Association of Patterns of Glaucomatous Macular Damage With Contrast Sensitivity and Facial Recognition in Patients With Glaucoma

Abstract

IMPORTANCEFacial recognition is a critical activity of daily living that relies on macular function. Glaucomatous macular damage may result in impaired facial recognition that may negatively affect patient quality of life.OBJECTIVE To evaluate the association of patterns of glaucomatous macular damage with contrast sensitivity and facial recognition among patients with glaucoma. DESIGN, SETTING, AND PARTICIPANTSIn this prospective cohort study at a single tertiary care center, 144 eyes of 72 consecutive patients with glaucoma with good visual acuity (20/40 or better in each eye) were studied. Data were collected from March to April 2019.EXPOSURES Eyes with macular damage were categorized as having focal, diffuse, or mixed (focal and diffuse) damage based on optic disc and macular spectral-domain optical coherence tomography and 10-2 visual field (VF) damage. Only eyes with focal or diffuse damage were included. Higher-acuity and lower-acuity eyes were determined by 10-2 VF mean deviation (MD). Facial disability was defined as facial recognition scores at the 2% level of normal participants. MAIN OUTCOMES AND MEASURES(1) Monocular contrast threshold as measured by the Freiburg Visual Acuity and Contrast Test and (2) binocular facial recognition as measured by the Cambridge Face Memory Test. RESULTSOf the 72 included patients, 49 (68%) were White and 41 (57%) were female, and the mean (SD) age was 67.0 (11.6) years. Eyes with diffuse damage had greater contrast impairment compared with eyes with focal damage (β = −0.5; 95% CI, −0.6 to −0.4; P < .001) after adjusting for 10-2 VF MD, 24-2 VF MD, age, presence of an early cataract, and number of drops. Similarly, Cambridge Face Memory Test scores were significantly lower in patients with diffuse rather than focal macular damage, regardless of eye (better-seeing eye: β = 10.0; 95% CI, 2.0 to 18.2; P = .001; worse-seeing eye: β = 5.5; 95% CI, 0.8 to 10.0; P = .23). Relative risk of facial disability was greater for patients with diffuse but not focal macular damage in the better-seeing eye (relative risk, 86.2; 95% CI, 2.7 to 2783.3; P = .01). CONCLUSIONS AND RELEVANCEIn this cohort study, diffuse rather than focal glaucomatous macular damage was associated with diminished facial recognition and contrast sensitivity. Evaluation of macular optical coherence tomography and 10-2 VF and resultant detection of diffuse macular damage may help minimize glaucoma-related visual disability.

Detection of Primary Angle Closure Glaucoma Progression by Optical Coherence Tomography

“…It has been recognized that the use of regional correlations may improve the understanding of progression in both glaucoma subtypes. Hood and colleagues looked closely at RGCs within the macula along with the 10-2 VF test and described 2 patterns of macular damage: focal and/or diffuse 48. These 2 patterns of macular damage are best differentiated by comparing abnormal regions on the 10-2 VF with the corresponding regions on RGCs.…”

Association of Macular Optical Coherence Tomography Measures and Deficits in Facial Recognition in Patients With Glaucoma

“…Our study also suggests that diffuse rather than focal structural macular damage in the better seeing eye may be associated with diminished facial recognition, although this will need to be validated in future studies with larger sample sizes. These findings generally support previous work showing functional differences between patients with diffuse and focal macular damage . It also suggests that the global effect of diffuse damage appears to result in worsened visual function.…”

Effect of low luminance on face recognition in adults with central and peripheral vision loss

“…People with vision impairment report difficulties with both discrimination of familiar faces and recognition of facial expressions under a range of conditions, with potential to cause anxiety, embarrassment, avoidance of social situations and social isolation 1–4 . Studies have shown that ocular conditions affecting central or peripheral vision can cause reduced performance on various face recognition tasks, 5–18 and that both impaired visual acuity (VA) and contrast sensitivity (CS) are associated with poor face recognition 5–11 . Although most previous studies have investigated the relationship between vision impairment and face recognition under photopic conditions, people with vision impairment also report difficulties with face recognition under low luminance conditions, such as seeing faces in a dim restaurant 19 …”

“…Studies have found that, compared to age‐similar adults without ocular disease, both photopic discrimination of facial identity and recognition of facial expressions are reduced for patients with age‐related macular degeneration (AMD) 5–9,12–14 and glaucoma 10,12,15–18 . Furthermore, poorer discrimination of facial identity and poorer recognition of facial expressions under photopic conditions have been associated with greater disease severity and vision loss.…”