AimsPrevious studies and community information about everyday difficulties in age-related macular degeneration (AMD) have focussed on domains such as reading and driving. Here, we provide the first in-depth examination of how impaired face perception impacts social interactions and quality of life in AMD. We also develop a Faces and Social Life in AMD brochure and information sheet, plus accompanying conversation starter, aimed at AMD patients and those who interact with them (family, friends, nursing home staff).MethodSemi-structured face-to-face interviews were conducted with 21 AMD patients covering the full range from mild vision loss to legally blind. Thematic analysis was used to explore the range of patient experiences.ResultsPatients reported faces appeared blurred and/or distorted. They described recurrent failures to recognise others' identity, facial expressions and emotional states, plus failures of alternative non-face strategies (e.g., hairstyle, voice). They reported failures to follow social nuances (e.g., to pick up that someone was joking), and feelings of missing out ('I can't join in'). Concern about offending others (e.g., by unintentionally ignoring them) was common, as were concerns of appearing fraudulent ('Other people don't understand'). Many reported social disengagement. Many reported specifically face-perception-related reductions in social life, confidence, and quality of life. All effects were observed even with only mild vision loss. Patients endorsed the value of our Faces and Social Life in AMD Information Sheet, developed from the interview results, and supported future technological assistance (digital image enhancement).ConclusionPoor face perception in AMD is an important domain contributing to impaired social interactions and quality of life. This domain should be directly assessed in quantitative quality of life measures, and in resources designed to improve community understanding. The identity-related social difficulties mirror those in prosopagnosia, of cortical rather than retinal origin, implying findings may generalise to all low-vision disorders.

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Multifocal pupillographic objective perimetry (mfPOP) has recently been shown to be able to measure cortical function. Here we assessed 44 regions of the central 60 degrees of the visual fields of each eye concurrently in 7 minutes/test. We examined how foveally- and peripherally-directed attention changed response sensitivity and delay across the 44 visual field locations/eye. Four experiments were completed comparing white, yellow and blue stimulus arrays. Experiments 1 to 4 tested 16, 23, 9 and 6 subjects, 49/54 being unique. Experiment 1, Experiments 2 and 3, and Experiment 4 used three variants of the mfPOP method that provided increasingly improved signal quality. Experiments 1 to 3 examined centrally directed attention, and Experiment 4 compared effects of attention directed to different peripheral targets. Attention reduced the sensitivity of the peripheral locations in Experiment 1, but only for the white stimuli not yellow. Experiment 2 confirmed that result. Experiment 3 showed that blue stimuli behaved like white. Peripheral attention showed increased sensitivity around the attentional targets. The results are discussed in terms of the cortical inputs to the pupillary system. The results agree with those from multifocal and other fMRI and VEP studies. mfPOP may be a useful adjunct to those methods.

Purpose Patients with advanced age-related macular degeneration (AMD) may have preserved visual function despite significant retinal structural changes. We aimed to evaluate the relationships among retinal thickness, macular sensitivity, and visual acuity (VA) in advanced AMD. Methods We examined 43 eyes of 22 patients with advanced AMD (ages 66–93 years), prospectively recruited from the Canberra Hospital Ophthalmology Department. Visual function was measured on participants with low and high contrast visual acuity (LCVA and HCVA) and 10-2 Matrix visual fields. Retinal structure was determined with spectral domain optical coherence tomography (OCT), and customized software mapped the 64 OCT macular thickness regions onto the 44 regions of the 10-2 test. Results Median retinal thickness at each 10-2 region was near normal. Just 7 of 88 regions from the OCT analysis that were thicker than the median had sensitivity that declined significantly with increasing thickness (r = −0.698 ± 0.082, mean ± SD), whereas 17 of 88 thinner regions showed significantly decreasing sensitivity with decreasing thickness (r = 0.723 ± 0.078). The absolute value of deviations from median optical coherence tomography thickness (aOCT) outside the central eight degrees was significantly correlated with HCVA (r = −0.34, P = 0.047). Thickness in the central eight degrees was not. Similarly, matrix sensitivities inside the central eight degrees were significantly correlated with outer aOCT (r = −0.49, P = 0.002). Conclusions Retinal thickness outside eight degrees were significantly associated with HCVA and macular sensitivity. These results suggest that outer macular thickness may be a useful prognostic indicator in AMD. Translational Relevance Retinal structure at the borders of the macula may be a surrogate marker of vision and retinal thickness near fixation.

Patients with age-related macular degeneration (AMD) have difficulty recognising people’s faces. We tested whether this could be improved using caricaturing: an image enhancement procedure derived from cortical coding in a perceptual ‘face-space’. Caricaturing exaggerates the distinctive ways in which an individual’s face shape differs from the average. We tested 19 AMD-affected eyes (from 12 patients; ages 66–93 years) monocularly, selected to cover the full range of vision loss. Patients rated how different in identity people’s faces appeared when compared in pairs (e.g., two young men, both Caucasian), at four caricature strengths (0, 20, 40, 60% exaggeration). This task gives data reliable enough to analyse statistically at the individual-eye level. All 9 eyes with mild vision loss (acuity ≥ 6/18) showed significant improvement in identity discrimination (higher dissimilarity ratings) with caricaturing. The size of improvement matched that in normal-vision young adults. The caricature benefit became less stable as visual acuity further decreased, but caricaturing was still effective in half the eyes with moderate and severe vision loss (significant improvement in 5 of 10 eyes; at acuities from 6/24 to poorer than <6/360). We conclude caricaturing has the potential to help many AMD patients recognise faces.