Visual distortion refers to the change of the shape of the object seen, mostly due to macular degeneration or retinal and choroidal lesions near the macula, causing significant edema of the retina, making the interval of the optic cells on the retina wider, or due to retinal adhesions, scarring contraction traction, making the optic cells crowded in one piece or overlapping, etc. When looking at something, the shape and size of the object will change greatly, such as the object becoming smaller or larger. Differential diagnosis: 1. Central plasmacytoid chorioretinopathy: Most commonly seen in males aged 20 to 45 years, usually manifests as a self-limiting disease. It is characterized by dark shadows in front of the eyes, distortion of visual objects, such as becoming smaller and more distant; decreased visual acuity, but often not less than 0.5, which can be partially corrected by convex lens lenses. A circular reflective wheel in the macula with a dark red central concavity and loss of light reflection can be seen in the fundus, and there can be grayish-white subretinal fibrin deposition, and the macula shows a dome-shaped disc-like detached area under binocular indirect inspection lens. Fluorescence angiography, in the venous phase, there is one or several fluorescein leakage points in the macula, which gradually becomes jet-like or ink-like and expands into a strong fluorescent spot. 2.Age-related macular degeneration: It is a common blinding eye disease in developed areas over 50 years old. With the aging of the society, the incidence increases. It is divided into two types: dry and wet. It may be related to long-term chronic photodamage of macula, genetic, metabolic, nutritional and other factors. 3.Macular cystoid edema: It is not an independent disease, often caused by other lesions. FFA shows that the edema comes from the retinal capillaries with abnormal permeability around the central sulcus, showing most small leakage points and accumulation of fluorescence in the cystic cavity, forming a petal-like shape due to the radial arrangement of Henle fibers. It may present as reduced visual acuity or distorted vision, or may be asymptomatic. On fundus examination, the central concave light reflection disappears, and the retinal reflection in the macula is enhanced in a hairy glass shape. Sometimes it is difficult to determine under the examiner’s eye. FFA can confirm the diagnosis. 4.Macular and pigment epithelial dystrophy: mainly manifested as yellow material deposition in macula and RPE, and gradual cell loss. 5.Macular fissure: It can be caused by trauma, degeneration, long-term CME, high myopia, vitreous retraction, etc. The fundus shows a 1/2 to 1/4 PD size dark red hole with clear border in the macula, and there may be yellow particles at the bottom of the hole. The central vision is significantly reduced. In highly myopic eyes with macular fissure, there is a great chance of retinal detachment, which needs to be treated by retinal detachment reset surgery or vitreous surgery. 6. Macular retinal anterior membrane: It occurs on the inner surface of the retina and is a fibrotic membrane formed due to the migration and proliferation of retinal glial cells and RPE. It can occur in a variety of lesions. The macular ERM formed after retinal detachment is thicker and grayish in color, which affects vision. It is also seen in RVO, chronic CME, intraocular inflammation, retinitis pigmentosa and other fundus diseases, after ocular trauma and photocoagulation and condensation procedures. Contraction of the membrane can cause folds and deformation of the macula and macular edema, causing vision loss and distortion of visual objects. In cases where the ERM is thick and obscures the central recess and vision is significantly reduced or distorted, vitreous surgery may be used to peel the anterior membrane.