Improving face perception and quality of life in age-related macular degeneration
Date
2018
Authors
Lane, Joanne Rachel
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Abstract
The ability to see faces is essential for successful social
interactions and good quality of life. Age-related macular
degeneration (AMD) is a progressive eye condition that damages
central vision required to see faces clearly. This thesis aims to
investigate potential means to improve quality of life in AMD,
via a two-pronged approach.
The first prong examines the importance of face recognition
difficulties, using a qualitative study of the effects of poor
face perception in AMD on social interactions and quality of
life. Previous studies of the impact of AMD on quality of life
have focussed on domains including reading, driving, and
self-care. Paper 1 of the thesis presents the first in-depth
study of the quality-of-life impacts arising specifically from
poor face perception. Results showed that, across all levels of
vision loss (still driving through legally blind), AMD patients
experience everyday problems with recognising who people are
(face identity) and their emotions (facial expressions). These
result in difficulties in social interactions, fear of offending
others (e.g., appearing to ignore them deliberately),
misinterpreting how others are feeling, and missing out in social
situations. Patients also reported others did not understand
their vision loss, and worried about appearing a fraud. These
outcomes often contributed to social withdrawal and reduced
confidence and quality of life. Paper 1 uses the study findings
to develop new community resources (Faces and Social Life in AMD
information sheet, conversation-starter, brochure for low-vision
clinics), intended to improve patient and community understanding
of how AMD affects face perception, and to provide practical tips
for improving social interactions.
The second prong focusses on improving face perception in AMD
patients via image enhancement. The broad idea here is that,
potentially, face images can be displayed to patients on screens
or smart glasses after being digitally altered in ways that make
them easier for patients to see and interpret. The specific image
enhancement tested here is caricaturing, which involved
exaggerating the shape information in the face image away from
the average face (for face identity) or a neutral expression (for
face expression). Paper 2 demonstrates that caricaturing can
improve perception of identity in AMD; this benefit was observed
for all eyes tested with mild vision loss, and half of eyes
tested with moderate-to-severe vision loss. Paper 3 demonstrated
that caricaturing can improve perception of facial expression in
AMD, particularly for low-intensity expressions that are poorly
recognised in their natural form, again across a wide range of
vision loss.
Overall, this thesis demonstrates that poor face perception in
AMD is an important contributor to patients’ reduced quality of
life. With the aim of enhancing quality of life, I have developed
resources to improve community understanding, plus demonstrated
that caricaturing provides a useful image enhancement method in
AMD. Future research should focus on: further evaluation of the
helpfulness of the community resources (to patients, carers and
orthoptists); testing whether combining image enhancement methods
(e.g., caricaturing plus contrast manipulations) can further
improve face perception; and engineering advances needed to
implement accurate caricaturing for patients in real-time.
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face perception, age-related macular degeneration, quality of life, social interactions, caricaturing
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Thesis (PhD)
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