People with the intermediate stage of AMD may have difficulty reading road signs, and letters and other straight objects may appear distorted or crooked. In advanced stages of AMD, there may be areas in the vision, especially in the center, that have a dark spot, or scotoma, from either blood or geographic areas of atrophy or scar. However, in AMD, only the central vision usually is lost; peripheral vision remains intact except in rare cases where the neovascular process may extend beyond the equator or extensive hemorrhage breaks through into the vitreous. Otherwise, people with the advanced stage of AMD usually can walk around independently. They may not be able to read, drive, watch television, or do other fine tasks, especially when both eyes have the advanced stage, but they would generally not require assistance such as a guide dog or a cane because of AMD. Referral to a low-vision specialist may be helpful in improving their quality of life.