Bull’s eye maculopathy

What causes bull’s eye maculopathy and who is at risk?

Inherited conditions affecting the retina

BEM can be caused by inherited conditions affecting the retina. Inherited conditions are conditions that are passed down to us by one or both of our parents. If one of your parents has bull’s eye maculopathy, you have a 50% chance of also having it.

Other eye conditions

Bull’s eye maculopathy can develop in people who have Stargardt disease, cone-rod dystrophy, age-related macular degeneration or retinitis pigmentosa.

Drug-related causes

The condition can also be caused by certain drugs that weaken the immune system, called hydroxychloroquine and chloroquine. These medicines are prescribed for things like malaria or rheumatoid arthritis. 

Blood transfusions

People who have frequent blood transfusions can sometimes get a buildup of iron in their body (hemochromatosis) which can also lead to bull’s eye maculopathy, as it damages the macula.

Risk factors

There are many factors that can increase your likelihood of developing bull’s eye maculopathy:

• Whether you have a family history of relatives with the condition
• If you smoke - smokers are more likely to develop bull’s eye maculopathy
• Your lifestyle: if you are overweight or have a diet lacking in vitamins and minerals most often found in fruit and vegetables, you will have a higher risk of developing the condition

How to recognise early symptoms of bull’s eye maculopathy

Some people with this condition do not have any symptoms to begin with, but bull’s eye maculopathy gets worse over time. It can be mild or severe. Unfortunately, for some with the condition, it can eventually mean permanent central vision loss, but this is rare. Symptoms vary, even in people from the same family, but usually include:

• Night blindness
• Colour-blindness
• Difficulty in seeing fine detail
• Trouble reading
• Blurred vision
• Distorted vision (straight lines look wavy)

If you think you might be having symptoms that affect your central vision, then don’t delay and make an appointment to see an eyecare specialist as soon as you can. Early detection of bull’s eye maculopathy is very important.

If you have been diagnosed and want to discuss your diagnosis, you can call our helpline on 0300 3030 111. You can also email us on help@macularsociety.org

How bull’s eye maculopathy is diagnosed: tests and what to expect

Bull’s eye maculopathy is usually diagnosed by an eyecare specialist such as an optometrist or an ophthalmologist. They do this with specialist tests. Though the appearance of the eye (like a target, hence the name) is a good indicator that you have developed bull’s eye maculopathy, they will need to do more tests to understand how best to help you.

Tests for bull’s eye maculopathy include:

• Visual acuity: this test looks at how well you can identify letters and numbers from a distance without using any visual aids, like glasses
• Dilated pupils eye exam: your eyecare specialist will carefully look at your retina after they have applied special eye drops that widen your pupil (the black part at the centre of your eye)
• OCT (Optical Coherence Tomography) using light waves, this test helps your optometrist check for changes to your retina that will affect your vision. An OCT machine takes thousands of pictures in seconds

All these tests are painless and fairly quick and easy to do.

Managing bull’s eye maculopathy: treatments, lifestyle changes, and support

Treatment options will depend on what has caused the condition. 

Drug-related causes

If BEM was caused by a medicine, then your doctor may ask you to stop taking it.

Many people who take a drug called hydroxychloroquine have an increased risk of developing bull’s eye maculopathy. If you are taking this drug, then regular checkups to monitor your sight are recommended. You can read more about what to do if you are taking this drug on our hydroxychloroquine screening page.

Monitoring usually starts about five years after you start taking this drug. This is because eye damage caused by hydroxychloroquine is rare and slow to develop when you first start taking the drug. After five years, the risk of eye damage begins to increase.

For some people, bull’s eye maculopathy will continue to get worse after stopping medication, but this will depend on your circumstances. Please be aware that you must always consult a doctor before stopping your prescribed medication.

Genetic causes (family history)

Though inherited bull’s eye maculopathy has no cure, there are various low vision aids that you might find useful. What works for you depends on your condition, so make sure you discuss this with your eyecare professional.

How to reduce your risk of bull’s eye maculopathy

Some people will not be able to reduce their risk of getting bull’s eye maculopathy as it is something that can be passed on to us from our parents. If you are taking hydroxychloroquine, you will need regular monitoring to ensure the drug is not causing you problems with your eyes. You can find out more about this in our guide to hydroxychloroquine retinopathy screening.

If you know you have a family history of vision problems, you can protect your eyes by:

• Getting regular eye check ups
• Following the advice of your eye specialist
• Wearing sunglasses to protect your eyes in the sunlight. Make sure they have 100% UV protection, which should be detailed on the label in the shop
• Following medical advice about what drugs to take and talking to your doctor before stopping any medicines

Living with bull’s eye maculopathy

Finding ways to adapt is the key to coping with bull’s eye maculopathy and there are a few things you can do to improve your quality of life when you’re living with this condition.

Practical advice

Use a magnifying device to increase the size of whatever you’re looking at. From a simple magnifying glass to various handheld magnifying devices or even apps, these will help you to read more comfortably.

Light it up: make the most of the lighting in your rooms by adding lamps with adjustable light levels to reduce the strain on your eyes and maximise the vision you have.

Apps and electronic devices that come with accessibility features can help you read or even read to you, increase font sizes on websites or change the colours of what you’re viewing.

Your mental health

Firstly, be kind to yourself and seek out ways of exploring your emotions about living with changes to your eyesight. Family and friends can be helpful when you want to express yourself, but professional help can be very useful too. The Macular Society provides a helpline on 0300 3030 111 or you can email us on help@macularsociety.org. You can also find your local support group or access, free, telephone-based counselling provided by The Macular Society.

Driving with bull’s eye maculopathy

As bull’s eye maculopathy affects your vision, it may be something that you must disclose to the DVLA. You should discuss this with the person managing your eye health, or whoever diagnosed your condition.

You may find that bull’s eye maculopathy impacts your quality of life. Dealing with deteriorating eyesight is difficult and support is available from the Macular Society.

We’re here to help - call us on 0300 3030 111 for more information and advice.

Current research and developments for bull’s eye maculopathy

As bull’s eye maculopathy is so rare and difficult to tell apart from other eye conditions, research is at a very early stage. More research is needed on those who are affected to help us understand where the faulty genes are and how the condition is caused.

Researchers are currently looking at:

• Which genes are involved in bull’s eye maculopathy.
• How medicines can damage the retina.
• New imaging machines and techniques to find damage more easily and detect changes earlier.
• If treatment for related conditions could help bull’s eye maculopathy

Support for people with bull’s eye maculopathy

The Macular Society is here to help anyone with a macular condition – and their friends and family. Whatever you’re worried about, however many questions you have, we can get you the answers you need.

We have skilled advisors available to you Monday to Friday from 9am to 5pm. Just call 0300 3030 111 to talk to someone who understands and can listen.

You can be referred for counselling, which is helpful for anyone struggling with their emotional health because of poor eyesight.

Our befriending service will help you find someone to talk to who has been where you are and can give you advice and listen to your worries.

We have a network of support groups across the country where you can find a community of supportive people who understand what you’re going through.

We also provide a range of guides that tackle the various challenges that face people with a macular condition.

These cover:

Employment issues like how to tell your employer, what rights you have at work, and how to make changes in the workplace.

How to make changes in your home to make life easier when you have low vision.

Ways to redesign your lighting to reduce glare, brighten key areas and make seeing easier.

Information for people feeling anxious about getting out and about.

FAQs about bull’s eye maculopathy

What is bull’s eye maculopathy?

It is a rare eye condition that can affect your central vision. Its name comes from the way the eye looks (like a bull’s eye target).

Will I go blind if I have bull’s eye maculopathy?

Total blindness is rare. Most people with this condition have problems with their central vision, but keep side vision.

Is bull’s eye maculopathy inherited?

It can be. In many cases it is caused by a family history of the condition (inherited genetics).

What can cause bull’s eye maculopathy?

It can be passed down from parents to their children, caused by certain medicines, or it can be caused by other eye conditions

Will bull’s eye maculopathy get worse over time?

Yes, for many people symptoms will worsen over time, but it is different for everyone.

Last review date: 08 2026

Next review date: 08 2028