By: W. Jarrod Long, OD, FAAO, FIALVS

Many people with macular degeneration are told that their eye-chart vision has not changed very much, yet they know they are not seeing as well in everyday life. Faces may look washed out, steps can be difficult to distinguish, food may blend into the plate, and reading becomes harder when the print is faint or the lighting is poor. The missing piece may be contrast sensitivity—the ability to distinguish an object from its background.

Visual acuity and contrast sensitivity measure different parts of vision. A standard eye chart typically uses sharp black letters against a bright white background, which is close to an ideal viewing situation. The real world is rarely that cooperative. A gray newspaper, a beige curb, a dark stairway, or a person’s face in dim light provides much less contrast. Research has found that contrast sensitivity can be reduced in people with macular degeneration even when their conventional visual acuity remains relatively good, and that this loss is closely connected to everyday visual difficulty and quality of life.

Contrast can often be improved by changing the environment. Adjustable task lighting may make reading, cooking, and handwork easier, although the light should be directed onto the activity rather than into the eyes. High-contrast household choices can also help: a dark cutting board for light-colored food, a white mug for coffee, contrasting tape along stair edges, bold black pens, and large-print labels. Phones, tablets, and computers allow users to enlarge text, increase contrast, reverse the display to white letters on a dark background, or have content read aloud. Because glare can reduce useful contrast, blinds, matte surfaces, visors, filters, and anti-glare sunglasses may also be helpful. The National Eye Institute recommends brighter lighting, glare control, magnification, and increased digital contrast as practical ways to make better use of remaining vision.

A thorough low vision evaluation looks beyond the smallest letters a person can read on an eye chart. It considers how vision performs under realistic conditions and which activities have become difficult. Depending on the task, the solution may involve stronger contrast, better lighting, magnification, specialized glasses, electronic devices, or a combination of approaches. The goal of low vision care is not simply to improve a number on an eye chart—it is to make the everyday world easier to see and navigate.

 About Jarrod Long, OD, FAAO, FIALVS

Dr. Jarrod Long, OD, FAAO, FIALVS, is a distinguished member of the Macular Degeneration Association’s Medical Advisory Board. He is an optometrist in Bloomington, Indiana, specializing in advanced low vision care and macular degeneration. Dr. Long founded Midwest Low Vision and the Macular Health Center, where he provides innovative treatment strategies and functional vision solutions designed to help patients maximize their vision and maintain independence.

Dr. Long also contributes to the Macular Degeneration Association’s educational resource, “Low Vision with Dr. Long,” where he shares practical information and guidance for individuals living with vision loss.