How Does Age-Related Macular Degeneration (AMD) Affect Vision?

By Lylas G. Mogk, M.D.
Edited by Maureen A. Duffy, M.S., CVRT

The macula is the only part of the retina that gives us crystal-clear, detailed vision. When it is damaged, details—such as the words on this page or a facial expression—become obscured. Your relative or friend with age-related macular degeneration (AMD) may not be able to see your eyes, but may still make eye contact because he or she can see at least the outline of your face and know where your eyes are.

Individuals with vision loss from age-related macular degeneration look fine. Their eyes appear to be just like they always were and their peripheral (side) vision is preserved, so they can walk around with little or no difficulty and may even spot a small dark button dropped on a light rug. This ability to see everything around a room but not to see the very thing one is looking at is confusing to others. This is in part because we tend to think of vision as a dichotomy of full sight vs. blindness.

Individuals with age-related macular degeneration are “in between”; they may not have full sight, but they are certainly not blind and never will be. They have low vision, or an even better description is that they are “hard of seeing,” a term coined by the late Dr. Lorraine Marchi, Founding Director of the former National Association for Visually Handicapped. Like the familiar term “hard of hearing,” it sounds more manageable and it is more accurate.

Some Simulations of Vision Loss from AMD

Here are some simulations of how individuals with vision loss from age-related macular degeneration would see various scenes. They were created by David J. Marmor, MFA and Michael F. Marmor, MD, and published in Archives of Ophthalmology, 2010; 128:117-125. (Used with permission.) The top image shows the photo a camera would take; the middle image shows what someone with full vision would see (as we see clearly only in the very center of our vision, what we are looking directly at); and the bottom image shows how someone with vision loss from age-related macular degeneration would see it.

street scene: top image shows the photo a camera would take (entirely focused); the middle image shows what someone with full vision would see (as we see clearly only in the very center of our vision, what we are looking directly at); and the bottom image shows how someone with vision loss from AMD would see it, with a blurry spot in the middle

group of people: top is simulation of how a camera would record a group of people (perfectly focused), how a person with full vision would see it (some blurring at the edges, since we see clearly only in the very center of our vision) and finally how a person with age-related macular degeneration would see it (with blurriness at the edges but also in the very center)

text in a book: top shows how camera would capture it (fully focused), middle shows how a person with full vision would see it (clear in the center of visual field, where the person is focusing), and how a person with age-related macular degneration would see it (blurry on the edges but also in the very middle)

To help family members and friends further understand the visual and functional effects of age-related macular degeneration, Macular Degeneration Support has created another online simulation gallery, entitled Through Our Eyes: How People with AMD See.

Charles Bonnet Syndrome, or Visual Hallucinations

About 20% of individuals with vision loss, from any cause, see life-like images from time to time that they know are not really there. This phenomenon is named Charles Bonnet syndrome (CBS) after the Swiss naturalist and philosopher who first described it in 1760.

The phantom images of Charles Bonnet syndrome are common, pleasant, everyday things like flowers or animals or people and the experience is somewhat like looking at a picture or watching a silent movie in color. The images are in full color and they may move, but there is no sound, smell, or contact. It’s important to know that Charles Bonnet syndrome is related to vision loss, not to loss of mental capacity.