们的研究大多涉及群体和群体平均值，偶尔才涉及个体疾病情况。临床眼科主要处理个体，而非群体平均值。美国眼科学会的座右铭提醒我们，患者护理的终点不仅仅是“保留视力”。它还包括通过创造条件，使患者能够通过视觉引导行为与环境进行目标导向的互动，从而“赋能生活”。传统上，视觉研究主要涉及视觉的有意识部分，主要在腹侧流中处理。然而，视觉的潜意识部分，主要在背侧流中处理，也必须予以考虑。计算机视觉、图像处理和人工智能的需求进一步激发了这一点。视力康复传统上通过更好的照明和各种放大设备来处理输入方面。这是低视力辅助器具的领域。然而，它越来越多地还必须解决输出方面以及其他感官（盲文、长手杖和有声读物）的参与问题。这需要更好地理解目标导向的高级视觉过程。补充材料涵盖了数字量表的开发，以不仅量化视力，还量化视觉能力，以及不同测试的使用。
作者对本文中讨论的任何材料均无专有或商业利益。
