It is generally appreciated that patients with macular disease frequently experience reduced visual acuity. It is not as widely appreciated that they often have significant central visual field disruption, which, by itself, can cause significant problems with activities of daily living, such as reading and driving, even when they maintain good visual acuity. Few patients who are referred for low vision rehabilitation are free of scotomas in their macular area. A scanning laser ophthalmoscope (SLO) macular perimetry study involving 1,339 eyes of 825 patients with low vision showed that 90.9% of the eyes had a dense scotoma somewhere within the area of the central 20 degrees (Fletcher & Schuchard, 1997). With SLO, perimetry is performed with direct observation of stimuli falling on the retina; the central visual field can be mapped onto an image of the macula. In testing for dense scotomas, a bright stimulus is flashed onto a macular location, and the patient indicates whether he or she is able to see it. This method of testing provides a more accurate map than do other techniques. In the large population of patients with low vision in the study conducted by two of the authors of this report (Fletcher & Schuchard, 1997), the method showed considerably complex scotoma patterns. Whereas some scotomas were round and centered on the fovea, many were not. Some patients maintained fixation at the fovea but had nearby scotomas on all four sides of fixation (right, left, superior, and inferior). When all four borders of fixation were scotomatous, we classified the pattern as a ring scotoma (like looking at the world through a doughnut hole). These patients could fixate in a small central island of vision and could see in their peripheral fields but had an area of scotoma in all directions immediately around the fixation. This ring scotoma pattern occurred in 17.4% of the patients (73.5% of the patients had some other type of scotoma pattern in their central field, and 9.1% did not have any scotomas). Patients with ring scotomas often maintain relatively good visual acuity but have significant functional problems on the basis of the disruption in their central field. In this report, we describe the case of a patient with macular disease whose relatively good visual acuity was maintained but whose fixation was surrounded by a ring scotoma. The patient experienced considerable difficulty maintaining an independent lifestyle, and many of the subject's activities of daily living were disrupted. REPORT OF THE CASE A 79-year-old retired physician with age-related macular degeneration had been told that he also had cataracts. At the evaluation, he wondered if his increasing visual difficulties were related to the cataracts. He was found to have cataracts in both eyes, which were mild and not thought to be a significant contributor to his complaints. There was severe macular degeneration in the right eye with a disciform scar and overlying hemorrhage. The macular degeneration in the left eye appeared to be atrophic, with a central island of intact macular area. This patient also complained of difficulty with several activities of daily living and was appropriately referred for low vision rehabilitation in spite of his relatively good visual acuity. He had stopped driving five years earlier even though he maintained sufficiently good visual acuity and peripheral fields to pass the vision testing at the department of motor vehicles. He did not feel confident driving and was happy to let his wife do all the driving for them. He reported difficulty with reading both small and large print and in writing. He was also a golfer, and his primary difficulty with the sport was in following the ball after a tee shot. He had reported these difficulties to his ophthalmologists in the state of his summer residence and was told on several occasions that his vision tested fine and that he should not be having any problems. …