Characterizing the prevalence and nature of facial recognition deficits in non-proliferative diabetic retinopathy

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Project summary/abstract Facial perception and memory are visual abilities that are driven by an interplay between low-level visual and higher-level cognitive functioning. Deficits in facial perception and memory are associated with diminished quality of life and a range of social challenges, and it has been suggested that this functional deficit may be an early marker for the later onset of structural abnormalities in a variety of conditions. One of these conditions—one that has received scant attention—is diabetic retinopathy. In a recent systematic review, difficulty in perceiving faces was noted as one of the greatest subjective restrictions on visual functioning. Diabetic retinopathy affects approx- imately one-third of individuals with diabetes world-wide. The vision loss associated with diabetic retinopathy is preventable, given early identification, medical intervention and monitoring, and behavioral interventions. Diabetic retinopathy can be generally separated into two classes. The first is non-proliferative diabetic retinopathy, which is characterized by micro-aneurysms, intraretinal hemorrhages, venous beading or intra-retinal microvascular ab- normalities. The second is proliferative diabetic retinopathy, which is characterized by retinal neovascularization. In cases of macular edema, there is a thickening of the macula which can result in the loss of central vision. Deficits in face processing have been studied more frequently in two pathologies that affect the macula: age- related macular degeneration (AMD) and glaucomatous macular damage. Patients with AMD regularly identify facial processing as tasks with which they experience significant difficulty. In the literature on AMD, deficits in facial processing have been identified as significant components of quality of life. The magnitude of the deficits in facial processing in AMD are such that they are second only to deficits in reading in subjective complaints. Finally, it has been noted that deficits in facial processsing are among the first subjectively-reported symptoms of AMD, often occurring before the detection of structural abnormalities. With respect to deficits in facial percep- tion and memory in glaucomatous macular damage, there is evidence that significant impairments exist despite patients having good central visual acuity. In addition, the amount of the diffuse macular damage is significantly related to impairments in contrast sensitivity and measures of facial recognition and identification. It has been suggested that other related visual pathologies—including diabetic retinopathy—should show similar patterns of performance deficits. However, very little work on this issue has been done in the case of diabetic retinopa- thy. The work proposed here represents an important first step in addressing this need. The accomplishment of this work will result in the first quantification of the prevalence and severity of deficits in facial processing in diabetic retinopathy, the first analytic empirical treatment of the pathology-related differences in processing feat- ural and configural information, and the first theoretical treatment of those differences. The novel application of two meta-theories using a new experimental design, along with a modeling approach capable of relating those meta-theories has the potential to be transformative in this domain.