Impacts of impaired face perception on social interactions and quality of life in age-related macular degeneration: A qualitative study and new community resources

Abstract

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.

Caricaturing can improve facial expression recognition in low-resolution images and age-related macular degeneration

“…The specific form of low resolution we tested was Gaussian blur. Blur is the most common feature of visual appearance reported by patients with AMD (Lane, Rohan, Sabeti, Essex, Maddess, Dawel, et al, 2018). We use the same blur simulation that we have previously shown to produce parallel results between real patients and simulations in face identity recognition (Irons et al, 2014;Lane, Rohan, Sabeti, Essex, Maddess, Barnes, et al, 2018).…”

“…The specific blur formula used was Marmor and Marmor's (2010) formula for blurring perceived in peripheral vision; this is of relevance to disorders producing central vision loss, such as AMD (although note that some patients might rely on islands of intact retina in central vision rather than peripheral vision and also that blur does not provide a complete simulation of all AMD patients' experience; Lane, Rohan, Sabeti, Essex, Maddess, Dawel, et al, 2018). We applied uniform spatial blur across the image by reducing the contrast of spatial frequencies higher than a given threshold (with threshold set lower for higher blur levels, using a Gaussian kernel filter of size defined by the cutoff frequency; Supplement S2 provides details).…”

“…This includes different ages of observer covering the full adult life span, from young adults (mean age 21 years) to older adults ranging in age from 65-89 years in normal vision observers and up to 93 years in AMD patients. It also includes different forms of low resolution in the faces, specifically spatially uniform Gaussian blur and the mix of blur, distortions, and missing parts commonly reported by AMD patients (Lane, Rohan, Sabeti, Essex, Maddess, Dawel, et al, 2018;Taylor et al, 2018). Finally, it includes different severities of low-resolution vision, including different levels of added blur for normal vision observers and across a wide range of levels of vision loss in AMD patients.…”

“…It causes progressive damage to the retina, impairs central vision, and reduces visual acuity. Patients report that faces and other objects can appear blurred, distorted, and/or with missing parts (Lane, Rohan, Sabeti, Essex, Maddess, Dawel, et al, 2018;Taylor, Edwards, Binns, & Crabb, 2018).…”

“…One result of AMD is impaired facial expression recognition (Boucart et al, 2008;Johnson, Woods-Fry, & Wittich, 2017;Tejeria, Harper, Artes, & Dickinson, 2002). This can result in an inability to recognize other people's emotions and social signals in everyday life, leading patients to suffer difficulties in social interactions and contributing to social withdrawal (Lane, Rohan, Sabeti, Essex, Maddess, Dawel, et al, 2018). It is, thus, important to develop techniques that have the potential to improve patient expression recognition ability.…”