Retinal versus physical stimulus size as determinants of visual perception in simultanagnosia

Patients with simultanagnosia following bilateral parieto-temporo-occipital brain damage show a characteristic impairment of global gestalt perception, while their perception of individual objects or elements remains intact. For instance, when shown 'hierarchical' stimuli comprising a larger global object (e.g. a large letter) made up from smaller components (e.g. multiple small letters), they typically report seeing one of the smaller components but not the global figure. Recent work on simultanagnosia revealed that global perception can be improved if local element spacing is reduced. However, it is still unclear whether the retinal separation or the physical (post-size-constancy) spatial separation is critical. Here, we presented various hierarchical global/local letter stimuli at different viewing distances and sizes to separate the impacts of retinal versus physical size. Our findings indicate a key role for visual angle in determining simultanagnosic perception. We observed that not only retinal spacing (in terms of visual angle) between local elements had a major impact on global perception in simultanagnosia, but also the physical size of the separation between local elements, provided that binocular cues to viewing distance were available. The results indicate both pre-size-constancy retinal influences and binocular-post-constancy influences upon conscious perception in simultanagnosia.