Researchers investigated the direct association between facial recognition and macular structural damage in glaucoma patients by using spectral-domain OCT of the retinal ganglion cell and inner plexiform layer (RGC+).

All participants (68 eyes) underwent a comprehensive examination, including OCT and standard automated perimetry (24-2 and 10-2). Facial recognition was assessed using the Cambridge Face Memory Test. Macular damage in the better-seeing eye, determined by mean RGC+, was categorized as focal, diffuse or mixed.

Fifty-four eyes had structural macular damage and 14 did not. There was no difference between eyes with and without macular damage with respect to age, number of glaucoma medications, logMAR visual acuity, proportion with early cataract, spherical equivalence or significant astigmatism.

This study shows that decreased mean RGC+ in the better-seeing eye was independently associated with diminished facial recognition, even after adjusting for central visual field loss (10-2). “This suggests that field loss may not be the only visual deficit resulting from macular damage and that the resultant functional losses may impair facial recognition,” the authors noted in their study.

Patients with diffuse macular damage recognized fewer faces than those with focal macular damage or those without macular damage.

“Our study also suggests that diffuse rather than focal structural macular damage in the better seeing eye may be associated with diminished facial recognition, although this will need to be validated in future studies with larger sample sizes,” the authors added. “These findings generally support previous work showing functional differences between patients with diffuse and focal macular damage. It also suggests that the global effect of diffuse damage appears to result in worsened visual function.”

Khan SS, Hirji, SH, Hood, Dc, et al. Association of macular optical coherence tomography measures and deficits in facial recognition in patients with glaucoma. JAMA Ophthalmol. March 11, 2021. [Epub ahead of print].