Metamorphopsia

Metamorphopsia is a visual disturbance in which straight lines appear bent, wavy, or distorted, and objects may seem smaller or larger or displaced from their true position. It is a symptom rather than a disease and most often indicates a macular problem affecting central vision, where the retina’s finest image detail is produced.

Common causes are diseases and conditions that involve the macula, the central retinal area. These include age-related macular degeneration, diabetic macular edema, macular holes, central serous chorioretinopathy, epiretinal membranes, and inflammatory or infectious retinopathies. Metamorphopsia arises when the orderly arrangement of photoreceptors and retinal layers in the macula is disrupted, leading to misregistration of visual input.

Diagnosis begins with a patient history and examination, including a simple self-monitoring test such as the Amsler grid. Ophthalmic assessment typically uses optical coherence tomography (OCT) to visualize macular structure and detect edema, distortion, or layer irregularities; fluorescein angiography or OCT angiography can help identify vascular or perfusion abnormalities contributing to distortion.

Management targets the underlying cause. Treatments may include anti-VEGF injections for neovascular age-related macular degeneration or diabetic macular edema, laser therapy for select retinal lesions, or surgical repair of macular holes. Inflammatory or chronic edema conditions may be managed with corticosteroids or other therapies. Vision rehabilitation and low-vision aids can assist with functional impairment when distortion persists.

Prognosis depends on the underlying condition and its response to treatment. Early detection and targeted management can reduce distortion and support preservation of central vision, though metamorphopsia may persist if substantial macular damage remains.