As if glaucoma patients don’t struggle enough with progressive loss of visual function and an increasingly greater drop regimen, new research suggests their burden is even heavier than previously understood. Diffuse glaucomatous macular damage appears to be strongly linked to contrast sensitivity and facial recognition impairment, a study in JAMA Ophthalmology recently discovered.

The cohort included 144 eyes of 72 patients with various levels of glaucoma severity but generally good visual acuity of 20/40 or better in each eye.

Investigators found eyes with diffuse—as opposed to focal—damage had greater contrast impairment after adjusting for 10-2 visual field (VF) mean deviation (MD), 24-2 VF MD, age, early cataract and number of medications. Similarly, Cambridge Face Memory Test scores were significantly lower in patients with diffuse vs. focal macular damage, regardless of the eye.

Additionally, the team reported a greater relative risk of visual problems for patients with diffuse, but not focal, macular damage in the better-seeing eye.

Evaluation of macular OCT and 10-2 VF and resultant detection of diffuse macular damage may help minimize glaucoma-related visual disability, researchers concluded in their paper.


Hirji SH, Hood DC, Liebmann JM, et al. Association of patterns of glaucomatous macular damage with contrast sensitivity and facial recognition in patients with glaucoma. JAMA Ophthalmol. November 5, 2020. [Epub ahead of print].