Central Vision Loss Plays a Major Role in Mobility Decline in Adults with Maculopathy

In a recent study, researchers sought to assess the potential value of adding questions on falls/balance difficulties due to vision loss and testing contrast sensitivity in patients with maculopathy (mainly AMD) to help guide referral for mobility rehabilitation. They found that contrast sensitivity is associated more strongly and is more discriminative of balance and mobility difficulties than visual acuity, which underscores the clinical value of contrast sensitivity assessment for understanding functional vision in AMD. The findings were reported in  American Journal of Ophthalmology. Mobility limitation and fall-risk are major issues in central visual field loss needing consideration in low vision care. Researchers suggest that incorporating screening questions and having discussions about mobility difficulties in clinical practice for maculopathy patients can help identify limitations and facilitate appropriate referrals to low vision and mobility specialists. Click image to enlarge. A total of 125 patients over 55 years old with binocular maculopathy and intact peripheral vision presenting for a low vision rehabilitation consultation were included. Patients were asked questions regarding difficulties with their balance and mobility, including the 9-item Glaucoma Activity Limitation questionnaire (GAL-9). For analysis, patients were grouped by visual impairment severity using better-eye visual acuity (VA) and binocular contrast sensitivity (CS).The study found that 52% of patients reported balance or gait difficulties and 36% attributed mobility limitations to vision loss. Increasing vision deficit severity is related to greater mobility concerns (more than 50% of patients in the severe categories rated difficulty as 3/5 or higher) and higher referral rates. CS was a better predictor of mobility difficulties than VA. Based on reported concerns, 31.2% of patients were referred to orientation and mobility training and/or physical therapy (more than 50% in the severe groups).A key finding is that contrast sensitivity is associated more strongly and is more discriminative of balance and mobility difficulties than visual acuity, which underscores the clinical value of CS assessment for understanding functional vision in AMD (and more generally low vision), particularly in the context of fall risk, the authors explained.These findings suggest that AMD patients have similar mobility difficulties as those with glaucoma, as evidenced by the reported concerns on the mobility scenarios of the GAL-9 questionnaires, which is in line with studies reporting comparable mobility issues, and fall risk and incidence in individuals with central and peripheral field loss. The prevalence of falls and referral rates in the mild group suggest that the bar for balance/mobility rehabilitation needs to be lowered for all CFL patients—particularly since patients with better VA or monocular field loss are unlikely to be referred for low vision rehabilitation despite clear benefits.Building on these findings that contrast sensitivity is most closely related to mobility limitations, other ways of mitigating fall risk could be through contrast enhancement. “For example, refraction could be optimized using contrast enhancing filters and augmented reality devices, while indoor lighting can enhance scene contrast in different environments,” the authors wrote in their American Journal of Ophthalmology paper.As mobility limitations and falls affecting a substantial proportion of AMD patients may go undiscussed in eye clinics, the authors concluded that incorporating screening questions and explicit discussion of mobility difficulties in clinical practice in maculopathy can help elucidate patient mobility limitations. “Realization of these limitations is the prerequisite to initiate appropriate referrals to low vision and mobility specialists to improve mobility and manage falls risk,” the researchers wrote in their paper. “Clinical practice may also benefit from assessment of contrast sensitivity as this is a better indicator of difficulties in daily living.“Our results, along with prior literature, underscore the need to recognize the role of central vision loss, and vision loss more broadly, in mobility decline. Thus, a central vision loss-specific mobility questionnaire may be needed to facilitate patient screening in the future.” Click here for the journal source. Agathos CP, Shanidze NM, Fletcher DC. Importance of screening for contrast sensitivity, falls and mobility limitations in older adults with maculopathy. Amer J Ophthalmol. August 25, 2025. [Epub ahead of print.]This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.