EURETINA 2026: Why peripheral vision matters in macular degeneration

At the 26th EURETINA Congress in Vienna, Austria, Tunde Peto, [CREDENTIAL], professor of clinical ophthalmology at Queen’s University Belfast, discussed how ultra-widefield imaging has changed her group’s understanding of macular degeneration. She also explained why measuring peripheral vision matters for patients’ everyday lives.

Macular degeneration beyond the macula

Peto’s group has used ultra-widefield technology, including the Optos camera, since 2008, when it carried out the Reykjavik Eye Study follow-up. That work showed that macular degeneration affects the retinal periphery as well as the macula.

According to Peto, this peripheral involvement leads to a loss of the ability to navigate at dusk and dawn, and to difficulty functioning in ambient lighting. “These patients need very good levels of lighting and a lot of contrast in order to perform their daily tasks,” she said.

She noted that the findings changed her group’s understanding of how patients live in normal circumstances, not only in clinical settings.

Peripheral deposits in Alzheimer disease and Down syndrome

Peto’s group has also examined whether patients with Alzheimer disease, or with conditions that genetically predispose them to early disease such as Down syndrome, have deposits in the back of the eye. She said these patients do have such deposits, predominantly in the peripheral retina.

As a result, these patients “might struggle with everyday life more than we give them credit for based on their visual acuity,” Peto said.

Why peripheral vision matters

Peto explained that peripheral vision lets people navigate in real life. It helps them see bollards, A-frames and cars parked on the pavement. When peripheral vision is destroyed, a person is “locked into a very small area of your vision,” she said.

She gave an example: when three friends approach, a person with peripheral vision loss may see only the one in the middle. The other two may think they have done something wrong and that the person is unable to communicate with them.

Measuring peripheral and central vision

Peto said the most important thing is to measure both peripheral and central vision. Some methods for measuring peripheral vision exist, but she said they are not very good.

Her group’s further research focuses on how to measure these changes in peripheral vision. Peto said she looks forward to new cameras now in development that will give both functional and structural measurements of how patients see and navigate in the lived environment.