Loss of Central Vision

Central vision is what you see when you look directly at something. It allows you to read, recognize faces, drive, and see fine detail. Loss of central vision—while peripheral (side) vision may remain—significantly impacts daily activities even though you're not completely blind.

What Central Vision Loss Feels Like

People with central vision loss often describe:

• A blurry, hazy, or dark spot when looking directly at something
• Difficulty reading—words seem to disappear or blur
• Unable to recognize faces or facial expressions
• Straight lines appearing wavy or distorted
• Colors appearing faded or less vivid
• Difficulty seeing in dim lighting
• Need for more light to see detail
• Problems with driving, particularly reading signs
• Preserved ability to walk and navigate (using peripheral vision)

Comparing Central and Peripheral Vision

Aspect	Central Vision	Peripheral Vision
Function	Detail, reading, color	Motion, navigation
Main structures	Macula/fovea	Rest of retina
If lost	Can't read, recognize faces	Can't navigate safely
Feels like	Spot blocking what you look at	Tunnel vision, bumping into things

Common Causes

Macular Conditions (Retinal)

• Age-related macular degeneration (AMD)—most common cause in older adults
  • Dry AMD—gradual deterioration
  • Wet AMD—abnormal blood vessel growth, more rapid
• Diabetic macular edema—swelling from diabetes
• Macular hole—gap in center of macula
• Macular pucker—scar tissue on macula causing distortion
• Central serous retinopathy—fluid under the macula

Optic Nerve Conditions

• Optic neuritis—inflammation causing central scotoma
• Ischemic optic neuropathy—blood flow loss to optic nerve
• Leber hereditary optic neuropathy (LHON)—genetic condition in young adults
• Toxic/nutritional optic neuropathy—from B12 deficiency, alcohol, medications
• Compressive optic neuropathy—tumor pressing on optic nerve

Other Causes

• Stargardt disease—inherited macular dystrophy in young people
• Best disease—inherited macular condition
• Myopic macular degeneration—in highly nearsighted eyes
• Ocular histoplasmosis—fungal infection affecting macula

Distinguishing Macular from Optic Nerve Causes

Feature	Macular Disease	Optic Nerve Disease
Distortion (wavy lines)	Common	Rare
Color vision loss	Usually mild	Often significant
Pain	None	May have (especially optic neuritis)
Pupil response	Normal	May have RAPD
OCT finding	Macular abnormality	RNFL thinning

When to Seek Care

How Central Vision Loss Is Diagnosed

Eye Examination

• Visual acuity testing—checking detail vision with eye chart
• Amsler grid testing—checking for distortion (wavy lines)
• Dilated fundus exam—examining macula and optic nerve
• Pupil examination—checking for RAPD (optic nerve problem)
• Color vision testing—often affected in optic nerve disease

Imaging

• Optical coherence tomography (OCT)—detailed imaging of macula and optic nerve
• Fluorescein angiography—imaging blood vessels in retina
• Visual field testing—mapping central scotoma
• MRI of brain and orbits—if optic nerve cause suspected

Additional Tests

• OCT angiography—imaging blood flow without dye
• Electroretinography (ERG)—testing retinal function
• Blood tests—if nutritional or inflammatory cause suspected
• Genetic testing—for inherited conditions

Treatment Options

Treatment depends on the underlying cause:

For Macular Degeneration

Wet AMD:

• Anti-VEGF injections—medications injected into eye to stop abnormal blood vessel growth
• Monthly or less frequent treatments
• Can stabilize or improve vision if started promptly

Dry AMD:

• AREDS2 vitamins—may slow progression in intermediate/advanced cases
• Monitoring—regular exams to catch conversion to wet AMD
• Emerging treatments—complement inhibitors for geographic atrophy

For Optic Nerve Conditions

• Optic neuritis—IV steroids may speed recovery
• Nutritional deficiency—B12 and folate supplementation
• Toxic causes—stopping offending agent
• Compressive causes—surgery to remove tumor

For Other Macular Conditions

• Diabetic macular edema—anti-VEGF injections, laser, steroid implants
• Macular hole—vitrectomy surgery
• Central serous retinopathy—observation, sometimes laser or PDT

Low Vision Rehabilitation

For permanent central vision loss:

• Magnification devices—handheld, stand, or electronic magnifiers
• Eccentric viewing training—learning to use peripheral vision for reading
• Large print and audio books
• **Screen readers and text-to-speech software
• Smartphone accessibility features
• Specialized lighting
• See our guide: Living with Vision Loss

Living with Central Vision Loss

Reading Adaptations

• Large print books and e-readers with adjustable fonts
• Magnifiers (handheld, desktop, or CCTV)
• Audio books and podcasts
• Text-to-speech software
• High contrast settings on devices

Daily Life

• Good lighting—task lighting for detailed work
• High contrast—use contrasting colors for organization
• Organizational systems—consistent placement of items
• Labeling—large print or tactile labels

Maintaining Independence

• Low vision rehabilitation services
• Orientation and mobility training
• Support groups and counseling
• Vocational rehabilitation if needed

Frequently Asked Questions

Will I go completely blind?

Most conditions causing central vision loss spare peripheral vision, so complete blindness is unlikely. You'll likely maintain the ability to navigate and be independent, though reading and detail work will be challenging without aids.

Can central vision be restored?

It depends on the cause. Vision lost to macular degeneration or optic nerve damage is usually permanent, but treatment can prevent further loss. Some conditions like optic neuritis often improve significantly.

What's the difference between central vision loss and macular degeneration?

Macular degeneration is one cause of central vision loss—the most common in older adults. But central vision loss can also come from optic nerve conditions, other macular diseases, or brain problems.

Can I still drive with central vision loss?

Possibly, depending on severity. Most states require certain visual acuity (often 20/40 or better) to drive. A low vision specialist and driver rehabilitation specialist can evaluate your situation.

What's eccentric viewing?

Eccentric viewing means learning to look slightly off to the side of what you want to see, using an area of peripheral vision that still functions. With training, this can partially compensate for central vision loss.

References