lens problems can certainly cause difficulty in reading an eye chart, but so can macular degeneration. The problems depend on what the symptoms are. With my dry eye I have a few little blank spots in my vision. I can't see the letters on the chart where those blank spots are although my other eye makes up for it to a certain extent. With my wet eye I see some letters "sloping" it is hard to make out what they are. There's a bit of luck involved as to whether the problem areas are right in the middle of your central vision, or just off to the side a bit. None of my problem areas is right in the very centre, so that makes it a bit easer. I had 20/20 vision in both eyes for many years after being diagnosed with macular degeneration. I hope this helps explain the issues with the eye chart for you. Best wishes, Wendy, Patient Leader.