Impacts of impaired face perception on social interactions and quality of life in age-related macular degeneration: A qualitative study and new community resources

The experience of visual art for people living with mild-to-moderate vision loss

BACKGROUND

Visual art can enhance wellbeing and quality-of-life; however, the experience of visual art for people with mild-to-moderate vision loss has not been examined.

METHODS

Eight participants (6 females, 2 males; Mean age = 81 years, SD = 7.9, range 70-91 years; 4 with mild vision loss and 4 with moderate vision loss based on binocular visual acuity) completed a mixed-methods study comprising: a semi-structured interview on visual art experience; an eye examination; and questionnaires about visual functioning and quality-of-life.

RESULTS

Various themes were identified: visual perception of art (e.g. altered colours, visual distortions, etc.), viewing conditions, elements of art, personal preference, deriving meaning, appreciation of art, impact of impaired visual perception, and social aspects of art.

CONCLUSIONS

The overall experience of art is influenced by how an individual sees, perceives, and makes meaning from art. Even mild vision loss can impair this experience and impact emotional and social wellbeing.

Great expectations: Aligning visual prosthetic development with implantee needs

Purpose

Visual prosthetics have emerged as a promising assistive technology for individuals with vision loss, yet research often overlooks the human aspects of this technology. While previous studies have concentrated on the perceptual experiences of implant recipients (implantees) or the attitudes of potential implantees towards near-future implants, a systematic account of how current implants are being used in everyday life is still lacking.

Methods

We interviewed six recipients of the most widely used visual implants (Argus II and Orion) and six leading researchers in the field. Through thematic and statistical analyses, we explored the daily usage of these implants by implantees and compared their responses to the expectations of researchers. We also sought implantees' input on desired features for future versions, aiming to inform the development of the next generation of implants.

Results

Although implants are designed to facilitate various daily activities, we found that implantees use them less frequently than researchers expected. This discrepancy primarily stems from issues with usability and reliability, with implantees finding alternative methods to accomplish tasks, reducing the need to rely on the implant. For future implants, implantees emphasized the desire for improved vision, smart integration, and increased independence.

Conclusions

Our study reveals a significant gap between researcher expectations and implantee experiences with visual prostheses, underscoring the importance of focusing future research on usability and real-world application.

Translational relevance

This work advocates for a better alignment between technology development and implantee needs to enhance clinical relevance and practical utility of visual prosthetics.

The impact of degraded vision on emotional perception of audiovisual stimuli: An event-related potential study

Emotion recognition will be challenged for individuals when visual signals are degraded in real-life scenarios. Recently, researchers have conducted many studies on the distinct neural activity between clear and degraded audiovisual stimuli. These findings addressed the "how" question, but the precise stage of the distinct activity that occurred remains unknown. Therefore, it is crucial to use event-related potential (ERP) to explore the "when" question, just the time course of the neural activity of degraded audiovisual stimuli. In the present research, we established two conditions: clear auditory + degraded visual (AcVd) and clear auditory + clear visual (AcVc) multisensory conditions. We enlisted 31 participants to evaluate the emotional valence of audiovisual stimuli. The resulting data were analyzed using ERP in time domains and Microstate analysis. Current results suggest that degraded vision impairs the early-stage processing of audiovisual stimuli, with the superior parietal lobule (SPL) regulating audiovisual processing in a top-down fashion. Additionally, our findings indicate that negative and positive stimuli elicit greater EPN compared to neutral stimuli, pointing towards a subjective motivation-related attentional regulation. To sum up, in the early stage of emotional audiovisual processing, the degraded visual signal affected the perception of the physical attributes of audiovisual stimuli and had a further influence on emotion extraction processing, leading to the different regulation of top-down attention resources in the later stage.

Prosopagnosia: face blindness and its association with neurological disorders

Loss of facial recognition or prosopagnosia has been well-recognized for over a century. It has been categorized as developmental or acquired depending on whether the onset is in early childhood or beyond, and acquired cases can have degenerative or non-degenerative aetiologies. Prosopagnosia has been linked to involvement of the fusiform gyri, mainly in the right hemisphere. The literature on prosopagnosia comprises case reports and small case series. We aim to assess demographic, clinical and imaging characteristics and neurological and neuropathological disorders associated with a diagnosis of prosopagnosia in a large cohort. Patients were categorized as developmental versus acquired; those with acquired prosopagnosia were further subdivided into degenerative versus non-degenerative, based on neurological aetiology. We assessed regional involvement on [18F] fluorodeoxyglucose-PET and MRI of the right and left frontal, temporal, parietal and occipital lobes. The Intake and Referral Center at the Mayo Clinic identified 487 patients with possible prosopagnosia, of which 336 met study criteria for probable or definite prosopagnosia. Ten patients, 80.0% male, had developmental prosopagnosia including one with Niemann-Pick type C and another with a forkhead box G1 gene mutation. Of the 326 with acquired prosopagnosia, 235 (72.1%) were categorized as degenerative, 91 (27.9%) as non-degenerative. The most common degenerative diagnoses were posterior cortical atrophy, primary prosopagnosia syndrome, Alzheimer's disease dementia and semantic dementia, with each diagnosis accounting for >10% of this group. The most common non-degenerative diagnoses were infarcts (ischaemic and haemorrhagic), epilepsy-related and primary brain tumours, each accounting for >10%. We identified a group of patients with non-degenerative transient prosopagnosia in which facial recognition loss improved or resolved over time. These patients had migraine-related prosopagnosia, posterior reversible encephalopathy syndrome, delirium, hypoxic encephalopathy and ischaemic infarcts. On [18F] fluorodeoxyglucose-PET, the temporal lobes proved to be the most frequently affected regions in 117 patients with degenerative prosopagnosia, while in 82 patients with non-degenerative prosopagnosia, MRI revealed the right temporal and right occipital lobes as most affected by a focal lesion. The most common pathological findings in those with degenerative prosopagnosia were frontotemporal lobar degeneration with hippocampal sclerosis and mixed Alzheimer's and Lewy body disease pathology. In this large case series of patients diagnosed with prosopagnosia, we observed that facial recognition loss occurs across a wide range of acquired degenerative and non-degenerative neurological disorders, most commonly in males with developmental prosopagnosia. The right temporal and occipital lobes, and connecting fusiform gyrus, are key areas. Multiple different pathologies cause degenerative prosopagnosia.

Effect of low luminance on face recognition in adults with central and peripheral vision loss

PURPOSE

To investigate the effect of low luminance on face recognition, specifically facial identity discrimination (FID) and facial expression recognition (FER), in adults with central vision loss (CVL) and peripheral vision loss (PVL) and to explore the association between clinical vision measures and low luminance FID and FER.

METHODS

Participants included 33 adults with CVL, 17 with PVL and 20 controls. FID and FER were assessed under photopic and low luminance conditions. For the FID task, 12 sets of three faces with neutral expressions were presented and participants asked to indicate the odd-face-out. For FER, 12 single faces were presented and participants asked to name the expression (neutral, happy or angry). Photopic and low luminance visual acuity (VA) and contrast sensitivity (CS) were recorded for all participants and for the PVL group, Humphrey Field Analyzer (HFA) 24-2 mean deviation (MD).

RESULTS

FID accuracy in CVL, and to a lesser extent PVL, was reduced under low compared with photopic luminance (mean reduction 20% and 8% respectively; p < 0.001). FER accuracy was reduced only in CVL (mean reduction 25%; p < 0.001). For both CVL and PVL, low luminance and photopic VA and CS were moderately to strongly correlated with low luminance FID (ρ = 0.61-0.77, p < 0.05). For PVL, better eye HFA 24-2 MD was moderately correlated with low luminance FID (ρ = 0.54, p = 0.02). Results were similar for low luminance FER. Together, photopic VA and CS explained 75% of the variance in low luminance FID, and photopic VA explained 61% of the variance in low luminance FER. Low luminance vision measures explained little additional variance.

CONCLUSION

Low luminance significantly reduced face recognition, particularly for adults with CVL. Worse VA and CS were associated with reduced face recognition. Clinically, photopic VA is a good predictor of face recognition under low luminance conditions.

Drift-diffusion modeling reveals that masked faces are preconceived as unfriendly

During the COVID-19 pandemic, the use of face masks has become a daily routine. Studies have shown that face masks increase the ambiguity of facial expressions which not only affects (the development of) emotion recognition, but also interferes with social interaction and judgement. To disambiguate facial expressions, we rely on perceptual (stimulus-driven) as well as preconceptual (top-down) processes. However, it is unknown which of these two mechanisms accounts for the misinterpretation of masked expressions. To investigate this, we asked participants (N = 136) to decide whether ambiguous (morphed) facial expressions, with or without a mask, were perceived as friendly or unfriendly. To test for the independent effects of perceptual and preconceptual biases we fitted a drift-diffusion model (DDM) to the behavioral data of each participant. Results show that face masks induce a clear loss of information leading to a slight perceptual bias towards friendly choices, but also a clear preconceptual bias towards unfriendly choices for masked faces. These results suggest that, although face masks can increase the perceptual friendliness of faces, people have the prior preconception to interpret masked faces as unfriendly.

Low vision devices for age-related macular degeneration: a systematic review

PURPOSE

Age-related macular degeneration (AMD) is a degenerative condition impacting central vision. Evaluating the effectiveness of low vision devices provides empirical evidence on how devices can rehabilitate and overcome deficits caused by AMD. This evidence could help to facilitate discussion on necessary future improvements to vision enhancement technology.

METHODS

A systematic review of the literature was conducted on low vision device use in AMD populations. Relevant peer-reviewed research articles from six databases were screened.

RESULTS

The findings of thirty-five studies revealed a significant positive impact of low vision devices leading to improvements in visual acuity, reading performance, facial recognition, and more. While the studies were found to have moderate risks of bias, a GRADE assessment of the evidence suggested the certainty of the evidence was low-moderate.

DISCUSSION

Simple hand-held low vision devices (e.g., magnifiers) appear to currently have greater preferential support than newer visual enhancement technology (e.g., head mounted devices). Financial, comfort or usability reasons may influence preferences more than performance-based findings. However, there is a lack of studies examining newer technologies in AMD populations, which future research should address. Moreover, given the presence of bias across the studies and limited controlled experiments, confidence in the results may be low.

CONCLUSIONS

Most studies indicated that low vision devices have positive impacts on reading and visual performance. But, even though they are reported to be a valuable asset to AMD populations, more rigorous research is required to draw conclusive evidence. IMPLICATIONS FOR REHABILITATIONLow vision devices can improve patient outcomes (e.g., vision, reading ability) for age-related macular degeneration populations.A multidisciplinary combination of low vision devices and rehabilitative services (i.e., eccentric viewing training, counselling, education) may enhance quality of life.

Peripheral visual field loss and activities of daily living

PURPOSE OF REVIEW

Peripheral visual field (VF) loss affects 13% of the population over 65. Its effect on activities of daily living and higher order visual processing is as important as it is inadequately understood. The purpose of this review is to summarize available literature on the impact of peripheral vision loss on driving, reading, face recognition, scene recognition and scene navigation.

RECENT FINDINGS

In this review, glaucoma and retrochiasmal cortical damage are utilized as examples of peripheral field loss which typically spare central vision and have patterns respecting the horizontal and vertical meridians, respectively. In both glaucoma and retrochiasmal damage, peripheral field loss causes driving difficulty - especially with lane maintenance - leading to driving cessation, loss of independence, and depression. Likewise, peripheral field loss can lead to slower reading speeds and decreased enjoyment from reading, and anxiety. In glaucoma and retrochiasmal field loss, face processing is impaired which impacts social functioning. Finally, scene recognition and navigation are also adversely affected, impacting wayfinding and hazard detection leading to decreased independence as well as more frequent injury.

SUMMARY

Peripheral VF loss is an under-recognized cause of patient distress and disability. All peripheral field loss is not the same, differential patterns of loss affect parameters of activities of daily living (ADL) and visual processing in particular ways. Future research should aim to further characterize patterns of deranged ADL and visual processing, their correlation with types of field loss, and associated mechanisms.

Empowerment-Based Physical Activity Intervention for People with Advanced Dry Age-Related Macular Degeneration: Mixed-Methods Protocol

Age-related macular degeneration (AMD) is the most common cause of incurable visual impairment and impacts daily life. These impacts include loss of social activities, decreased functional independence, and reduced physical activity. This protocol aims to describe a prospective, mixed-methodology for studying a population with AMD before, during, and after an empowerment-based physical activity intervention (EPI). A study framework was also developed for EPI. The intervention will include 20 older individuals (age 65+ years) with AMD recruited in Sweden. The intervention period is six months and comprises adapted physical activity and social activities in a group twice a week and individual health coaching on three occasions. The quantitative pre-test and three follow-ups include physical functional tests, an accelerometer that monitors physical activity continuously for one week, and questionnaires. Individual and focus-group interviews and ethnographic observations will explore the experience of living with AMD and what it means to participate in the EPI for individuals with AMD. The chosen methodology offers a structured way for researchers to explore the experiences and factors that may provide insights into the potential of creative supervised, adapted physical activity in groups, health coaching, and socialising that are significant to enable well-being among older individuals with AMD.

The Patient Voice in Neovascular Age-Related Macular Degeneration: Findings from a Qualitative Study

INTRODUCTION

Visual impairment resulting from diseases such as neovascular age-related macular degeneration (nAMD) may cause behavioural, environmental, psychological, and logistical challenges that could act as barriers to effective uptake and sustainability of treatment with anti-vascular endothelial growth factor agents (anti-VEGFs). Understanding emotions and experiences of patients with nAMD may help inform the determinants of adherence, and could contribute to improvements in ophthalmic outcomes and quality of life.

METHODS

Seventeen patients with nAMD receiving anti-VEGF injections were enrolled from three clinics: one each in France (n = 5), Germany (n = 6), and the UK (n = 6). Patients' health information and treatment characteristics were collected. Individual phone interviews were conducted by experienced health care interviewers. Transcripts were analysed thematically.

RESULTS

Patients (53% female) had a mean age of 77 years. Bilateral anti-VEGF injections were received by 24% (n = 4); and most (76%, n = 13) were adherent to their treatment. Patient emotions at diagnosis ranged from happiness at learning about the treatment for nAMD to being terrified of receiving an injection in the eye. Most patients mentioned feeling anxious and fearful before their first injection despite receiving reassurance. After the first injection, these feelings and apprehension abated for many, but not all. With the goal of maintaining the best possible vision, few (24%, n = 4) patients reported more than one missed appointment, and most had never considered stopping treatment. No patient reported additional assistance beyond family support; however, many had difficulties with recreational and domestic activities and had developed coping strategies.

CONCLUSION

This study provides insights on patients' emotions related to their experience of nAMD and its management, highlighting the varying experiences between individuals. It shows the importance of the patient's voice when considering patient care and management, and how the nature and timing of interventions can improve the experience of living with and managing nAMD.

Enhancing socio-emotional communication and quality of life in young cochlear implant recipients: Perspectives from parameter-specific morphing and caricaturing

The use of digitally modified stimuli with enhanced diagnostic information to improve verbal communication in children with sensory or central handicaps was pioneered by Tallal and colleagues in 1996, who targeted speech comprehension in language-learning impaired children. Today, researchers are aware that successful communication cannot be reduced to linguistic information—it depends strongly on the quality of communication, including non-verbal socio-emotional communication. In children with cochlear implants (CIs), quality of life (QoL) is affected, but this can be related to the ability to recognize emotions in a voice rather than speech comprehension alone. In this manuscript, we describe a family of new methods, termed parameter-specific facial and vocal morphing. We propose that these provide novel perspectives for assessing sensory determinants of human communication, but also for enhancing socio-emotional communication and QoL in the context of sensory handicaps, via training with digitally enhanced, caricatured stimuli. Based on promising initial results with various target groups including people with age-related macular degeneration, people with low abilities to recognize faces, older people, and adult CI users, we discuss chances and challenges for perceptual training interventions for young CI users based on enhanced auditory stimuli, as well as perspectives for CI sound processing technology.

Face masks disrupt holistic processing and face perception in school-age children

Face perception is considered a remarkable visual ability in humans that is subject to a prolonged developmental trajectory. In response to the COVID-19 pandemic, mask-wearing has become mandatory for adults and children alike. Recent research shows that mask-wearing hinders face recognition abilities in adults, but it is unknown if the same holds true in school-age children in whom face perception is not fully developed. Here we tested children (n = 72, ages 6-14 years old) on the Cambridge Face Memory Test - Kids (CFMT-K), a validated measure of face perception performance. Faces were presented with or without masks and across two orientations (upright/inverted). The inclusion of face masks led to a profound deficit in face perception abilities. This decrement was more pronounced in children compared to adults, but only when task difficulty was adjusted across the two age groups. Additionally, children exhibited reliable correlations between age and the CFMT-K score for upright faces for both the mask and no-mask conditions. Finally, as previously observed in adults, children also showed qualitative differences in the processing of masked versus non-masked faces. Specifically, holistic processing, a hallmark of face perception, was disrupted for masked faces as suggested by a reduced face-inversion effect. Together, these findings provide evidence for substantial quantitative and qualitative alterations in the processing of masked faces in school-age children.

Clinical decision support in primary care for better diagnosis and management of retinal disease

Misdiagnosis of retinal disease is a common problem in primary care that can lead to irreversible vision loss and false-positive referrals, resulting in inappropriate use of health services. Clinical decision support systems describe tools that leverage information technology to provide timely recommendations that assist clinicians in the decisions they make about the care of a patient. They, therefore, have the potential to reduce the rate of misdiagnosis by promoting evidence-based medicine and more effective and efficient healthcare. This narrative review aims to support primary care practitioners in better understanding the current and emerging capacity of clinical decision support systems in eye care. Different types of clinical decision support systems are discussed, using current examples and evidence from the available literature to demonstrate how they may improve diagnostic effectiveness and aid the management of retinal disease. Comments are made on the future directions of clinical decision support in primary eye care and the potential applications of artificial intelligence.

Impact of Lighting Assessment and Optimization on Participation and Quality of Life in Individuals with Vision Loss

This pilot study was designed to investigate the effects of a holistic lighting intervention on the quality of life for individuals with low vision. Sixty participants (44 women; median age 69 years) with visual impairment received lighting interventions, including a home visit and consultation in a lighting lab. Assisted by low vision consultants, participants evaluated their performance using the Canadian Occupational Performance Measure (COPM) before and after the intervention. Improvements in visual functioning and quality of life were evaluated using the 39-item National Eye Institute Visual Function Questionnaire (NEI VFQ-39), the Groffman Visual Tracing Test, and the Farnsworth Dichotomous Test (D15). Following the lighting intervention, scores improved for all activities in the COPM (p < 0.01), for near activities and vision-specific role difficulties in the VFQ-39 (p < 0.05), and overall in the D15 test (p < 0.05). These results suggest the intervention provided an effective method for improving the participants' quality of life and performance.

Neurocognitive effects of a training program for poor face recognizers using shape and texture caricatures: A pilot investigation

Recent research suggested disproportional usage of shape information by people with poor face recognition, although texture information appears to be more important for familiar face recognition. Here, we tested a training program with faces that were selectively caricatured in either shape or texture parameters. Forty-eight young adults with poor face recognition skills (1 SD below the mean in at least 2/3 face processing tests: CFMT, GFMT, BFFT) were pseudo-randomly assigned to either one of two training groups or a control group (n = 16 each). Training comprised six sessions over three weeks. Per session, participants studied ten unfamiliar facial identities whose shape or texture characteristics were caricatured. Before and after training (or waiting in the control group), all participants completed EEG experiments on face learning and famous face recognition, and behavioral face processing tests. Results showed small but specific training-induced improvements: Whereas shape training improved face matching (training tasks, and to some extent GFMT), texture training elicited marked improvements in face learning (CFMT). Moreover, for the texture training group the N170 ERP was enhanced for novel faces post-training, suggesting training-induced changes in early markers of face processing. Although further research is necessary, this suggests that parameter-specific caricature training is a promising way to improve performance in people with poor face recognition skills.

Identifying the content for an item bank and computerized adaptive testing system to measure the impact of age-related macular degeneration on health-related quality of life

PURPOSE

We are developing an age-related macular degeneration (AMD) health-related quality of life (HRQoL) item bank, applicable to Western and Asian populations. We report primarily on content generation and refinement, but also compare the HRQoL issues reported in our study with Western studies and current AMD-HRQoL questionnaires.

METHODS

In this cross-sectional, qualitative study of AMD patients attending the Singapore National Eye Centre (May-December 2019), items/domains were generated from: (1) AMD-specific questionnaires; (2) published articles; (3) focus groups/semi-structured interviews with AMD patients (n = 27); and (4) written feedback from retinal experts. Following thematic analysis, items were systematically refined to a minimally representative set and pre-tested using cognitive interviews with 16 AMD patients.

RESULTS

Of the 27 patients (mean ± standard deviation age 67.9 ± 7.0; 59.2% male), 18 (66.7%), two (7.4%), and seven (25.9%) had no, early-intermediate, and late/advanced AMD (better eye), respectively. Whilst some HRQoL issues, e.g. activity limitation, mobility, lighting, and concerns were similarly reported by Western patients and covered by other questionnaires, others like anxiety about intravitreal injections, work tasks, and financial dependency were novel. Overall, 462 items within seven independent HRQoL domains were identified: Activity limitation, Lighting, Mobility, Emotional, Concerns, AMD management, and Work. Following item refinement, items were reduced to 219, with 31 items undergoing amendment.

CONCLUSION

Our 7-domain, 219-item AMD-specific HRQoL instrument will undergo psychometric testing and calibration for computerized adaptive testing. The future instrument will enable users to precisely, rapidly, and comprehensively quantify the HRQoL impact of AMD and associated treatments, with item coverage relevant across several populations.

Coarse-to-Fine(r) Automatic Familiar Face Recognition in the Human Brain

At what level of spatial resolution can the human brain recognize a familiar face in a crowd of strangers? Does it depend on whether one approaches or rather moves back from the crowd? To answer these questions, 16 observers viewed different unsegmented images of unfamiliar faces alternating at 6 Hz, with spatial frequency (SF) content progressively increasing (i.e., coarse-to-fine) or decreasing (fine-to-coarse) in different sequences. Variable natural images of celebrity faces every sixth stimulus generated an objective neural index of single-glanced automatic familiar face recognition (FFR) at 1 Hz in participants' electroencephalogram (EEG). For blurry images increasing in spatial resolution, the neural FFR response over occipitotemporal regions emerged abruptly with additional cues at about 6.3-8.7 cycles/head width, immediately reaching amplitude saturation. When the same images progressively decreased in resolution, the FFR response disappeared already below 12 cycles/head width, thus providing no support for a predictive coding hypothesis. Overall, these observations indicate that rapid automatic recognition of heterogenous natural views of familiar faces is achieved from coarser visual inputs than generally thought, and support a coarse-to-fine FFR dynamics in the human brain.

Assessment of vision-related quality of life and depression and anxiety rates in patients with neovascular age-related macular degeneration

PURPOSE

To assess the vision-related quality of life and the depression and anxiety rates in patients with neovascular Age-Related Macular Degeneration (nAMD).

METHODS

A cross-sectional study of patients with nAMD treated with intravitreal injections was performed. The patients completed two validated questionnaires: the Visual Functioning Questionnaire (VFQ-25, score from 0 to 100), and the Hospital Anxiety and Depression Scale (HADS) questionnaire. Age, gender and visual acuity (VA) in the Early Treatment Diabetic Retinopathy Study (ETDRS) scale was registered.

RESULTS

Fifty-five patients with nAMD participated with a mean age of 80.9 ± 6.6 years-old (range 67-93) and a mean VA in the best eye of 73.5 ± 12.7 letters (range 44-95). The global VFQ-25 mean score was 57.4 ± 21.9 being 38.9 ± 13.2 for the general vision and 42.0 ± 19.5 for the general health. VA in the best eye was associated with the global score of the VFQ-25 scale (R = 0.608; P < .001), but no correlation was observed with general health (P = .936). In the HADS scale, 26.9% and 25.5% of patients had symptoms of depression and anxiety respectively. A negative correlation was found between the HADS and VFQ-25 scales for the general vision score (R = -0.438).

CONCLUSION

This study elucidates the impact of vision impairment and the visual functioning in nAMD, describing an important rate of depression and anxiety symptoms.

Social cognition in refugee children: an experimental cross-sectional study of emotional processing with Syrian families in Turkish communities

More than 5.6 million people have fled Syria since 2011, about half of them children. These children grow up with parents that often suffer from war-related mental health problems. In this study, we assess emotional processing abilities of 6-18 year-old children growing up in families that have fled from Syria and reside in Turkish communities (100 families, 394 individuals). We demonstrate that mothers', but not fathers', post-traumatic stress (PTS) impacts children's emotional processing abilities. A 4% reduction of mothers' PTS was equivalent to 1 year of development in children, even when controlling for parents' traumatic experiences. Making a small investment in increased mental health of refugee mothers might have a positive impact on the lives of their children.

Impact of living with a bilateral central vision loss due to geographic atrophy-qualitative study

OBJECTIVE

Geographic atrophy (GA), a type of dry age-related macular degeneration, affects vision as central vision loss (CVL). The challenges faced due to bilateral CVL in activities of daily living and strategies taken to overcome those challenges are not very well understood in the Indian population. This qualitative study aims to understand the impact on everyday life activities and related adaptive and coping strategies in people with long-standing bilateral CVL due to GA in India.

DESIGN, PARTICIPANTS, SETTING AND METHODS

A qualitative study using a semistructured face-to-face interview was conducted on 10 people with bilateral CVL after obtaining written informed consent. The interviews were audio-recorded, and were transcribed verbatim. Thematic analysis was carried out to understand the challenges faced and adaptive methods due to the impact of CVL.

RESULTS

Ten participants (50% male) with a median age (IQR) of 72 (70, 74) years were interviewed. All the participants had best-corrected visual acuity of ≤6/60 in the better eye and reported an absolute central scotoma with the home Amsler chart. Qualitative thematic analysis identified four main themes: challenges in everyday living (difficulty in face identification, reading), challenges with lifestyle and socialisation (driving, cooking, reading for a longer duration, watching TV, socially inactive), psychological implications (depression, poor self-esteem, fear due to poor vision) and strategies to overcome the challenges (voice identification, technology support).

CONCLUSION

GA has a severe negative impact on the quality of life in people with CVL. Inability to recognise faces was the main reason for dependency on others and being socially disconnected. The findings will help clinicians in providing improved rehabilitative care.

Relationships between retinal structure and function and vision-related quality of life measures in advanced age-related macular degeneration

PURPOSE

To evaluate the association between ophthalmic structure/function measures and five standardized quality of life (QoL) instruments, in patients with advanced age-related macular degeneration (AMD).

METHODS

We examined 20 AMD patients (ages 66-93 years) recruited from the Canberra Hospital Ophthalmology Department. Visual function measures included low and high contrast visual acuity (LCVA and HCVA) and measures from 10-2 Matrix visual fields (VF). Optical coherence tomography (OCT) quantified central retinal thickness (CRT), average macular thickness (AT), and retinal nerve fibre layer thickness (RNFL). The QoL instruments were the macular degeneration-related quality of life (MacDQoL), the National Eye Institute Visual Functioning Questionnaire (VFQ), its two face-recognition questions (A6 and 11), and the Geriatric Depression Scale (GDS). Pearson correlations, Canonical Correlation Analysis (CCA), and cross-validated stepwise-regression were used to examine the relationships between structure/function measures and the QoL instruments.

RESULTS

The selected models for the five instruments had R² ranging from 0.65 ± 0.12 to 0.90 ± 0.05 (mean ± SD) and median F-statistics > 188. HCVA was strongly associated with all QoL except the GDS, for which CRT, AT and RNFL figured highly. RNFL was most important for MacDQoL, and 2^nd for VFQ question-A6. Centrally weighted VF measures were rarely selected but global VF measures were common, especially for the overall NEI-VFQ questionnaire. CCA revealed that the structure/function measures and QoL instruments contained 2 statistically independent mechanisms.

CONCLUSIONS

In patients with advanced AMD, CRT and HCVA were strong determinants of QoL instruments in AMD patients.

Correlation of Central Versus Peripheral Macular Structure-Function With Acuity in Age-Related Macular Degeneration

Purpose

Patients with advanced age-related macular degeneration (AMD) may have preserved visual function despite significant retinal structural changes. We aimed to evaluate the relationships among retinal thickness, macular sensitivity, and visual acuity (VA) in advanced AMD.

Methods

We examined 43 eyes of 22 patients with advanced AMD (ages 66–93 years), prospectively recruited from the Canberra Hospital Ophthalmology Department. Visual function was measured on participants with low and high contrast visual acuity (LCVA and HCVA) and 10-2 Matrix visual fields. Retinal structure was determined with spectral domain optical coherence tomography (OCT), and customized software mapped the 64 OCT macular thickness regions onto the 44 regions of the 10-2 test.

Results

Median retinal thickness at each 10-2 region was near normal. Just 7 of 88 regions from the OCT analysis that were thicker than the median had sensitivity that declined significantly with increasing thickness (r = −0.698 ± 0.082, mean ± SD), whereas 17 of 88 thinner regions showed significantly decreasing sensitivity with decreasing thickness (r = 0.723 ± 0.078). The absolute value of deviations from median optical coherence tomography thickness (aOCT) outside the central eight degrees was significantly correlated with HCVA (r = −0.34, P = 0.047). Thickness in the central eight degrees was not. Similarly, matrix sensitivities inside the central eight degrees were significantly correlated with outer aOCT (r = −0.49, P = 0.002).

Conclusions

Retinal thickness outside eight degrees were significantly associated with HCVA and macular sensitivity. These results suggest that outer macular thickness may be a useful prognostic indicator in AMD.

Translational Relevance

Retinal structure at the borders of the macula may be a surrogate marker of vision and retinal thickness near fixation.

Masking Emotions: Face Masks Impair How We Read Emotions

To date, COVID-19 has spread across the world, changing our way of life and forcing us to wear face masks. This report demonstrates that face masks influence the human ability to infer emotions by observing facial configurations. Specifically, a mask obstructing a face limits the ability of people of all ages to infer emotions expressed by facial features, but the difficulties associated with the mask’s use are significantly pronounced in children aged between 3 and 5 years old. These findings are of essential importance, as they suggest that we live in a time that may potentially affect the development of social and emotion reasoning, and young children’s future social abilities should be monitored to assess the true impact of the use of masks.

Why the other-race effect matters: Poor recognition of other-race faces impacts everyday social interactions

What happens to everyday social interactions when other-race recognition fails? Here, we provide the first formal investigation of this question. We gave East Asian international students (N = 89) a questionnaire concerning their experiences of the other-race effect (ORE) in Australia, and a laboratory test of their objective other-race face recognition deficit using the Cambridge Face Memory Test (CFMT). As a 'perpetrator' of the ORE, participants reported that their problems telling apart Caucasian people contributed significantly to difficulties socializing with them. Moreover, the severity of this problem correlated with their ORE on the CFMT. As a 'victim' of the ORE, participants reported that Caucasians' problems telling them apart also contributed to difficulties socializing. Further, 81% of participants had been confused with other Asians by a Caucasian authority figure (e.g., university tutor, workplace boss), resulting in varying levels of upset/difficulty. When compared to previously established contributors to international students' high rates of social isolation, ORE-related problems were perceived as equally important as the language barrier and only moderately less important than cultural differences. We conclude that the real-world impact of the ORE extends beyond previously identified specialized settings (eyewitness testimony, security), to common everyday situations experienced by all humans.

Association of Patterns of Glaucomatous Macular Damage With Contrast Sensitivity and Facial Recognition in Patients With Glaucoma

Importance

Facial recognition is a critical activity of daily living that relies on macular function. Glaucomatous macular damage may result in impaired facial recognition that may negatively affect patient quality of life.

Objective

To evaluate the association of patterns of glaucomatous macular damage with contrast sensitivity and facial recognition among patients with glaucoma.

Design, Setting, and Participants

In this prospective cohort study at a single tertiary care center, 144 eyes of 72 consecutive patients with glaucoma with good visual acuity (20/40 or better in each eye) were studied. Data were collected from March to April 2019.

Exposures

Eyes with macular damage were categorized as having focal, diffuse, or mixed (focal and diffuse) damage based on optic disc and macular spectral-domain optical coherence tomography and 10-2 visual field (VF) damage. Only eyes with focal or diffuse damage were included. Higher-acuity and lower-acuity eyes were determined by 10-2 VF mean deviation (MD). Facial disability was defined as facial recognition scores at the 2% level of normal participants.

Main Outcomes and Measures

(1) Monocular contrast threshold as measured by the Freiburg Visual Acuity and Contrast Test and (2) binocular facial recognition as measured by the Cambridge Face Memory Test.

Results

Of the 72 included patients, 49 (68%) were White and 41 (57%) were female, and the mean (SD) age was 67.0 (11.6) years. Eyes with diffuse damage had greater contrast impairment compared with eyes with focal damage (β = -0.5; 95% CI, -0.6 to -0.4; P < .001) after adjusting for 10-2 VF MD, 24-2 VF MD, age, presence of an early cataract, and number of drops. Similarly, Cambridge Face Memory Test scores were significantly lower in patients with diffuse rather than focal macular damage, regardless of eye (better-seeing eye: β = 10.0; 95% CI, 2.0 to 18.2; P = .001; worse-seeing eye: β = 5.5; 95% CI, 0.8 to 10.0; P = .23). Relative risk of facial disability was greater for patients with diffuse but not focal macular damage in the better-seeing eye (relative risk, 86.2; 95% CI, 2.7 to 2783.3; P = .01).

Conclusions and Relevance

In this cohort study, diffuse rather than focal glaucomatous macular damage was associated with diminished facial recognition and contrast sensitivity. Evaluation of macular optical coherence tomography and 10-2 VF and resultant detection of diffuse macular damage may help minimize glaucoma-related visual disability.

A Randomized Study of Nutritional Supplementation in Patients with Unilateral Wet Age-Related Macular Degeneration

The purpose of this study is evaluate the efficacy and safety of medicinal products containing the original Age-Related Eye Disease group (AREDS) formulation at doses approved in Europe (EU, control group; n = 59) with a product that adds DHA, lutein, zeaxanthin, resveratrol and hydroxytyrosol to the formula (intervention group; n = 50). This was a multicenter, randomized, observer-blinded trial conducted in patients aged 50 years or older diagnosed with unilateral exudative Age related Macular Degeneration AMD. At month 12, the intervention did not have a significant differential effect on visual acuity compared with the control group, with an estimated treatment difference in Early Treatment Diabetic Retinopathy Study (ETDRS) of −1.63 (95% CI −0.83 to 4.09; p = 0.192). The intervention exhibited a significant and, in most cases, relevant effect in terms of a reduction in some inflammatory cytokines and a greater improvement in the fatty acid profile and serum lutein and zeaxantin concentration. In patients with unilateral wet AMD, the addition of lutein, zeaxanthin, resveratrol, hydroxytyrosol and DHA to the AREDS EU recommended doses in the short-term did not have a differential effect on visual acuity compared to a standard AREDS EU formula but, in addition to improving the fatty acid profile and increasing carotenoid serum levels, may provide a beneficial effect in improving the proinflammatory and proangiogenic profile of patients with AMD.

Exacerbation of AMD Phenotype in Lasered CNV Murine Model by Dysbiotic Oral Pathogens

Emerging evidence underscores an association between age-related macular degeneration (AMD) and periodontal disease (PD), yet the biological basis of this linkage and the specific role of oral dysbiosis caused by PD in AMD pathophysiology remains unclear. Furthermore, a simple reproducible model that emulates characteristics of both AMD and PD has been lacking. Hence, we established a novel AMD+PD murine model to decipher the potential role of oral infection (ligature-enhanced) with the keystone periodontal pathogen Porphyromonas gingivalis, in the progression of neovasculogenesis in a laser-induced choroidal-neovascularization (Li-CNV) mouse retina. By a combination of fundus photography, optical coherence tomography, and fluorescein angiography, we documented inflammatory drusen-like lesions, reduced retinal thickness, and increased vascular leakage in AMD+PD mice retinae. H&E further confirmed a significant reduction of retinal thickness and subretinal drusen-like deposits. Immunofluorescence microscopy revealed significant induction of choroidal/retinal vasculogenesis in AMD+PD mice. qPCR identified increased expression of oxidative-stress, angiogenesis, pro-inflammatory mediators, whereas antioxidants and anti-inflammatory genes in AMD+PD mice retinae were notably decreased. Through qPCR, we detected Pg and its fimbrial 16s-RrNA gene expression in the AMD+PD mice retinae. To sum-up, this is the first in vivo study signifying a role of periodontal infection in augmentation of AMD phenotype, with the aid of a pioneering AMD+PD murine model established in our laboratory.

The COVID-19 pandemic masks the way people perceive faces

The unprecedented efforts to minimize the effects of the COVID-19 pandemic introduce a new arena for human face recognition in which faces are partially occluded with masks. Here, we tested the extent to which face masks change the way faces are perceived. To this end, we evaluated face processing abilities for masked and unmasked faces in a large online sample of adult observers (n = 496) using an adapted version of the Cambridge Face Memory Test, a validated measure of face perception abilities in humans. As expected, a substantial decrease in performance was found for masked faces. Importantly, the inclusion of masks also led to a qualitative change in the way masked faces are perceived. In particular, holistic processing, the hallmark of face perception, was disrupted for faces with masks, as suggested by a reduced inversion effect. Similar changes were found whether masks were included during the study or the test phases of the experiment. Together, we provide novel evidence for quantitative and qualitative alterations in the processing of masked faces that could have significant effects on daily activities and social interactions.

Quality of Life in Patients with Unresolved Facial Nerve Palsy and Exposure Keratopathy Treated by Upper Eyelid Gold Weight Loading

Background

Loading of the upper eyelid with gold weights is a well-established procedure for the correction of paralytic lagophthalmos. There is no reliable research evaluating the results of this treatment from the patients’ viewpoint.

Aim

The aim of this research was to evaluate quality of life (QOL) domains through two standardized questionnaires (SF-36 and NEI-VFQ39) in patients treated by upper eyelid gold weight loading compared to healthy individuals (the “healthy” group) as well as patients with other ophthalmologic conditions (the “sick” group).

Patients and Methods

This prospective comparative clinical study of 416 surveys was conducted in 2012–2018. The study group includes 59 people: 40 women, 19 men aged 55.5 ± 17.4 treated with gold weights for corneal complications due to unresolved facial nerve palsy. General QOL was assessed using the SF-36 questionnaire. Eye-related QOL was assessed through the NEI-VFQ39 questionnaire. The results were compared with those obtained in 2 control groups: the “healthy” and the “sick,” 53 individuals each.

Results

A statistically significant increase in QOL domains was noted in patients with facial nerve palsy after treatment (p<0.001). No statistically significant differences were found in categories defining the Physical Component Score in these patients as compared to those from the “sick” control group (p = 0.95). After surgery, the results of the Mental Component Score were comparable to those in the “healthy” control group (p = 0.51). The eye-related health scores changed significantly after surgery and differed significantly compared to the “sick” control group (p <0.05); however, they did not reach the level of the “healthy” control group (p <0.001).

Conclusion

Patients with untreated facial nerve palsy had the lowest QOL levels among all individuals involved in this study. Treatment of lagophthalmos by gold weights significantly improved their QOL, with the greatest impact on mental aspects of health.

The patients' view: age-related macular degeneration and its effects - a meta-synthesis

Aim: The aim of this meta-synthesis is to find out what it means for patients with age-related macular degeneration to live with visual impairment, how they cope with the illness and how they experience their medical care, including vascular endothelial growth factor inhibitor therapy.Method: Inclusion criteria: qualitative studies exploring patients' experiences with age-related macular degeneration in their daily lives and with medical care, published in journals in English or German. The included studies were analysed following the rules and principles of grounded theory.Results: For the analysis, twenty-four articles matching the inclusion criteria were identified. Three main analytic themes emerged from the included studies: (i) a life shaped by losses; (ii) the burden of medical treatment; and (iii) coping with vision loss. For patients, visual impairment/vision loss means living with multiple losses in various domains of life. With the introduction of vascular endothelial growth factor inhibitor therapy, patients with neovascular age-related macular degeneration have a good chance of slowing down the disease progression; therapy does, however, also represent a major burden.Conclusion: New strategies need to be conceived to reduce the burden of medical treatment and to improve the dissemination of information about age-related macular degeneration.IMPLICATIONS FOR REHABILITATIONMost of the people with age- related macular degeneration seem to adapt to visual impairment.Medical treatment implies a great physical and psychological burden for patients with neovascular (wet) age- related macular degeneration.The physical and psychological burden needs to be recognized and addressed in the management of patients with neovascular (wet) AMD in medical facilities.More research is needed on how rehabilitation services may support the adaptation process of patients in the different stages of AMD.

A critical period for faces: Other-race face recognition is improved by childhood but not adult social contact

Poor recognition of other-race faces is ubiquitous around the world. We resolve a longstanding contradiction in the literature concerning whether interracial social contact improves the other-race effect. For the first time, we measure the age at which contact was experienced. Taking advantage of unusual demographics allowing dissociation of childhood from adult contact, results show sufficient childhood contact eliminated poor other-race recognition altogether (confirming inter-country adoption studies). Critically, however, the developmental window for easy acquisition of other-race faces closed by approximately 12 years of age and social contact as an adult — even over several years and involving many other-race friends — produced no improvement. Theoretically, this pattern of developmental change in plasticity mirrors that found in language, suggesting a shared origin grounded in the functional importance of both skills to social communication. Practically, results imply that, where parents wish to ensure their offspring develop the perceptual skills needed to recognise other-race people easily, childhood experience should be encouraged: just as an English-speaking person who moves to France as a child (but not an adult) can easily become a native speaker of French, we can easily become “native recognisers” of other-race faces via natural social exposure obtained in childhood, but not later.