Visual Perception and Fixation Patterns in an Individual with Ventral Simultanagnosia, Integrative Agnosia and Bilateral Visual Field Loss.

Background/objectives: As high-acuity vision is limited to a very small visual angle, examination of a scene requires multiple fixations. Simultanagnosia, a disorder wherein elements of a scene can be perceived correctly but cannot be integrated into a coherent whole, has been parsed into dorsal and ventral forms. In ventral simultanagnosia, limited visual integration is possible. This case study was the first to record gaze during the presentation of a series of visual stimuli, which required the processing of local and global elements. We hypothesised that gaze patterns would differ with successful processing and that feature integration could be disrupted by distractors.

Methods: The patient received a neuropsychological assessment and underwent CT and MRI. Eye movements were recorded during the following tasks: (1) famous face identification, (2) facial emotion recognition, (3) identification of Ishihara colour plates, and (4) identification of both local and global letters in Navon composite letters, presented either alone or surrounded by filled black circles, which we hypothesised would impair global processing by disrupting fixation.

Results: The patients identified no famous faces but scanned them qualitatively normally. The only emotion to be consistently recognised was happiness, whose scanpath differed from the other emotions. She identified none of the Ishihara plates, although her colour vision was normal on the FM-15, even mapping an unseen digit with fixations and tracing it with her finger. For plain Navon figures, she correctly identified 20/20 local and global letters; for the "dotted" figures, she was correct 19/20 times for local letters and 0/20 for global letters (chi-squared NS for local, p < 0.0001, global), with similar fixation of salient elements for both.

Conclusions: Contrary to our hypothesis, gaze behaviour was largely independent of the ability to process global stimuli, showing for the first time that normal acquisition of visual information did not ensure its integration into a percept. The core defect lay in processing, not acquisition. In the novel Navon task, adding distractors abolished feature integration without affecting the fixation of the salient elements, confirming for the first time that distractors could disrupt the processing, not the acquisition, of visual information in this disorder.