04/07/2026
Your patient tells you their vision is getting worse. Their chart says 20/40 stable. They’re probably both right.
In early and intermediate dry AMD, drusen and RPE dysfunction can impair how patients see in low light, read in a restaurant, and recognise faces, before any significant change shows up on a standard acuity test.
BCVA measures foveal cone resolution under ideal conditions. Most of what your AMD patient is actually experiencing happens outside those conditions.
Contrast sensitivity helps close that gap. It captures object-background discrimination across spatial frequencies, the visual capacity that governs real-world tasks, and research shows it detects deficits earlier and tracks functional decline more closely than BCVA changes alone.
If your AMD monitoring ends at the eye chart, there’s meaningful clinical data you’re not seeing.