Drusen are common in aging adults over the age of 50. While drusen alone don't signify macular degeneration, people with larger or numerous drusen have an increased risk.
Did your eye doctor inform you that there are yellow spots underneath your retina, which could be indicative of macular degeneration? Were you only instructed to schedule to return for a follow-up appointment next year?
These yellow spots are known as drusen, which are small accumulations of fatty proteins that form underneath the retina. Drusen are a normal part of the aging process, and it is common for adults over the age of 50. However, they can also serve as early signs of macular degeneration. So, what's the connection between drusen and macular degeneration? Can you have drusen without macular degeneration?
What are drusen?
Drusen are small deposits of protein, lipids, and cellular waste that form under the retina. The retina is the light-sensitive tissue at the back of the eye. Drusen build up between the retina and a layer underneath called Bruch’s membrane. Ophthalmologists can see drusen during a dilated eye exam. They look like pale yellow dots scattered throughout the retina.1
There are a few different types of drusen:1
- Hard drusen, also called “small drusen,” are small dot-like drusen that look like sprinkled mustard seeds. They are considered normal age-related changes.
- Soft drusen are larger, with more irregular borders. Multiple large, soft drusen increase the risk of macular degeneration.
- Cuticular drusen look like hard drusen, but they are more numerous and often aggregate. High numbers of cuticular drusen also raise the risk of macular degeneration.
Drusen in different stages of macular degeneration
The risk of progression to age-related macular degeneration (AMD) increases as the size of the drusen increases. Similarly, an increase in the number of drusen further raises the likelihood of progression.2
- Early AMD is identifiable through the presence of medium-sized drusen, which are often detected during routine eye exams.2
- Intermediate AMD is characterized by the presence of large drusen and/or retinal pigment changes.2
- Advanced or late AMD is distinguished by significant central vision loss resulting from the development of geographic atrophy or neovascular AMD. This vision loss is often accompanied by the fusion of large drusen.2
What are the risk factors for drusen?
Age is the biggest risk factor for drusen. After age 50, drusen become increasingly common. When the drusen become larger or aggregated, the risk of AMD increases.6
Other factors that can also increase the risk include smoking, being overweight, having a family history of the disease, having high blood pressure, and having high levels of cholesterol in your bloodstream.6
Can you have drusen without macular degeneration?
Yes, drusen alone do not necessarily mean you have macular degeneration.
Drusen are a normal part of the aging process, and it is common for adults over the age of 50 to have at least one drusen.3 So if your eye doctor told you that you may have potential signs of macular degeneration, but only asked you to come back next year for a follow-up, it is possible that you only have some small drusen.
What if I have drusen - what can I expect?
If you have drusen, the first step is to make sure you have a thorough evaluation of your eyes. Your eye doctor will examine the type, number, and location of the drusen to determine your specific risk profile.
If you only have a few small hard drusen, your doctor will likely monitor them during your annual exams. No specific treatment is needed for hard drusen alone. It's worth noting that a review study found that treating drusen with a laser can make them disappear, but it does not reduce the risk of developing wet AMD or geographic atrophy.4
Afterward, from the onset of early AMD, characterized by larger and more numerous drusen, to intermediate AMD, the progression is usually slow and can take several years. For instance, within a five-year period, up to three out of 100 individuals with early AMD may progress to intermediate AMD, while half of those with intermediate AMD may advance to the vision-threatening late stage.
Furthermore, your eye doctor may recommend interventions aimed at halting the progression of AMD only starting from the intermediate stage (see AREDS 2 supplement) since there is no proven treatment for early AMD.
Key takeaways
So, in summary – yes, drusen can occur without macular degeneration. But larger, softer drusen increase the risk of AMD and should be monitored closely.
Be sure to get a dilated eye exam every 1-2 years if you are over 65 or as your eye doctor recommends.5 Catching concerning changes early provides the best opportunity to slow or prevent macular degeneration progression.
And lastly, if your eye doctor asks you to come back in a year, it is okay! They're well-experienced to handle any "softy" situation that may arise while staking out the hard ones.
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- VanDenLangenberg, Adam M. and Michael P. Carson. “Drusen Bodies.” StatPearls, StatPearls Publishing, 1 May 2023.
- Ferris, Frederick L 3rd et al. “Clinical classification of age-related macular degeneration.” Ophthalmology vol. 120,4 (2013): 844-51.
- Klein R, Klein BEK, Linton KLP. Prevalence of Age-related Maculopathy: The Beaver Dam Eye Study. Ophthalmology. 2020;127(4S):S122-S132.
- Virgili, Gianni et al. “Laser treatment of drusen to prevent progression to advanced age-related macular degeneration.” The Cochrane database of systematic reviews vol. 2015,10 CD006537. 23 Oct. 2015.
- Pelletier, Allen L et al. “Vision Loss in Older Adults.” American family physician vol. 94,3 (2016): 219-26.
- American Academy of Ophthalmology. (2023, July 15). What are drusen? Retrieved from https://www.aao.org/eye-health/diseases/what-are-drusen
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