Visual Pathway

and Lesions

UM2010
NEUROENDOCRINE
BLOCK
 about
MR IZUCHUKWU OBAZIE (he/his/him)
BSc., M.Sc., Human Anatomy , PGCAP., FHEA
Teaching fellow, Anatomy
School of Medicine
University of Central Lancashire, Preston
Email: [email protected]
 Learning Outcomes

Describe Correlate Discuss

Describe the anatomy of Correlate specific visual Discuss the anatomy of the
the visual pathway, pathway lesions with pupillary light reflex and
including the structures clinical manifestations, clinical importance
involved from the eye to demonstrating an
the primary visual cortex, understanding of how
and explain the role of each damage to different parts of
component in visual the pathway can result in
processing. distinct visual deficits
Structure

Part 1 –
Part 2 – Part 3 –
Visual
Visual Pupil Light
Organ and
Pathway Reflex
Retina
 • How important is vision?
• How do we see (organ and nervous
Thoughts! system)?
• What happens when these
components of vision are impaired?
 Part 1
VISUAL ORGAN AND RETINA
Spatial Orientation
and the Visual field

Visual Field
• That area in space perceived when the eyes are
in a fixed, static position looking straight ahead.

Monocular Visual Field

• The area in space visible to one eye.

Binocular Visual Field

• The area of overlap of the visual field of one eye
with that of the opposite eye is called the
binocular field
 Visual Acuity
The ability to detect and Binocular fusion
The process of producing a single

Visual
recognize small objects
image from the two disparate
visually depends on the monocular images
refractory (focusing) power of

Capacitie the eye's lens system and the

cytoarchitecture of the retina.
Depth Perception
Ability of the nervous system to
utilize binocular images to the

s Colour Vision
The ability to detect
perception of a three-dimensional
world where the approximate
distance of an object can be
differences in the determined.
The Eye
As an organ of vision
• It has four functional
components
• A protective coat
• A nourishing lightproof coat
• A dioptric system
• A receptive integrating
layer.
The Dioptric
System (Refractive
media)
The transparent media of the eye function as a
biconvex lens that refracts light entering the eye
and focuses images of the external world onto
the light sensitive retina
 The neural retina is formed by alternating layers of
neuron cell bodies that appear dark and neuron
processes that appear light in Nissl-stained tissue.
The receptor cells synapse with bipolar and
horizontal cells in the outer plexiform layer. The
bipolar cells, in turn, synapse with amacrine and
ganglion cells in the inner plexiform layer. The axons
of the retinal ganglion cells exit the eye to form the
optic nerve

The retina an ectodermal derivation, an outward

The Retina extension of the brain , to which it is connected to by the
optic nerve
 Rods Cones
• contain the photopigment • contain photopigments that
rhodopsin, which breaks down breakdown in the presence of
when exposed to a wide a limited bandwidth of light
bandwidth of light (i.e., it is (i.e., cone photopigments are
achromatic). chromatic).
• Rhodopsin is also more • are colour sensitive.
sensitive to light and reacts at • are less sensitive to light and
lower light levels than the require high (daylight)
colour sensitive (chromatic) illumination levels.
cone pigments. • are concentrated in the fovea
• have longer outer segments,
• in the fovea have image of
more outer segment disks and,
the central visual field
consequently, contain more
projected on them.
photopigment.
• • in the fovea are responsible
are more sensitive to light and
function at scotopic (low) for photopic, light-adapted
levels of illumination. vision (i.e., high visual acuity
• dominate in the peripheral and colour vision) in the

Rods and retina, which is colour central visual field

insensitive, has poor acuity,
but is sensitive to low levels of

Cones
illumination
Clinical Manifestations
of retinal dysfunction
Vitamin A deficiency Macular Degeneration
• Can cause permanent blindness. Produces
degeneration of photoreceptors with visual
• Age-related. Leading cause of blindness
symptoms first presenting as “night blindness”. in elderly. Involves intraocular
proliferation of cells in the macular area
Retinitis pigmentosa (an inherited (i.e. In the fovea and the immediately
disorder) surrounding retinal area), or capillaries
• Gradual and progressive failure to maintain the of the choroid coat invading the
receptor cells. Symptoms include night blindness macular area and destroying receptor
and loss of peripheral vision.
cells and neurons.
Diabetic retinopathy
• This involves microaneurysms and punctate Retinal detachment
haemorrhages in the retina. Bleeding in the • When retina is torn away from the
choroid layer damage the receptor cells and
retinal neurons and can result in blindness in the
retinal pigment epithelium. There is a
affected regions. loss of vision in the area of detachment
 The stimulus properties essential for visual perception, include
colour, brightness, contrasts, visual field representation,
binocular fusion, and depth perception.

The organ of vision is the eye and it has four functional

components: protective coat, nourishing lightproof coat,
refractive or dioptric system and a receptive integrating layer

Light passes through the dioptric system to reach the visual

receptor cells (rods and cones) in the retina.

The receptor cells axons synapse with the bipolar cells which

Summary
synapse with the ganglion cells. The axons of the ganglion
cells form the optic nerve

There are differences between the central visual field (colour-

sensitive, high acuity, photopic subsystem) and the peripheral
visual field (more sensitive in low light, colour-insensitive, poor
acuity, scotopic subsystem).
Generally, there is a convergence of information from 125
million receptors to 10 million bipolar cells and further to 1
million retinal ganglion cells, with varying degrees of
convergence regionally.
End of Part 1
P R O C E E D T O P A RT I I
 Part 2
V I S U A L P AT H W AY S
 Visual field and
Retinal field
The eye’s lens function like a biconvex
lens and focuses image on the retina that
is inverted, left-right reversed and smaller
than the object viewed
 Visual pathway

Optic
Optic Optic radiatio
nerve tract ns

Optic Lateral Visual

chiasma genicula cortex
 Optic
Nerve • Axons of ganglion cells in the retina gather together at the optic disk in the
posterior pole of the eye, penetrate the sclera, and form the optic nerve.
• Covered by extensions of the meninges that ensheathes the brain
• Enters the cranial cavity through the optic foramen
• Lesions of the optic nerve produce unilateral blindness on the affected
side
 Optic
Chiasm • The two optic nerves come together at the chiasma , where partial crossing of
optic nerve fibers takes place.
• Optic nerve fibers from the nasal half of each retina cross at the optic
chiasma.
• Fibers from temporal halves remain uncrossed.
• Lesions of the optic chiasm results in loss of vision in both temporal fields of
vision (bitemporal hemianopia)
 • The crossed and uncrossed fibers from both optic
nerves join caudal to the chiasma to form the optic
tract.

Optic Lesions of the optic tracts, therefore, cause

•

degeneration of optic nerve fibers from the temporal

half of the ipsilateral retina and nasal half of the

Tract •
contralateral retina.
This produces loss of vision in the contralateral half of
the visual field (homonymous hemianopia)
 • Laminated into six (6) layers of neuron (grey matter)
alternating with white matter (optic fibres)
• Not all parts of the retina are represented equally in
the LGN
Lateral Geniculate • Proportionally, much more of the nucleus is devoted to

Body/Nucleus (LGN) representation of the central area than the periphery of

the retina
Part of the thalamus. Serves as a relay
station in the brain for visual information • Lesion will lead to homonymous hemianopia
• Rarely the site of an isolated field defect
Optic nerve ->
Optic Chiasma -
>Optic tract ->
LGN
 • Geniculocalcarine fibers from the upper halves of both retinae
course directly backward around the lateral ventricle in the
inferior part of the parietal lobe to reach the visual cortex.
• Geniculocalcarine fibers from the lower halves of both retinae
course forward towards the tip of the temporal horn of the lateral
Optic Radiation ventricle and then loop backward (Meyer’s loop, Flechsig’s loop,
(Geniculocalcarin Archambault’s loop in the temporal lobe to reach the visual
cortex
e tract) • Lesions of this tract give rise to a contralateral homonymous
hemianopia.
• Lesions involving parts of this tract (parietal/temporal) results in
contralateral quadratic visual field defect
 • Fibers from the upper retina terminate in the upper calcarine gyrus
(cuneus)

Fibers from the lower retina terminate in the lower calcarine gyrus (lingual

Visual cortex
•

gyrus)

the Geniculocalcarine fibers project on • Fibers from the macular area terminate posteriorly and those from the
neurons in the primary visual cortex peripheral retina terminate anteriorly
(V1/Area 17 of Brodmann). Involved in the
initial cortical processing of all visual
• Lesions destroying the whole of the visual cortex on one side produces
information necessary for visual contralateral homonymous hemianopia
perception • Lesions destroying the upper or lower calcarine gyrus will produce only a
contralateral lower or upper quadratic visual field defect
Secondary visual
cortex/ Extrastriate
visual cortex
• All of the occipital lobe areas
surrounding the primary visual
cortex
• Information from the “colour”,
“shape/form”, "location" and
“motion” detecting V1, neurons
are sent to different areas of the
extrastriate cortex.
• Damage to the extrastriate cortex
does not result in a “simple loss of
vision”; rather it results in higher
order visual perceptual deficits.
 Dorsal stream Ventral stream
Neurons in the parietal association Neurons in the inferior temporal
cortex and superior and middle visual association cortex
temporal visual association cortex

responsible for producing our responsible for processing

sense of information necessary for our
• spatial orientation abilities to
• recognize objects and
• binocular fusion/depth
colours
perception
Visual • the location, the
• read text and
• learn and remember
association movement and the
visual objects (e.g., words
movement direction and
cortex velocity of objects in
and their meanings)
This ventral stream processes
extends anteriorly from the space.
extrastriate cortex to encompass information about the “what”
The dorsal stream processes
adjacent areas of the posterior of the visual stimulus
parietal lobe and much of the information about the
posterior temporal lobe “where” of the visual
stimulus
Summary
• The optic image on the retina is upside-down and left-right reversed.
• The monocular visual fields of the two eyes overlap partially to form the binocular
visual field .
• The temporal hemiretina of one eye and the nasal hemiretina of the other eye have
projected on them the images of corresponding halves of their visual fields. For
example, the temporal (left) hemiretina of left eye and the nasal (left) hemiretina
of right eye both have projected on them the right half of the visual fields of each
eye.
• Beyond the optic chiasm, the corresponding visual hemifields of the two eyes are
represented in the contralateral side of the visual pathway. For example, the left
hemifield of both eyes are represented in the right optic tract, right lateral
geniculate nucleus, right optic radiations and right striate cortex.
• The fibers of the optic radiation fan out into the temporal, parietal and occipital
lobes on their course to the striate cortex. Those forming the sublenticular optic
radiations carry information about the superior hemifield, whereas those forming
the retrolenticular optic radiations carry information about the inferior hemifield).
The optic radiation fibers traveling the most direct course back to the striate cortex
carry information about the central visual field.
• There are many more receptor cells in the fovea and many more bipolar and
ganglion cells in the macula than in the periphery of the retina. Consequently, the
central visual field is disproportionately represented in the visual system. That is,
more visual receptors, more optic nerve fibers and more LGN and cortical neurons
are involved in processing and carrying information about that portion of the retinal
Visual field defects/ Visual
pathway lesions
CLINICAL CASES
Mrs. Anderson
needs to see things
from the right side!
• Mrs. Anderson, a 55-year-old woman,
presents to the ophthalmology clinic
with a gradual, painless loss of vision
in her right eye over the past few
weeks. She reports occasional
headaches but denies any trauma or
significant medical history.
Unseen
challenges on
Mr. Rodriguez, a 40-year-old avid soccer
•

the soccer
player, field!
expresses concerns about a general
feeling of malaise and recent visual
changes during his annual physical exam.
He describes difficulty on the soccer field,
frequently getting "blindsided" by players
approaching from the side.
Ophthalmoscope examination does not
reveal abnormalities in either eye.
Confrontation field testing indicates a
constriction of the temporal hemifields of
both eyes. The patient is referred for
neuroradiographic tests and perimetry
testing.
Navigating a
colourless world
after stroke
Mr. Thompson, a 65-year-old individual,
•

is referred to a neuro-ophthalmologist
for evaluation following a stroke two
months earlier. Despite stabilization, he
encounters difficulties with processing
visual information. He is unable to
describe the colour of objects presented
to him or recognize faces, a task that
was previously effortless. Spatial
orientation and motion detection remain
intact. The patient is referred for
perimetry testing.
Summary of
Lesions of
the visual
pathway
End of Part 2
P R O C E E D T O P A RT I I I
 Part 3
PUPIL LIGHT REFLEX
Direct and
consensual
pupillary light
reflex
Learning
Outcomes Review
Describe
• Described the anatomy of the visual pathway,
including the structures involved from the eye to
the primary visual cortex, and explain the role of
each component in visual processing.
Correlate
• Correlated specific visual pathway lesions with
clinical manifestations, demonstrating an
understanding of how damage to different parts of
the pathway can result in distinct visual deficits
Discuss
• Discussed the anatomy of the pupillary light reflex
and clinical importance
Send me an email to
[email protected]

Questions?
Thank you

Izuchukwu Obazie
FHEA

[email protected]