# 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=541579 > 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. Central vision loss with preserved peripheral vision **✔ 정답** 2. Complete bilateral blindness 3. Peripheral vision loss with preserved central vision 4. Night blindness with normal day vision **정답: 1** ## 해설 Age-related macular degeneration (AMD) primarily affects the macula, leading to central vision loss while peripheral vision is preserved. Other options describe conditions like complete blindness, peripheral vision loss, or night blindness, which are not characteristic of 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 Clinical Guide: Age-Related Macular Degeneration (AMD) Assessment A 72-year-old client presents with suspected AMD. The most characteristic finding is **central vision loss with preserved peripheral vision**, resulting from progressive damage to the macula. Key Assessment Findings - **Visual Acuity:** Reduced distance and near vision (e.g., 20/200) despite intact side vision. - **Functional Complaints:** Difficulty reading, recognizing faces, or performing fine tasks; may report wavy or distorted central vision (metamorphopsia). - **Amsler Grid Testing:** Often reveals central scotomas or distorted lines, confirming macular involvement. Nursing Interventions - Educate on the use of low-vision aids (magnifiers, large-print materials) to maximize remaining vision. - Assess home safety and recommend environmental modifications (e.g., improved lighting, contrast markers on stairs). - Refer to ophthalmology for anti-VEGF therapy or laser treatment if wet AMD is suspected. - Provide emotional support and resources for vision rehabilitation services. Differential Considerations - **Glaucoma:** Presents with peripheral vision loss first, often asymptomatic until advanced. - **Cataracts:** Causes overall blurring or glare, not selective central loss. - **Retinitis Pigmentosa:** Leads to night blindness and tunnel vision from peripheral retinal degeneration. ## 핵심 개념 - **Macula** — The central portion of the retina responsible for sharp, detailed central vision. - **Age-Related Macular Degeneration (AMD)** — A progressive eye condition that damages the macula, leading to central vision loss. - **Central Vision** — The straight-ahead vision used for reading, recognizing faces, and seeing fine details. - **Peripheral Vision** — Side vision that allows detection of motion and objects outside the direct line of sight. ## 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=541578) - [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._