“Straight lines look wavy and there’s a blur in the middle of my sight — it’s just old age, isn’t it?”

Gradual loss of CENTRAL vision with METAMORPHOPSIA (straight lines appearing wavy/distorted) and difficulty reading/recognising faces, with PRESERVED peripheral vision, in an older adult is the hallmark of AGE-RELATED MACULAR DEGENERATION (AMD) — recognise the pattern rather than accept "just old age". The critical distinction is DRY AMD (gradual over months/years; no specific cure — managed with visual aids, support and risk modification; NICE NG82 makes only a research recommendation on supplements, and beta-carotene formulas are unsafe in smokers) versus WET (neovascular) AMD, which causes RAPID, recent distortion/central loss and is a TIME-SENSITIVE URGENT referral to a macula service, normally within 1 working day (NICE NG82, 2018 — urgent, not an emergency), with diagnosis and treatment within 14 days (NICE QS180), because prompt anti-VEGF injections (NICE TA1022 and earlier appraisals) can preserve sight — so recent, rapidly progressive distortion must be treated as possible wet AMD and referred urgently. Take a targeted history (speed of onset, which eye, functional impact, Amsler-grid distortion — a low-sensitivity prompt), leave acuity to the macula service rather than trying to measure it on video, and address modifiable risk — SMOKING cessation is the major modifiable factor (NICE NG209), with general cardiovascular health — optimising other eye health. Refer urgently for wet-AMD features and routinely for slow dry AMD, with safety-netting for new distortion or blur to detect conversion to wet AMD (the Amsler grid helps but can miss change). Crucially, counter the "it’s just old age, nothing can be done" fatalism: wet AMD is treatable and even dry AMD benefits from aids, support and risk modification; and take the functional and emotional impact seriously — loss of reading, faces, independence and driving (DVLA implications), with falls and isolation risk — involving low-vision support, certification of visual impairment and information about Charles Bonnet syndrome (NICE NG82; QS180).