The scattered around the macular region are little mounds beneath the retinal pigment epithelium. They are tombstones of dead retinal pigment epithelial cells. The commonest cause is age-related macular degeneration, a common but poorly understood disorder of the elderly.
At this stage, visual acuity may be only slightly abnormal. If the retinal pigment epithelium dies further, vision will fail as the foveal region turns into a confluent yellow-white area. The greatest threat to vision, however, is the development of submacular neovascularization, which can cause .