Glaucomatous macular damage may lead to decreased facial recognition
Reduced contrast sensitivity plays a role in diminished facial recognition in patients with glaucoma-related macular damage, according to findings published in the American Journal of Ophthalmology.
Sitara H. Hirji, BA, and colleagues, sought to examine the relationship between glaucomatous macular damage and facial recognition. The researchers also assessed the role of contrast sensitivity caused by macular damage and its relationship to the impairment of facial recognition.
“Facial recognition is an activity of daily living that is vital for social interaction and forming and maintaining relationships,” Hirji, department of ophthalmology at Columbia University, and colleagues wrote. “It is likely that decreased facial recognition skills negatively impacts patient quality of life by affecting patients’ ability to interact socially.”
The researchers analyzed data from a prospective cross-sectional study consisting of patients with open angle glaucoma in one or both eyes and a visual acuity of 20/40 or better in each eye. In all, 144 eyes of 72 patients were examined.
Hirji and colleagues wrote that the presence or absence of macular damage was determined by comparing corresponding regions of the retina nerve fiber layer and retinal ganglion cell layer spectral domain OCT with a 10-2 visual field. Better or worse eye was determined by 10-2 visual field mean deviations.
The researchers identified that, regardless of eye, there was a notable correlation between facial recognition and 10-2 visual field mean deviation (P < .0001 for better, worse eye). Following adjustment for potential confounders including severity, contrast sensitivity, age and visual acuity, the 10-2 visual field mean deviation remained a significant predictor of facial recognition (P = .004 for better eye; P = .019 for worse eye).
“In summary, this work increases our understanding of the visual disability experienced by patients with glaucoma,” Hirji and colleagues wrote. “In particular, glaucomatous patients with macular damage in either eye experience impaired facial recognition.”
Perspective
Back to Top
Historically, open angle glaucoma was thought to cause initial peripheral visual field loss, with central vision spared until advanced disease. Over the past half-decade, a number of investigators have challenged that belief by demonstrating that macular damage is common in early glaucoma, but poorly detected by conventional clinical investigative techniques including retinal nerve fiber layer OCT and 24-2 visual field analyses. Through leveraging macular retinal ganglion cell thickness measurement and the 10-2 visual field grid, we now understand that central vision is involved in well over half the patients traditionally classified as having “early” glaucoma (eg, a mean deviation less than –6 dB on 24-2 testing … and an aside, given that a mean deviation of –3 dB corresponds to a 50% loss of retinal ganglion cells, perhaps our definition of “early” glaucoma should be revisited).
In this report, Hirji and colleagues demonstrated that paracentral visual field defects and reduced contrast sensitivity decrease facial recognition ability, despite preservation of visual acuity. Other investigators have proven that driving, reading and mobility are similarly affected. All support the routine assessment of macular retinal ganglion cell structure and function in the management of patients through all stages of the glaucoma continuum.
No matter how you slice it, “early” glaucoma is anything but, and our response should be commensurate.
Collapse
Read more about