Bryan Wolynski, OD, is a board-certified community optometrist who has been in the eye care field for over 30 years. He works in private practice in New York City.
Central vision is the straight-ahead vision you use to see fine detail in order to read, drive and recognize faces. You rely on your central vision to complete everyday tasks, watch a movie, or scan your smartphone.
When people say they have "good vision," this is the vision they mean. It is quantified with numbers like normal 20/20 acuity, the clarity of objects at 20 feet away. When it needs improvement, you can get corrective lenses, such as eyeglasses or contact lenses, or have certain kinds of surgery like refractive surgery or cataract lens replacement.
This article will discuss the anatomy responsible for central vision, conditions that can lead to central vision loss, and tests to measure central vision.
The retina is the general light-sensitive tissue at the back of the eye. The macula is the central part of the retina , and the fovea is the center of the macula. Central vision relies on these two areas.
The macula is only about 5 millimeters across. It delivers much of your color vision and the fine detail that you see. It has the highest concentration of light-detecting cells known as photoreceptors. When you see images, these photoreceptors are the ones that send the signals to the brain that are then translated as pictures.
The fovea is a tiny divot inside the macula. It gets its name from the Greek term for small pit. This is the smallest part of the eye and the part that offers the very finest vision. This incredibly small region is only 0.35 millimeters in diameter but is extremely powerful.
It is the area that has the most color discernment and that produces the very sharpest visual acuity (the ability of the eye to distinguish shapes and details of objects at a given distance). When you focus on an object, the fovea is directly aligned with the object and the central axis of the lens. Think of a straight line from the object, through the middle of the lens, to the fovea.
It is able to provide the best vision because it is packed with the highest concentration of cones, the cells we rely on to provide fine detail and color vision. Cones are the only vision cells in the area. The rods (which are responsible for black and white vision) are mostly located in the periphery of the retina.
Side, or peripheral, vision, which is far less detailed, is located on the rest of the retina.
You can have central vision loss if you have a condition that affects the macular area or tiny fovea. It can begin with a small dark spot in the center of your vision that expands with time or it can be distortion to your vision, making straight lines look wavy and details (such as faces or pictures) seem twisted or otherwise abnormal.
Keep in mind that this can happen pretty quickly. So, if you notice any changes to this vision, you should immediately consult with your eye practitioner.
Central vision loss can commonly occur with conditions such as the following:
A variety of tests can be done to help detect central vision loss due to conditions such as age-related macular degeneration, diabetic retinopathy, and others.
A basic Amsler grid test is often used. This involves a grid pattern resembling graph paper, with a dot in the center surrounded by squares of equal size. The idea is to focus on the central dot with one eye closed and see if you notice any lines that are missing, wavy, or otherwise distorted (called metamorphopsia).
This test is typically used to monitor possible disease progression in cases of age-related macular degeneration. The Amsler grid is simple enough to be used at home. This way, you can alert your practitioner if you notice any changes.
A visual acuity test, the kind measured with what's known as a Snellen chart, can help show if your reading vision is affected at various distances. If your acuity drops even somewhat, your doctor can perform other tests looking at the central retina to see what's going on.
Also, fundus photography can be done. After dilating your eye, a customized camera can photograph the back of the eye to look for signs of disease on the macula as well as on the optic nerve.
The doctor may also do another noninvasive test known as optical coherence tomography (OCT) to produce cross-sectional images of the retina. This alerts the doctor if there are any signs of macular degeneration with a condition like dry AMD, something that is associated with advanced disease.
Some at-home prescription-only monitoring options, such as the ForeseeHome AMD Monitoring System and myVisionTrack may be available. Discuss these with your doctor to see if they are appropriate for your care.
Central vision is what you see in the center of your visual field. It provides the sharpest details and is used for many tasks. The macula and fovea in the center of the retina, the light-detecting layer in the back of the eye, are responsible for central vision.
Many conditions can lead to a loss of central vision, including diabetic retinopathy and age-related macular degeneration. Tests of central vision include the Amsler grid, Snellen eye chart, fundus photography, and optical coherence tomography.
Maintaining good central vision is a top priority that may require some vigilance if you have a condition that threatens it. If you notice any changes in this central, detailed vision, you should immediately contact your doctor so that steps can be taken to preserve it.
Even just a small blank spot can be important, since this can grow with time. The good news is that it is now easier than ever to detect any central vision problems, allowing you to promptly have it diagnosed and treated.
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Macular Society. What is the macula?
All About Vision. Fovea centralis. Updated November 2021.
Singapore National Eye Centre. Central vision loss.
American Academy of Ophthalmology. Vision loss, central.
BrightFocus Foundation. Macular degeneration research.
American Academy of Ophthalmology. Catching CNV early with at-home monitoring.
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