Editors Selection IGR 21-4

Quality of Life: Patterns of Damage Associated with Visual Disability in Glaucoma I

Deanna Taylor
David Crabb

Comment by Deanna Taylor & David Crabb on:

91802 Association of Patterns of Glaucomatous Macular Damage With Contrast Sensitivity and Facial Recognition in Patients With Glaucoma, Hirji SH; Hood DC; Liebmann JM et al., JAMA ophthalmology, 2021; 139: 27-32

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The importance of facial recognition, crucial to social interactions and relationships, cannot be underestimated. Indeed, long-term face recognition problems can lead to chronic anxiety, social isolation and employment difficulties.1 Whilst it is evidenced in the literature that individuals with advanced glaucoma are likely to experience difficulties recognizing faces,2-4 the study by Hirji and colleagues is first to investigate the association between patterns of macular damage and face recognition performance.

Hirji et al. recruited 72 patients with either focal or diffuse glaucomatous macular damage to perform the Freiburg Visual Acuity and Contrast Test (FrACT) and the Cambridge Face Memory Test (CFMT). The CFMT, originally designed for use in prosopagnosia, is a widely used and recognized face recognition test, used in previous eye research including our lab's work in glaucoma and age-related macular degeneration,2,5 Hirji et al. found diffuse macular damage to be associated with worse contrast threshold and face recognition performance compared with eyes with focal macular damage.

Diffuse macular damage is associated with worse contrast threshold and face recognition performance compared with eyes with focal macular damage

This has important clinical implications. Clinicians should use these findings to tailor counselling and educate patients as to what their specific pattern of visual field loss might mean in their day-to-day lives. Moreover, as the authors suggest, where diffuse macular damage is suspected, 'early and aggressive intervention' should be considered.

One limitation of the CFMT is its reliance on memory. In this study, participants were required to pass the Short Test of Mental Status in order to take part. However, this was designed as a dementia screening tool and it is possible that participants may have passed the test with mild cognitive impairment, perhaps affecting their performance on the CFMT. Future research should consider including face recognition tests that eliminate the recall aspect of the task, such as the Caledonian Face Test6 or similar.7 Nevertheless, this work adds important evidence to an under-researched area in the field, with clear implications for both patients and clinicians.


  1. Yardley L, McDermott L, Pisarski S, Duchaine B, Nakayama K. Psychosocial consequences of developmental prosopagnosia: A problem of recognition. Journal of Psychosomatic Research. 2008/11/01/ 2008;65(5):445-451. doi:https://doi. org/10.1016/j.jpsychores.2008.03.013
  2. Glen FC, Crabb DP, Smith ND, Burton R, Garway-Heath DF. Do Patients with Glaucoma Have Difficulty Recognizing Faces? Invest Ophthalmol Vis Sci. 2012;53(7):3629-3637. doi:10.1167/iovs.11-8538
  3. Mazzoli LS, Urata CN, Kasahara N. Face memory deficits in subjects with eye diseases: a comparative analysis between glaucoma and age-related macular degeneration patients from a developing country. Graefe's Arch Clin Exper Ophthalmol. 2019/09/01 2019;257(9):1941-1946. doi:10.1007/s00417-019-04380-5
  4. Roux-Sibilon A, Rutge F, Aptel F, et al. Scene and human face recognition in the central vision of patients with glaucoma. PLOS ONE. 2018;13(2):e0193465. doi:10.1371/journal.pone.0193465
  5. Taylor DJ, Smith ND, Binns AM, Crabb DP. The effect of non-neovascular age-related macular degeneration on face recognition performance. Graefe's Arch Clin Exper Ophthalmol . 2018;256(4):815-821. doi:10.1007/s00417-017-3879-3
  6. Logan AJ, Wilkinson F, Wilson HR, Gordon GE, Loffler G. The Caledonian face test: A new test of face discrimination. Vis Res. 2016/02/01/ 2016;119:29-41. doi:https://
  7. Jones PR, Tigchelaar I, Demaria G, et al. Refinement and preliminary evaluation of two tablet-based tests of real-world visual function. opo.12658. Ophthalmic and Physiological Optics. 2020/01/01 2020;40(1):35-46. doi:

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