Preserved cortical hierarchy characterizes vision without awareness after visual cortex damage

After primary visual cortex (V1) damage, some patients successfully detect stimuli yet deny seeing them, a rare condition known as "blindsight". Blindsight provides a unique natural experiment in consciousness research: visual information guides behavior without entering awareness. Why only some patients with comparable lesions show blindsight is unknown, and current accounts have focused on spared, V1-bypassing pathways. One extant question concerns how the functional organization of the remaining brain helps explain the divergent behavioral outcomes of V1 damage. Using resting-state fMRI, we quantified regional coupling as mutual information in the largest available cohort of psychophysically defined blindsight-positive and negative patients with age-matched controls. Despite overlapping lesions and field defects, blindsight-positive patients retained a control-like sensory-association coupling pattern, whereas blindsight-negative patients showed reduced unimodal-transmodal differentiation, reflecting lower coupling of unimodal cortex. This differentiation tracked blind-field stimulus detection and predicted performance across the patient cohort. The ipsilesional posterior thalamus, in a location consistent with the pulvinar, showed the same group difference and stronger coupling with contralesional visual and frontal pre-motor regions in blindsight-positive patients. Together, our findings outline the complementary contribution of the local and global functional organization through which V1 bypassing visual signals can influence behavior. An intrinsic cortico-subcortical functional architecture previously implicated in conscious states also bears on visual behavior without awareness.