Sensitivity to Central Crowding for Faces in Patients With Glaucoma

Abstract

Purpose: to investigate whether face recognition difficulties reported by some patients with glaucoma result from a greater sensitivity to inner crowding in central vision. Method: Seventeen patients with glaucoma and 17 age-matched normally sighted controls participated. An isolated mouth (uncrowded condition) or a mouth within a face (crowded condition) was randomly displayed centrally for 200 ms. For each condition, participants were asked to decide whether the mouth was closed or open. The stimuli were presented at three angular sizes (0.6° x 0.4°, 1° x 0.72°, and 1.5° x 1.08°). Accuracy was measured. Results: Crowding affected performance differentially for patients and controls. Consistent with previous studies controls exhibited a "face superiority effect", with a better accuracy when the mouth was located within the face than when it was isolated. A sensitivity to crowding, reflected in a better accuracy with the isolated mouth, was observed in 10 out of 17 patients only for small images. Crowding disappeared for larger faces, as the facial features were spaced out. Five patients were not sensitive to crowding. Importantly, no difference was found between the two subgroups of patients (sensitive vs non sensitive) in terms of Mean Deviation, contrast sensitivity, acuity, thickness of the RNLF or macular GCIPL. Conclusion: An excessive sensitivity to central crowding might explain the difficulties in face perception and reading reported by some patients with glaucoma. The sensory or cognitive processes underlying this excessive sensitivity must be elucidated to improve central perception in glaucoma. Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation The photo number 18 of the NimStim database is allowed for publication in scientific journals. "Only models #01, 03, 18, 28, 40, & 45 may be published, and these may only be published in scientific journals. Researchers may not publish images from the remaining models anywhere."

Foveal crowding appears to be robust to normal aging and glaucoma unlike parafoveal and peripheral crowding

“…face superiority effect), 10 of 17 glaucoma subjects performed better for the isolated mouth condition and this result was only observed for the small images (angular size of 0.6 degrees × 0.4 degrees). One possible explanation for the apparent discrepancy between their results and our findings might have to do with the severity range of glaucoma in their study ( Stievenard et al, 2021 ). In Stievenard et al's study ( Stievenard et al, 2021 ), the majority of the patients (13 of 17) were at the moderate to severe stages of glaucoma, whereas patients in our study were mostly at the mild to moderate stages of the disease.…”

“…One possible explanation for the apparent discrepancy between their results and our findings might have to do with the severity range of glaucoma in their study ( Stievenard et al, 2021 ). In Stievenard et al's study ( Stievenard et al, 2021 ), the majority of the patients (13 of 17) were at the moderate to severe stages of glaucoma, whereas patients in our study were mostly at the mild to moderate stages of the disease. Other important differences between the two studies include the nature of tasks in demand (e.g.…”

“…On the other hand, Stievenard et al ( Stievenard et al, 2021 ) using face stimuli reported increased foveal crowding in glaucoma compared to age-matched normal vision. In their study, subjects were asked to determine whether a mouth presented within a face (crowded) or in isolation (uncrowded) was open or closed.…”

“…However, accumulating evidence has shown substantial structural damage (i.e. degeneration of ganglion cell bodies and their axonal and dendritic structures) and functional deficits in the central vision of patients with glaucoma ( Anctil & Anderson, 1984 ; Elze et al, 2015 ; Glen et al, 2012 ; Hood, 2017 ; Hood et al, 2012 ; Hood et al, 2013 ; Hood et al, 2014 ; Kwon et al, 2017 ; Medeiros et al, 2013 ; Ramulu et al, 2013 ; Roux-Sibilon et al, 2018 ; Shamsi, Liu, Owsley, et al, 2022 ; Stievenard et al, 2021 ; D. L. Wang et al, 2015 ; Min Wang et al, 2009 ; Mengyu Wang, Tichelaar, Pasquale, Shen, Boland, Wellik, De Moraes, Myers, Ramulu, Kwon, Saeedi, Wang, Baniasadi, Li, Bex, & Elze, 2020 ). More relevantly, increased parafoveal and peripheral crowding have been observed even in relatively mild and moderate glaucoma ( Ogata et al, 2019 ; Shamsi, Liu, & Kwon, 2022 ).…”

“…Despite the conventional view that the central vision remains intact until the end stages of glaucoma, recent neuroanatomic and behavioral evidence support the presence of glaucomatous damage in the central vision ( Anctil & Anderson, 1984 ; Chien, Liu, Girkin, & Kwon, 2017 ; Elze, Pasquale, Shen, Chen, Wiggs, & Bex, 2015 ; Glen, Crabb, Smith, Burton, & Garway-Heath, 2012 ; Hood, 2017 ; Hood, Raza, de Moraes, Johnson, Liebmann, & Ritch, 2012 ; Hood, Raza, de Moraes, Liebmann, & Ritch, 2013 ; Hood, Slobodnick, Raza, de Moraes, Teng, & Ritch, 2014 ; Kwon, Liu, Patel, & Girkin, 2017 ; Medeiros, Lisboa, Weinreb, Liebmann, Girkin, & Zangwill, 2013 ; Ramulu, Swenor, Jefferys, Friedman, & Rubin, 2013 ; Roux-Sibilon, Rutgé, Aptel, Attye, Guyader, Boucart, Chiquet, & Peyrin, 2018 ; Shamsi, Liu, Owsley, & Kwon, 2022 ; Stievenard, Rouland, Peyrin, Warniez, & Boucart, 2021 ; Wang, Raza, de Moraes, Chen, Alhadeff, Jarukatsetphorn, Ritch, & Hood, 2015 ; Wang, Hood, Cho, Ghadiali, De Moraes, Zhang, Ritch, & Liebmann, 2009 ). Specifically, a number of retinal imaging studies have shown significant thinning of the retinal nerve fiber layer (RNFL) and the retinal ganglion cell plus inner plexiform layer (RGC+) even in the macular region of glaucomatous eyes ( Hood et al, 2012 ; Hood et al, 2013 ; Hood et al, 2014 ; Shamsi, Liu, Owsley, et al, 2022 ; D. L. Wang et al, 2015 ).…”