Modified images reflecting effects of age-related macular degeneration on perception of everyday scenes

Depictions of vision with age-related macular degeneration (AMD) in public information material typically show a central region of absolute vision loss. Patients with early and moderate disease frequently do not report this. We aimed to measure how a group of people with AMD perceive everyday scenes in order to produce accurate depictions.

We report on six people aged 65-82 years with monocular AMD (visual acuity +0.04 to +1.64 logMAR) and normal vision in the fellow eye. Participants viewed four images monocularly, alternating between eyes. The image was digitally altered to approximate participants' descriptions of their perception with the affected eye. The altered image was viewed with the unaffected eye, and compared with the original image viewed with the affected eye. This was repeated iteratively until a perceptual match was achieved between the modified image/unaffected eye and the original image/affected eye.

For five AMD participants with visual acuity +0.04 to +0.50 logMAR the modified images did not resemble those in current public information material. Image modifications required to achieve perceptual similarity with the affected eyes included localised distortion, contrast reduction and blur. Widespread colour desaturation was also required in some cases. One participant with advanced geographic atrophy reported an absolute positive scotoma, similar to existing depictions.

Vision in people with AMD may not conform to the common depiction of a central region of absolute vision loss. The accurate representations of AMD patients' vision produced in this study will enable better understanding of the visual consequences of AMD.