Bull's Eye Maculopathy: What It Is, Why It Happens, and How People Live With It
Updated: 3 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick answer
Bull's eye maculopathy is a rare condition causing degeneration of the macula, seen as light-colored rings around a dark center like a target [1]. It can be inherited, develop from other eye diseases or result from medications such as chloroquine or hydroxychloroquine [1]. There is no cure, and vision loss is usually permanent, so treatment focuses on stopping progression [1].
What the research says
According to PubMed:
Hydroxychloroquine retinopathy builds with treatment time and dose. A systematic review and meta-analysis of 19 observational studies of adults with rheumatic diseases screened with OCT found a pooled prevalence of 5.1%, with cumulative incidence of 0.1% at 5 years, 2.6% at 10 years, and 5.6% at 15 years. A daily dose above 5 mg/kg of actual body weight carried a higher risk (HR 4.32, 95% CI 2.80–6.65). (Daftarian et al., Arthritis Care Res, 2026 [8]).
Color vision changes and OCT findings helped flag the damage. In an Indian cohort of 110 long-term users, 11 (10%) had definite hydroxychloroquine retinopathy; they were much more likely to have color vision abnormalities (odds ratio 16.9, 95% CI 4.1–69.1), and OCT abnormalities were present in all 11. (Manoj et al., Rheumatol Int, 2021 [9]).
In some patients, retinal damage kept growing after the drug was stopped. In a retrospective study of 25 lesions in 18 eyes of 11 patients, OCT-measured damage progressed at an average of 131.6 μm per year after stopping hydroxychloroquine, which underlines why early detection matters. (Brown et al., Graefes Arch Clin Exp Ophthalmol, 2026 [7]).
Study details are from PubMed abstracts.
What Is Bull's Eye Maculopathy?
Bull's eye maculopathy is a rare condition that causes degeneration (deterioration) of your macula [1]. The macula is the part of your retina — the layer of tissue at the back of your eye — that handles detailed central vision [2].
The degeneration appears as discolored rings on your macula, like a target or bull's eye pattern [1]. Bull's eye maculopathy can cause permanent vision loss [1].
You can inherit bull's eye maculopathy — your biological parents can pass it down to you. You can also develop it as a complication of other eye diseases or from long-term use of certain medications [1]. When people inherit bull's eye maculopathy, healthcare providers might call it benign concentric annular macular dystrophy (BCAMD) [1].
While any type of vision loss is scary, your healthcare provider can get to the root of the issue and provide treatments and support to help you cope.
How does it affect your vision?
Bull's eye maculopathy damages the cells that help you see, so it can lead to varying degrees of central vision loss [1]. Some people have trouble seeing detail or color. It might be hard to see at night [1]. Central vision loss can make it hard to read, drive, and see things in front of you. The disease can affect one or both eyes [1].
Most people with bull's eye maculopathy don't have an issue with their peripheral vision — what you see out of the outer corners of your eyes [1]. But it's usually progressive, meaning it can get worse over time [1].
How common is bull's eye maculopathy?
Bull's eye maculopathy is rare. It affects fewer than 1,000 people in the U.S [1].
What are the risk factors?
A risk factor is something that increases your risk of developing a condition. Risk factors for bull's eye maculopathy include:
Risk factor | What it means |
Family history of bull's eye maculopathy | Your biological parents can pass the condition down to you [1] |
Macular degeneration | A related eye disease affecting the macula |
Genetic conditions like Batten disease or Stargardt disease | Inherited diseases that can lead to macular damage |
Certain medications | DMARDs (disease-modifying antirheumatic drugs) used for autoimmune diseases can raise risk [1] |
What Causes Bull's Eye Maculopathy?
Bull's eye maculopathy has three main groups of causes, and research suggests the drug hydroxychloroquine may cause it by binding to retinal cells [1].
Cause group | How it happens |
Genetics | The inherited form (BCAMD) is an autosomal dominant condition. A child with a biological parent who has the mutated gene has a 50% chance of inheriting the condition [1] |
Other diseases | Eye diseases like cone-rod dystrophy or retinitis pigmentosa can lead to bull's eye maculopathy [1]. It may also develop in people with genetic diseases like Batten or Stargardt disease |
Toxicity | Long-term use of chloroquine or hydroxychloroquine (used for rheumatoid arthritis or lupus) can damage macular cells. People who need frequent blood transfusions can develop hemochromatosis (iron overload), which can also damage your macula [1] |
How does hydroxychloroquine cause bull's eye maculopathy?
Experts aren't sure exactly how hydroxychloroquine causes bull's eye maculopathy. Research suggests that the drug binds to cells in your retina and may affect how they work [1].
What Are the Symptoms of Bull's Eye Maculopathy?
Symptoms of bull's eye maculopathy may include:
Symptom | What it feels like |
Blurry or cloudy vision | Your central vision loses sharpness |
Dark spots in your field of vision | Shadows or gaps in what you can see |
Difficulty seeing color | Colors look dull; in some cases, complete color blindness [1] |
Eye floaters or flashes | Specks or flickers drifting across your vision |
Low vision | Everyday tasks like reading become hard [3] |
What does bull's eye maculopathy look like?
You can't see bull's eye maculopathy with the naked eye, so you won't notice it if you look at your eyes in a mirror. An eye care specialist uses a tool called an ophthalmoscope to see your macula and retina [1].
The bull's eye pattern usually appears as a round, dark area surrounded by lighter rings. The round, dark area in the center represents the normal retina [1]. The rings are abnormal. The rings might be pale shades of orange, pink or purple [1]. The different colors are the result of macular damage or degeneration.
How Is Bull's Eye Maculopathy Diagnosed?
Healthcare providers diagnose bull's eye maculopathy using a range of different eye exams [1].
Test | What it does |
Visual acuity test | Your provider checks your vision by asking you to read different-sized letters on a standardized chart (Snellen chart) or video monitor [6], with both eyes and then one eye covered |
Visual field test | Checks your central and peripheral vision to determine if you have blind spots, using a grid of lines, lights, or hand movements [1] |
Color vision test | You look at an image of colored dots with differently colored numbers in the center (color plate test). If you can't see the numbers, you may have color blindness [5]. An anomaloscope may also examine how well you see the brightness of lights and colors |
Ophthalmoscopy (fundoscopy) | Eye drops dilate your pupils, then an ophthalmoscope examines your cornea, lens, retina, macula, optic nerve, and surrounding blood vessels |
Optical coherence tomography (OCT) | A noninvasive test that uses light waves to create highly detailed, 3D images of your retina's layers, including your macula. OCT shows macular damage and degeneration earlier and more clearly than other tests [1] |
Fundus autofluorescence imaging (FAF) | A newer imaging technique that uses blue light to examine pigmented cells in your retina [1]. Cells that absorb or reflect the light differently can help your provider identify retinal damage or degeneration |
If you're noticing changes in your vision — blurriness, dark spots, trouble seeing color, or difficulty seeing at night — schedule an eye exam promptly. Never let problems with your eyesight go unchecked, even though vision changes can be scary and stressful.
Is There a Cure for Bull's Eye Maculopathy?
Bull's eye maculopathy has no cure, and no treatment can reverse the vision loss it causes, though stopping a toxic drug may prevent progression [1].
If the condition results from drug or iron toxicity, stopping the drug or managing iron levels may prevent disease progression [1].
How is vision loss managed?
Most treatments focus on helping people cope with vision loss and color blindness [1]. Your provider may recommend:
Coping tool | How it helps |
Assistive technology | |
Glasses or contact lenses | Sharper correction for remaining vision |
Low vision rehabilitation or occupational therapy | |
Vision aids | Handheld magnifiers, telescopes, or light-filtering lenses [1] |
What's the Outlook?
Vision loss from bull's eye maculopathy is usually permanent and may be progressive [1]. You might be able to stop toxicity-related macular damage from progressing further by avoiding the toxin [1].
How Can I Prevent Bull's Eye Maculopathy?
There's no way to prevent the inherited form, but the risk from hydroxychloroquine can be lowered by keeping the daily dose at or below 5 mg/kg of actual body weight and having regular retinal screening [1].
What Questions Should I Ask My Provider?
Useful questions to ask your provider about bull's eye maculopathy include whether your medications could worsen it, whether vision loss is permanent and when driving becomes unsafe.
Am I taking any medications that could make the condition worse?
Are there any nutritional supplements that could help my eyesight?
How can I cope with vision loss?
How do I know when it's no longer safe to drive?
Is my vision loss permanent?
What are the chances my vision will get worse?
Conclusion
Bull's eye maculopathy is a rare eye condition that leaves a target-shaped pattern of damage on the macula — the part of your retina responsible for detailed central vision. It can be inherited, follow other eye diseases, or result from long-term medication use. While there is no cure and vision loss is usually permanent, stopping the trigger early can halt progression in some cases, and low vision rehabilitation, magnifiers, and assistive technology help most people continue daily life. If you're noticing changes in your vision, don't wait it out — an eye exam can find the cause and start you on the right support.
Want more clear, trustworthy health guidance? Explore our complete library of human-readable medical guides at www.rinnit.com.
Frequently asked questions
What is bull's eye maculopathy?
Bull's eye maculopathy is a rare condition that causes degeneration (deterioration) of your macula, the part of your retina at the back of your eye. The degeneration appears as discolored rings around a dark center, like a target or bull's eye.
Why is it called "bull's eye"?
Because the damage on the macula looks like a target — a round, dark area (the normal retina) surrounded by abnormal lighter rings in pale shades of orange, pink, or purple.
Is bull's eye maculopathy common?
No. It's rare and affects fewer than 1,000 people in the U.S.
Is bull's eye maculopathy inherited?
Bull's eye maculopathy can be. The inherited form is called benign concentric annular macular dystrophy (BCAMD) and is autosomal dominant — a child of a parent with the mutated gene has a 50% chance of inheriting it.
Can medications cause bull's eye maculopathy?
Yes. Long-term use of chloroquine or hydroxychloroquine (used for rheumatoid arthritis or lupus) can damage cells in your macula. Certain DMARDs for autoimmune diseases are also a risk factor.
How does hydroxychloroquine damage the macula?
Experts aren't sure exactly. Research suggests the drug binds to cells in your retina and may affect how they work.
What diseases can lead to bull's eye maculopathy?
Eye diseases like cone-rod dystrophy or retinitis pigmentosa, and genetic diseases like Batten disease or Stargardt disease.
What are the symptoms?
Blurry or cloudy vision, dark spots in your field of vision, difficulty seeing color (or complete color blindness), eye floaters or flashes, and low vision.
Can I see bull's eye maculopathy in a mirror?
No. You can't see it with the naked eye. An eye care specialist needs an ophthalmoscope to see the macula and retina.
Does it affect peripheral vision?
Usually not. Most people with bull's eye maculopathy don't have issues with peripheral vision — what you see out of the outer corners of your eyes. The condition mainly affects central vision.
Can bull's eye maculopathy be cured?
No. There isn't a cure, and there aren't treatments to reverse vision loss. But if the cause is drug or iron toxicity, stopping the drug or managing iron levels may prevent further progression.
How is it diagnosed?
With a range of eye exams, including a visual acuity test, visual field test, color vision test, ophthalmoscopy (fundoscopy), OCT (optical coherence tomography), and FAF (fundus autofluorescence imaging). OCT often shows the damage earliest and most clearly.
Can I prevent bull's eye maculopathy?
The inherited form can't be prevented, but drug-related damage can be reduced with a safe hydroxychloroquine dose and regular eye screening.
How do I cope with vision loss from bull's eye maculopathy?
Options include assistive technology (video magnifiers, projectors, screen readers), glasses or contact lenses, low vision rehabilitation or occupational therapy, and vision aids like handheld magnifiers, telescopes, or light-filtering lenses.
When is it no longer safe to drive?
Ask your provider — this is one of the key questions to discuss, since central vision loss can make driving unsafe and the condition may worsen over time.
Related reading
This article is for general informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read here. If you think you may have a medical emergency, call your doctor or 911 immediately.
References
Cleveland Clinic. Bull's Eye Maculopathy: Symptoms & Treatment. Cleveland Clinic. Last updated July 23, 2023. https://my.clevelandclinic.org/health/diseases/25144-bulls-eye-maculopathy
Cleveland Clinic. Macula: What It Is, Anatomy & Function. Cleveland Clinic. Last updated January 26, 2025. https://my.clevelandclinic.org/health/body/23185-macula
Cleveland Clinic. Low Vision: Causes, Characteristics, Treatment & Prevention. Cleveland Clinic. Last updated March 7, 2024. https://my.clevelandclinic.org/health/diseases/8585-low-vision
National Eye Institute. At a glance: Low Vision. National Eye Institute. Last updated November 15, 2023. https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/low-vision
National Eye Institute. Testing for Color Vision Deficiency. National Eye Institute. Last updated December 6, 2024. https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/color-blindness/testing-color-blindness
National Library of Medicine. Visual acuity test. MedlinePlus Medical Encyclopedia. Reviewed January 20, 2025. https://medlineplus.gov/ency/article/003396.htm
Brown RB, Kitay AM, Driban M, et al. Progression of hydroxychloroquine-induced retinopathy after drug cessation. Graefes Arch Clin Exp Ophthalmol. 2026;264(4):975-982. PMID 41504875. https://doi.org/10.1007/s00417-025-07037-8
Daftarian N, Yue C, Levasseur SD, et al. Risk of retinopathy associated with long-term use of hydroxychloroquine in patients with rheumatic diseases: a systematic review and meta-analysis. Arthritis Care Res (Hoboken). 2026;78(10):1532-1543. PMID 41789886. https://doi.org/10.1002/acr.80033
Manoj M, Sahoo RR, Singh A, et al. Prevalence of hydroxychloroquine retinopathy with long-term use in a cohort of Indian patients with rheumatic diseases. Rheumatol Int. 2021;41(5):929-937. PMID 33704526. https://doi.org/10.1007/s00296-021-04831-5
Comments