1. Document visual acuity - use glasses if appropriate.

2. Using a pinhole may worsen visual acuity.

Fig. 4.18 Small submacular hemorrhage associated with visual distortion and age-related maculopathy (drusen).

Fig. 4.19 Amsler grid

1. cover one eye and hold chart at normal reading distance

2. ask patient to look at black spot in center of grid

3. with gaze fixed on central spot - patient should be aware of grid lines being straight - missing or distorted areas indicate maculopathy.

3. Ask patient to look at a door frame - if distorted, indicates maculopathy.

5. Pupil examination is normal - however is often miosed (small) in the elderly.

6. If the pupil is small - dilate with tropicamide 1%.

7. Look at the macula - to do this, ask the patient to look directly at the ophthalmoscope light or find the optic disc, and look temporally about two to three disc diameters.

8. Cataract may also be present in this population.

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