Macular Damage May Lead to Impaired Facial Recognition

Field loss may not be the only visual deficit resulting from macular damage while resulting functional losses may impair facial recognition, according to new research published in JAMA Ophthalmology.

Although it has been recently reported glaucomatous macular damage is directly correlated with diminished facial recognition in eyes with good central vision, it is possible this damage is not limited to impairment related to Humphrey visual field defects, authors wrote.

To investigate the association between facial recognition and macular structural damage, researchers carried out spectral-domain ocular coherence tomography (SD-OCT) retinal ganglion cell and inner plexiform layer (RGC+) assessments on patients with primary open-angle glaucoma in 1 or both eyes.

Study participants were recruited between March 2019 and April 2019 and underwent a comprehensive ophthalmologic examination. Using RGC+, macular damage in the better seeing eye was classified as focal, diffuse, or mixed. Investigators assessed facial recognition via the Cambridge Face Memory Test.

Of the 68 better-seeing eyes included in the study, 54 had structural macular damage and 14 did not, while no differences in age, number of antiglaucoma medications, logMAR visual acuity, proportion with early cataract, spherical equivalence, or significant astigmatism were reported between groups.

Analyses of the better eyes revealed:

• A positive association between facial recognition and mean RGC+ (β = 0.19; 95% CI, 0.01-0.37; P = .04), even after adjusting for the 10-2 visual field as well as age, visual acuity, and number and type of drops
• Patients with diffuse macular damage recognized fewer faces (47.9; 95% CI, 43.6-52.0) than those with focal macular damage (50.4; 95% CI, 47.4-53.4) or those without macular damage (51.6; 95% CI, 48.0-55.3), although the difference only approached significance at P = .051

“In the present study, we show that decreased mean RGC+ in the better-seeing eye was independently associated with diminished facial recognition, even after adjusting for central visual field loss,” researchers wrote.

Findings also indicate diffuse structural macular damage in the better seeing eye could be associated with diminished facial recognition compared with focal structural macular damage. Future studies with larger sample sizes are needed to validate this association.

“These findings generally support previous work showing functional differences between patients with diffuse and focal macular damage,” authors concluded. “It also suggests that the global effect of diffuse damage appears to result in worsened visual function.”

Reference

Khan SS, Hirji SH, Hood DC, Liebmann JM, and Blumberg DM. Association of macular optical coherence tomography measures and deficits in facial recognition in patients with glaucoma. JAMA Ophthalmol. Published online March 11, 2021. doi:10.1001/jamaophthalmol.2021.0137