Refractory error (improves with pinhole): Presbyopia (> 40-year-old), Myopia, Hyperopia, Astigmatism
Cataract (lens opacification) – Can be age-related (most common), congenital, metabolic, or traumatic.
Macular degeneration (atrophic or “dry” MD; age-related)
Diabetic retinopathy
Retinopathy from other causes, eg, hypertensive, sickle cell, severe anemia, radiation, SLE, talc emboli (from IV drug use)
Open-angle Glaucoma
Corneal opacity, eg, scar, pterygium
Medications: Steroids can cause cataracts/glaucoma); Ethambutol, methanol, and amiodarone can cause optic neuropathy; Hydroxychloroquine can cause maculopathy
Chronic uveitis
Pituitary tumor (bitemporal)
Stroke or brain tumor affecting visual pathways
Idiopathic intracranial hypertension (Pseudotumor cerebri)
Intraorbital tumor
Lens dislocation, eg, Marfan syndrome, homocystinuria
Optic neuritis from multiple sclerosis
Trachoma,
Leprosy,
onchocerciasis,
Xerophthalmia (vitamin A deficiency)
MD = Macular degeneration
Further Reading
Clin Geriatr Med. 1999 Feb;15(1):25-46. https://www.ncbi.nlm.nih.gov/pubmed/9855657