Matt Cavanaugh¹, Robbe Goris², Elisha Merriam³, Krystel Huxlin¹; ¹Flaum Eye Institute, University of Rochester, Rochester, NY, USA, ²Center for Perceptual Systems, University of Texas at Austin, Austin, TX, USA, ³Laboratory of Brain and Cognition, National Institute of Mental Health, NIH, Bethesda, MD, USA

Occipital strokes damage early visual areas, causing a large visual deficit. Psychophysical training can restore multiple perceptual abilities within this deficit, including direction and orientation discrimination. Here, we assessed metacognitive capabilities at blind-field locations in which orientation discrimination was either restored following training or remained impaired, using a gamified task to collect confidence reports simultaneous with orientation discrimination thresholds in seven patients (4 male; age: 37-71 years; time since stroke: 6.4-25.7 months). Five patients trained on fine direction discrimination (FDD) within their blind-field; two trained on fine orientation discrimination (FOD). Blind-field performance was initially at chance on both tasks. After training, blind-field FDD improved in all FDD-trained participants, with thresholds nearing intact-field levels (blind-field: 17.8±19.4; intact-field: 2.2±1.2; paired t-test: p=0.15). FOD thresholds likewise improved in both FOD-trained patients (blind-field: 3.4deg and 7.9deg; intact-field: 1.56 deg and 0.4 deg). Three FDD-trained participants failed to recover FOD thresholds at trained, blind-field locations, performing at chance on the gamified task (percent correct: 56.5±7.6%), and indicating high confidence on 6.0±9.2% of trials. All remaining patients (two FDD-trained and two FOD-trained) attained significantly improved orientation thresholds (blind-field: 5.0±4.5 deg), reporting high confidence on 49.3±10.8% of trials. Confidence and performance data were then fit with a computational model (CASANDRE, Boundy-Singer et al., 2023) to calculate meta-uncertainty, summarizing the quality of the brain's confidence computation (the higher meta-uncertainty, the noisier the confidence computation). All blind-field locations exhibited low meta-uncertainty (impaired: 0.013±0.005; recovered: 0.48±0.56) indistinguishable from the intact-field (0.87±0.75; intact vs recovered paired t-test p=0.52; intact vs impaired paired t-test p=0.13). Our results show discrimination confidence tracks lawfully with orientation discrimination performance within retrained blind-fields of patients with early visual cortex damage. We conclude that the metacognitive system can correctly process activity from visual circuitry spared by occipital strokes, which supports recovered orientation perception.