Brain-Computer Interfaces for Vision Recovery in Precortical Vision Loss

Introduction: Precortical vision loss remains a major global health challenge. Advances in brain-computer interfaces (BCIs) offer a new pathway towards restoring functional vision by bypassing damaged structures in the visual pathway. Methods: This narrative review aims to synthesize the current evidence on BCIs for precortical vision recovery, including non-invasive and invasive techniques. Device design, testing, and outcomes are discussed, with an emphasis on developments in technology and engineering. Results: Non-invasive BCIs induce neuroplasticity and may restore vision in conditions of precortical vision loss such as glaucoma and optic neuropathy. Cortical visual prostheses demonstrate the ability to evoke visual precepts and recover functional vision. Integration of artificial intelligence and high-density electrode arrays has improved image encoding and device adaptability to enhance user experience and rehabilitation potential. Patient selection, safety, and long-term outcomes remain active areas of investigation. Discussion: BCIs present a paradigm shift in treating precortical blindness that offers hope for patients with no alternative options. Yet, challenges persist, including surgical risks, durability, and variability in response. Personalization of stimulation protocols and further technical refinement are needed to optimize efficacy and accessibility. Conclusion: BCIs are a promising experimental modality for precortical vision restoration. Continued research and interdisciplinary collaboration are essential to address current limitations. Plain Language Summary: Vision loss has a negative impact on functional independence and well-being. Conventional treatments like medications or surgery cannot always effectively manage vision loss caused by damage to the visual pathway. Therefore, researchers are exploring new ways to treat vision loss using brain-computer interfaces (BCIs) capable of bypassing damaged visual tissue. Studies have shown that BCIs can help people with blindness regain visual function when other treatments are not effective. Moreover, complementary technologies such as artificial intelligence have made BCIs more customizable. This review aims to discuss the theoretical underpinnings, history, progress, and challenges of using BCIs to treat patients experiencing vision loss, with a focus on translational potential. Keywords: brain computer interfaces, neuroprostheses, neuroplasticity, blindness, vision restoration