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Your optic nerve has been enhanced with the Optics Enhancer, increasing your Perception by 1.”— In-game description
This perk can't be picked during level up; it's an implant named Optics Enhancer. Doctor Usanagi in the New Vegas medical clinic will sell this to the Courier for four-thousand caps. It is designed to improve eyesight of the person it's installed in by acting as a pair of sight enhancing glasses, sharpening the view of the user of the implant. If the Courier has a perception of three or less, this implant costs three-thousand caps instead.