A nurse is performing a focused eye assessment. Select up to 5 unexpected findings.

A) Diabetic retinopathy: Diabetic retinopathy is a complication of diabetes that affects the blood vessels in the retina. It can lead to vision problems, including blurry vision, floaters, and in advanced stages, vision loss. However, the central vision loss specifically described in the question is more characteristic of macular degeneration, as diabetic retinopathy typically causes peripheral vision loss rather than affecting the center of the visual field.

B) Detached retina: A detached retina occurs when the retina pulls away from its normal position, which can lead to sudden vision changes such as the appearance of floaters, flashes of light, and a shadow or curtain over the vision. While it can result in significant visual impairment, it does not typically cause a black spot in the center of vision. The loss of vision in a detached retina tends to occur in peripheral vision first, not centrally.

C) Macular degeneration: Macular degeneration, specifically age-related macular degeneration (AMD), is the most likely cause of the central vision loss described. It affects the macula, the part of the retina responsible for central vision. As the disease progresses, patients may notice a dark or empty spot in the center of their visual field, which matches the complaint of a "black large spot" in the center of their vision.

D) Glaucoma: Glaucoma is a group of eye diseases that typically cause increased intraocular pressure, leading to damage to the optic nerve and peripheral vision loss. It is more commonly associated with peripheral vision loss, and the central vision is generally preserved until the disease progresses to advanced stages. Therefore, central vision loss is not typically a characteristic symptom of glaucoma.

A) Rosenbaum test: The Rosenbaum test is used to assess near vision and is typically performed with a handheld card to check for presbyopia, which is the difficulty seeing up close. It is not appropriate for testing peripheral vision, which is the focus of the current assessment.

B) Consensual constriction: Consensual constriction refers to the reaction of the pupil in the opposite eye when light is shined into one eye. This test assesses the pupillary light reflex, which evaluates how well the pupils constrict in response to light. It is not used to assess peripheral vision and focuses more on the function of the optic nerve and pupil reaction.

C) Corneal Light Reflex: The corneal light reflex is a test used to assess for strabismus (misalignment of the eyes) by checking the symmetry of the light reflection on the cornea. This test helps in diagnosing eye alignment issues, but it does not evaluate peripheral vision.

D) Confrontation test: The confrontation test is a straightforward and effective method used to assess peripheral vision. The nurse and patient sit facing each other, and the patient covers one eye while the nurse tests the other eye’s visual fields by moving their fingers in from the periphery. This test evaluates the patient's ability to detect objects in their peripheral vision and is specifically designed for this purpose.