I’m Sorry, Who Are You?

When you got a diagnosis of macular degeneration (MD or AMD), were you told that if the disease progresses, you will not be able to see faces? This applies to any type of MD. I know this sounds awful. It can be. I’ve had people tell me that they can’t imagine not being able to see the faces of their grandchildren as they grow or not being able to recognize the people that they know well.

Facial recognition and AMD

Not being able to see faces causes people to not recognize other people when they are face-to-face but a distance away. Members of my Facebook group tell me that they've heard things like, “I’m embarrassed that I didn't recognize my own mother/father/sister/brother!”  That can be very upsetting not only to the person with AMD but also to the person who is not recognized.

Can't read facial expressions

Not only can it be difficult to recognize faces but also to recognize facial expressions. That can add to a person’s feeling of social isolation and can lead to misunderstandings. My friend Sue who has advanced dry AMD/geographic atrophy has heard, “You looked straight at me, I thought you recognized me!” Even those who know that she has low vision will ‘forget’ from time to time.

Dry or wet AMD

Losing the ability to see faces in one’s central vision can happen in the advanced stages of AMD (this doesn't apply to other types of macular degeneration which have different disease processes):

• Advanced dry AMD which is geographic atrophy causes blind spots because there are photoreceptors and RPEs that have died.
• Wet AMD is most often treated by using anti-VEGF medications that are injected into the eye. Many people are able to retain good visual acuity. It’s only when the treatments don’t work for whatever reason or the person refuses the injections that blind spots appear.

A person may start to experience this problem in the AMD intermediate/moderate stage when there can be distortions and blurriness. Not everyone progresses to the advanced stage. Of all the people with AMD, 90% have dry AMD, 10% have wet AMD.¹

Use eccentric viewing

The word ‘eccentric’ in this context means ‘off-center.’ When you have a blind or blurry spot (singular: scotoma) or spots (plural: scotomas or scotomata), you don’t do well looking straight at something or someone.

Finding the preferred retinal locus

Somewhere in the vision that you do have is what’s called ‘the sweet spot’ or PRL (Preferred Retinal Locus). You will find it in your remaining central vision or in your peripheral vision. One way to find PRL:

• With a dark pen, draw a clock face on white paper with a large dot in the center and the numbers around it.
• Stare at the dot or the approximate center of the clock if you can't see the dot. Some numbers may be obscured by your blurry or blind spot. Others may not be.
• While staring at the dot, shift your gaze to each number. Where is the dot the clearest? That can be used as your PRL. You may actually have more than one.

You can also use an Amsler Grid by staring at the center of it and noting where the lines are the clearest.

What does it mean?

Applying eccentric viewing to look at faces means that you don’t look straight at the center of a face. Move your eyes and if necessary move your head to put the person’s face in your PRL. Some people describe it as looking at a person's ear or the top of their head to best see the features of a face.

You may have to ask the person to come closer. It's great if you can enlist someone to help you practice because it DOES take practice.

Take photos

This won’t help you recognize people as they approach. This is for those who want to see every freckle on their grandchild’s face, for instance. You can take a photo or have someone take one. With a photo, you can enlarge all or part of it. You can move your gaze to where your PRL is. Some people find it helps to print the photo.

One-on-one social situations

Have you ‘trained’ your family and friends to announce themselves as they approach?  That’s helpful for you both. You might be able to learn to recognize people you know by their body shape, how they walk, and other characteristics.

You might enlist those who are frequently with you to tell you who is approaching. One thing that is a problem if you can’t see a person’s face is that you can’t tell what their emotional state is. They might say, “Here comes Bill who is looking unhappy.”

Group social situations

Not being able to see faces is a problem in a group. If you have someone with you, they can help by telling you who is there. Ask others to use names when they’re talking to someone. For example, “Mary, what do you think about that?” Another example might be, “This is Pam. I just want to say…”

Implantable miniature telescopes (IMT)

The natural lens of one eye is removed, and the IMT is inserted. It enlarges the image that comes into the eye and projects it onto a part of the retina that has not been affected which enables the person to see more clearly.

It’s only for those with end-stage AMD which means a person has advanced AMD in both eyes (geographic atrophy or wet AMD). A person is only eligible if the eye has not had cataract surgery.

Smart glasses and goggles

This is a relatively new technology that puts a device – some of them put a smartphone – over one or both eyes to enable the wearer to magnify and use other features to view the world. One of them doesn’t cover the eyes so the device is mounted on eyeglass frames. Most of them claim they can help a person see faces either by using magnification or by facial recognition techniques using a stored photo. The big drawback is the price which is high.

Summary

I hope that some of these tips help you when it comes to facial recognition and vision loss. Some of them may not. There may be times when you pass by someone in the grocery store that you know well, and they may feel offended.

You may say “Hi” to someone you think you know, but you don’t. I've been told that the best thing to do is to wave to everyone at the risk of being labeled as overly friendly.