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BackgroundVision loss after optic neuropathy is considered irreversible. Here, repetitive transorbital alternating current stimulation (rtACS) was applied in partially blind patients with the goal of activating their residual vision.MethodsWe conducted a multicenter, prospective, randomized, double-blind, sham-controlled trial in an ambulatory setting with daily application of rtACS (n = 45) or sham-stimulation (n = 37) for 50 min for a duration of 10 week days. A volunteer sample of patients with optic nerve damage (mean age 59.1 yrs) was recruited. The primary outcome measure for efficacy was super-threshold visual fields with 48 hrs after the last treatment day and at 2-months follow-up. Secondary outcome measures were near-threshold visual fields, reaction time, visual acuity, and resting-state EEGs to assess changes in brain physiology.ResultsThe rtACS-treated group had a mean improvement in visual field of 24.0% which was significantly greater than after sham-stimulation (2.5%). This improvement persisted for at least 2 months in terms of both within- and between-group comparisons. Secondary analyses revealed improvements of near-threshold visual fields in the central 5° and increased thresholds in static perimetry after rtACS and improved reaction times, but visual acuity did not change compared to shams. Visual field improvement induced by rtACS was associated with EEG power-spectra and coherence alterations in visual cortical networks which are interpreted as signs of neuromodulation. Current flow simulation indicates current in the frontal cortex, eye, and optic nerve and in the subcortical but not in the cortical regions.ConclusionrtACS treatment is a safe and effective means to partially restore vision after optic nerve damage probably by modulating brain plasticity. This class 1 evidence suggests that visual fields can be improved in a clinically meaningful way.Trial RegistrationClinicalTrials.gov NCT01280877

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In real-life situations, the appearance of a person's face can vary substantially across different encounters, making face recognition a challenging task for the visual system. Recent fMRI decoding studies have suggested that face recognition is supported by identity representations located in regions of the occipito-temporal cortex. Here, we used EEG to elucidate the temporal emergence of these representations. Human participants (both sexes) viewed a set of highly variable face images of four highly familiar celebrities (two male, two female), while performing an orthogonal task. Univariate analyses of event-related EEG responses revealed a pronounced differentiation between male and female faces, but not between identities of the same sex. Using multivariate representational similarity analysis, we observed a gradual emergence of face identity representations, with an increasing degree of invariance. Face identity information emerged rapidly, starting shortly after 100ms from stimulus onset. From 400ms after onset and predominantly in the right hemisphere, identity representations showed two invariance properties: (1) they equally discriminated identities of opposite sexes and of the same sex, and(2) they were tolerant to image-based variations. These invariant representations may be a crucial prerequisite for successful face recognition in everyday situations, where the appearance of a familiar person can vary drastically..