# A nurse is assessing a 72-year-old client with suspected age-related macular degeneration (AMD). Which assessment finding would be most characteristic of this condition?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=541578  
> language: ko  
> subject: Adult Health

## 문제

A nurse is assessing a 72-year-old client with suspected age-related macular degeneration (AMD). Which assessment finding would be most characteristic of this condition?

## 보기

1. Complete loss of peripheral vision with intact central vision
2. Distorted central vision with difficulty seeing fine details **✔ 정답**
3. Sudden onset of severe eye pain with halos around lights
4. Progressive loss of night vision with difficulty adapting to darkness

**정답: 2**

## 해설

Age-related macular degeneration (AMD) primarily affects the macula, causing central vision distortion (metamorphopsia) and difficulty with fine details. Other options describe symptoms of glaucoma (eye pain with halos), retinitis pigmentosa (night vision loss), or peripheral vision loss not typical for AMD.

## 심화 해설

Understanding the Pathophysiology

Age-related macular degeneration (AMD) is a chronic, progressive retinal disease that primarily affects the macula, the central and most sensitive part of the retina responsible for sharp, detailed vision. The provided literature confirms that AMD leads to "irreversible central vision loss" due to progressive damage to the central retina [1][3]. This damage occurs in the late stages, which manifest as either neovascular (wet) AMD, characterized by abnormal blood vessel growth under the macula, or atrophic (dry) AMD, involving the gradual breakdown of retinal pigment epithelial cells and photoreceptors [1]. The functional consequence of this macular damage is a loss of central visual acuity, making it difficult to see fine details, recognize faces, or read, which aligns directly with the correct assessment finding.

Analyzing the Correct Answer (Option 2)

The finding of "distorted central vision with difficulty seeing fine details" is the hallmark clinical presentation of AMD. This symptom, often referred to as metamorphopsia, is explicitly described in the literature as a characteristic feature of the disease, with patients experiencing "visual distortions, image blurring, and gradual central vision loss" [4]. A case report further illustrates this, detailing a patient with bilateral AMD whose corrected distance visual acuity was reduced to 20/125 (6/37.5) and near acuity to 2.5M (20/125), demonstrating a profound inability to discern fine details even with refractive correction [2]. This central vision deficit is a direct result of the pathological process limited to the macula, while the peripheral retina remains unaffected until very late stages.

Differentiating from Other Conditions

The other options describe symptoms of different ocular pathologies, and distinguishing them is a critical skill for the NCLEX-RN.

- **Option 1 (Complete loss of peripheral vision with intact central vision)** is the classic presentation of primary open-angle glaucoma, not AMD. In glaucoma, damage to the optic nerve fibers typically begins at the periphery, causing "tunnel vision" while sparing central acuity until the end stage. AMD does the opposite, destroying central vision first.

- **Option 3 (Sudden onset of severe eye pain with halos around lights)** is a hallmark of acute angle-closure glaucoma, a medical emergency. AMD is a painless condition with a gradual, not sudden, onset of vision loss [4].

- **Option 4 (Progressive loss of night vision with difficulty adapting to darkness)** is more indicative of retinitis pigmentosa or severe vitamin A deficiency, which primarily affect the rod photoreceptors concentrated in the peripheral retina. While patients with AMD may experience some difficulties in low light, the primary and most characteristic deficit is a progressive loss of central, not night, vision.

Clinical Assessment and Nursing Implications

For a 72-year-old client, a nurse's assessment should focus on functional vision changes. The strongest non-modifiable risk factors are age and family history, while smoking and cardiovascular disease are key modifiable contributors [1]. When assessing a client with suspected AMD, the nurse should inquire about difficulty with activities requiring fine central vision, such as reading, sewing, or seeing faces clearly. The use of an Amsler grid is a standard screening tool to detect the metamorphopsia and central scotomas characteristic of this condition. The literature emphasizes that AMD significantly impairs a patient's ability to perform everyday activities and reduces their quality of life, making safety assessments—such as fall risk evaluation and medication management—a nursing priority [4].References (research sources)

- [1]Age-related macular degeneration: Updates for general practitioners.Research articleEiselen C, Long M, Chong EW. (2026) · DOI: 10.31128/ajgp-10-25-7882

- [2]Clinical Low Vision Rehabilitation Interventions in Age-Related Macular Degeneration: A Case Report.Case reportAl-Tamimi NY, Amer M, Graini FNE. (2026) · DOI: 10.7759/cureus.109419

- [3]Retinotopic mapping of cortical plasticity in age-related macular degenerationResearch articleDuret A, Vallée J, Lahutsina A, Rdeini D, Coiffé ML, Gocho K, Sheynikhovich D, Ramanoel S. (2026) · DOI: 10.31234/osf.io/yaqmz_v1

- [4]Quality of life in patients with neovascular age-related macular degeneration before and after intravitreal therapy: a longitudinal observational study.Research articleNowak M, Cybulska AM, Derezińska A, Grochans E, Panczyk M, Kęcka K, Rachubińska K. (2026) · DOI: 10.3389/fmed.2026.1731481

## 임상 시나리오

AMD Screening & AssessmentIdentifying Central Vision Loss in Older Adults
The hallmark of age-related macular degeneration (AMD) is progressive, painless loss of central visual acuity. Patients report difficulty with fine details like reading or recognizing faces, and may describe metamorphopsia (distorted, wavy lines).

Assess using the Amsler grid to detect central distortions. Fundoscopic examination may reveal drusen (dry AMD) or subretinal fluid and hemorrhage (wet AMD). Visual acuity testing often shows reduced distance and near vision.

CautionSudden onset of central vision loss or new distortion in a patient with known AMD requires urgent ophthalmology referral to rule out progression to neovascular (wet) AMD, where treatment with anti-VEGF injections is time-sensitive.

## 핵심 개념

- **Macula** — The central, most sensitive part of the retina responsible for sharp, detailed, and color vision.
- **Metamorphopsia** — A visual distortion where straight lines appear wavy or bent, a hallmark symptom of macular disease.
- **Drusen** — Yellowish extracellular deposits beneath the retinal pigment epithelium, a key clinical sign of dry AMD.
- **Amsler Grid** — A diagnostic tool used to detect central visual field distortions characteristic of macular degeneration.
- **Neovascular (Wet) AMD** — Advanced form of AMD involving abnormal blood vessel growth under the macula, leading to rapid central vision loss.

## 같은 주제 문제

- [A nurse is assessing a 72-year-old client with suspected age-related macular degeneration …](https://mymerci.kr/pages/nclex_q.php?qn_id=541579)
- [A nurse is providing education to a 68-year-old client newly diagnosed with age-related ma…](https://mymerci.kr/pages/nclex_q.php?qn_id=541580)
- [A nurse is providing discharge teaching to a 72-year-old client diagnosed with age-related…](https://mymerci.kr/pages/nclex_q.php?qn_id=541581)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._