Seeing anew: Mechanisms, outcomes, and challenges in adapting to restored sight via visual prostheses.

Restoring vision through prosthetic devices represents one of the most ambitious frontiers in translational neuroscience. Despite decades of progress, functional outcomes remain highly variable, often falling short of patient expectations, as adapting to restored vision through visual prostheses is a complex process influenced by neural plasticity, perceptual learning, and psychological factors. We propose a five-stage framework that captures the hierarchically dependent yet fragile process of adaptation: Device Activation, Perceptual Calibration, Cognitive Integration, Behavioral Generalization, and Psychosocial Adjustment. Across retinal and cortical prosthesis designs, the earlier stages are frequently achieved, but progression to fluent, real-world use and sustained device acceptance is far less common. The most consistent point of failure lies between Cognitive Integration and Behavioral Generalization: skills acquired in structured training rarely transfer to unconstrained everyday behavior. Technical constraints, insufficient training, and unrealistic expectations frequently stall adaptation at this threshold, leading to frustration, limited daily use, or device abandonment. By examining visual-prosthesis clinical trials, case studies of surgical vision restoration, and evidence from cochlear implants and sensory substitution devices, we identify key determinants of successful adaptation: timely intervention, intuitive device usability, sustained rehabilitation, and long-term psychosocial support. Understanding the mechanisms of adaptation is essential for improving visual prostheses and ultimately enhancing quality of life for individuals with restored sight.