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Impaired Depth Perception (Micropsia)

Macular degeneration is a progressive eye condition that causes damage to the macula, which is near the center of the retina and impacts central vision. Getting early diagnosis and treatment is important, but for many people, macular degeneration is asymptomatic until the condition is fairly advanced, which is why regular comprehensive dilated eye exams are so important. The earlier that macular degeneration is diagnosed, the more proactive you can be about healthy lifestyle choices, possible supplementation, and preserving your existing vision.

Symptoms of macular degeneration

When macular degeneration does cause symptoms, they can vary. The experience of one person may be markedly different than another. The condition is progressive and affects central vision, leaving peripheral vision largely intact. Symptoms of macular degeneration can include1,2:

If you have any of these symptoms, see your eye doctor immediately. These may or may not indicate the presence of AMD.

What is micropsia?

Micropsia is a special kind of metamorphopsia in which objects are perceived to be smaller than they really are.3 This can make them seem further away than they actually are, and may impair depth perception. This may occur when fluid or blood separates the attachment of the retinal cones from the underlying support cell layer (retinal pigment epithelium), stimulating fewer perceptive elements when an object is visualized.3

When does micropsia occur?

Sometimes micropsia is also found in what’s called Todd’s syndrome, or “Alice in Wonderland syndrome.”4 Micropsia is more common in neurological conditions in which the brain processes signals from the eye abnormally. However, micropsia can also have ophthalmologic causes, as with AMD.

Finding causes

If you’re experiencing micropsia, your eye doctor will likely do an exam to check for any ophthalmologic causes for the distortion. This might include Amsler grid testing, as well as a comprehensive dilated eye exam. If they establish that it’s a symptom of macular degeneration, it can then be treated appropriately.

Treatment

Treatment for the macular degeneration that is causing the micropsia can vary, depending on your situation and the type of macular degeneration. They might have you start taking an AREDS2 vitamin supplement, or may recommend that you use handheld magnifiers, electronic magnifiers, or special lenses on your glasses to help you see objects at their regular size. Talk with your doctor to find out what treatments are available and appropriate for your situation. Micropsia is a less common symptom of macular degeneration, and each individual’s treatment may be different.

What can you do?

If you notice any symptoms of impaired vision, contact your doctor immediately. The sooner you can get an eye exam and find out the underlying cause of vision abnormalities, the sooner appropriate treatment can be started. Especially with progressive conditions like macular degeneration, early diagnosis and treatment means the possibility of slowing disease progression and preserving existing vision.

Jaime R. Herndon | December 2018
  1. Kellogg Eye Center. Age-Related Macular Degeneration (AMD or ARMD). 2018. https://www.umkelloggeye.org/conditions-treatments/age-related-macular-degeneration. Accessed November 25, 2018.
  2. Facts About Stargardt Disease. National Eye Institute website. 2015. https://nei.nih.gov/health/stargardt/star_facts. Accessed January 28, 2019.
  3. Midena E & Vujosevic S. Metamorphopsia: An overlooked visual symptom. Ophthalmic Res. 2016; 55: 26-36. Doi: https://doi.org/10.1159/000441033. Accessed November 25, 2018.
  4. Lanska JR & Lanska DJ. Alice in Wonderland syndrome: Somesthetic vs visual perceptual disturbance. Neurology. 2013. Doi: https://doi.org/10.1212/WNL.0b013e31828970ae.