Do All Patients With Drusen Have Macular Degeneration?

Drusen are commonly found in many individuals that have macular degeneration. Do all patients with drusen have macular degeneration? The answer is no.

There are characteristic findings in patients with macular degeneration.  Patients may have white dots located in the deeper layers of the retina.  These excrescences are called drusen.  There are two types of drusen, hard and soft.  Both may be found in macular degeneration and both, especially hard drusen, can also be a normal.  Other findings characteristic of macular degneration are pigment changes, either increased pigement or decreased pigment, fluid and/or blood.

How then do we distinguish normal from abnormal? The hardest scenario in which to diagnose macular degeneration is when a patient has only hard drusen.  There are no pigment changes.  No fluid or blood.  You must then add other pieces of the puzzle together.  Is there vision loss?  Is the vision symmetric and consistent with the findings in the retina (from experience you can kind of estimate how good or bad someone should be seeing by looking at the retina)?  Are there reasons other than macular degeneration for loss of vision, such as cataract?  What is the age of the patient?

Finally, (and this is according to the world of “Randy”) if a patient has drusen, no other findings, and either no loss of vision, or loss of vision that can be explained by something else (such as cataract), I have a hard time diagnosing them with macular degneration.

Many doctors diagnose macular degeneration everytime they see drusen.  It is not correct, it is not fair.  There are too many people wandering around just waiting to go blind from macular degeneration just because of a few drusen.

More later.

“Randy”

Randall V. Wong, M.D.
Ophthalmologist/Retina Specialist
www.TotalRetina.com

Comments

  1. J P Hickey says:

    My wife, Joan Hickey is a patient of yours. This is the first I have heard of drusen. I try to keep up on all the information on Macular degeneration.I will be a regular reader of your blogs.

  2. archie hill says:

    Hi Dr.
    my wife was diagnosed 2 years ago with soft drusen in both eyes her sight is still good is there a chance the disease wont get any worse.
    much obliged.
    archie

  3. Dear Archie,

    Yes. It is possible the disease does not get worse. I would recommend regular follow up.

    r

  4. I have ocular albinism. Vision is 20/400, pedular nystgmus, astigmatism and very little pigment in my eyes. And recently one lone floater was added to the mix which turns out is nothing to worry about but the Optomitrist I saw (a young guy who specializes in contact lenses) seemed to think that at 41 I MIGHT have macular degeneration.(cringe) He found a few crystals in one eye. I’m scared to death it may be MD but after reading what this doctor wrote I feel there’s a ray of hope in this. They did do retina imaging (chasing my dancing eyes around for 30 minutes with the machine) but nothing conclusive. Every opthamoligist I’ve seen in the past never mentioned seeing a few crystals. He did say the foveal may’ve appeared to be a little atrophied but ummmm due to my condition they’re VERY underdeveloped anyway and I ofcourse have NO binocular vision while depth perception stinks. I’m trying to convince myself the optomitrist (having never seen my condition) just wasn’t sure of what he was seeing.:) He did say I have very interesting eyes.(eye roll)

  5. Oh. I was wondering if the fact that my cat stuck his claws into the white part of the same eye the crystals were found in 11 years ago could be just the scar tissue (the doctor put a one time numbing drop in it to alleviate the pain) and then a couple of years ago I blacked that same eye pretty good in a fall.?

    He wants to do an OCT scan but knows it may not happen because of my roving eyes.:) I just really pray its my condition he saw in the few crystals and small foveal and NOT macuar degeneration because I cherish what vision I have to read, write and get around on my own despite not having steer vision.:(

  6. Hi
    I am most interested to read that you would not diagnose macular degeneration if a person has drusen – either hard or soft – but has no other symptoms such as loss of vision, cataracts etc.

    I live in Australia, am a female, 58 years old. I have been diagnosed with both hard and soft drusen – (in both eyes). The retina professor i saw told me that because of the size of the drusen, she would diagnose me as having macular degeneration. I have not had any changes in my eyes since being diagnosed a few years ago. I can still read well with glasses. I take supplements for my eyes, exercise and eat well, with lots of vegetables and leafy greens.

    As a previous post says, when given this diagnosis, many people are expecting to go blind, or have sight problems in the near future, or immediately.

    I realize you cannot comment on another professional opinion, but rather than scaring people, why can’t the diagnosis be explained in a more realistic manner, that the layperson can understand?

    Having read your comments has allowed me more peace of mind regarding my diagnosis of macular degeneration. I will continue to have regular follow ups.

    Great that you have this blog. I will read regularly. Any comments you have regarding my post, would be appreciated.

    Barb

  7. Dear Angie,

    Not sure if there is really anything to worry about. As you are aware, folks with ocular albinism have “underdeveloped” maculae due to the fact that you lack the necessary pigment that allows you to see. It is this very pigment that degenerates in macular degeneration.

    While have communicated already via email, I applaud your desire to learn so much about your disease. For you, your condition is stable, that is, it is unlikely to get worse, or better. On the other hand, this is the only vision you’ve known…but if you indeed have ocular albinism you should be stable.

    Thanks so much for contributing to my site!

    All the best and thanks for the “glass is half full” attitude!

    Randy

  8. Angie,

    I have no idea about these “crystals.”

    r

  9. Dear Barb,

    I agree with your comment regarding a different explanation.

    I don’t have a great reasons why this is not explained better. I’ve learned that the “truth is always in the middle.”

    That is, it is sometimes very difficult to explain “shades of grey” to patients. It is hard for the doctor to explain it convincingly and concretely and, on the other hand, it’s difficult to predict exactly what a patient hears or remembers.

    The format of print/text is better as it can be read over and over again, but many don’t read, hence they hear something, want absolutes and voila!

    I think I’ll write something in the near future.

    Thanks for the comments and inspiration!

    Randy

  10. I was told that i might have stargardts disease, and another doc who took pictures told me that i have dominant drusen. i am 32 years old, but am wondering what is actually going to happen to my eyesight?

  11. Dear Pamela,

    I would recommend an evaluation with a retina specialist who might perform and Fluorescein angiogram. Proceed from there, but I wouldn’t get too worked up. Not enough data right now.

    Randy

  12. Chris Miller says:

    I am 41 and had an eye exam earlier this year that I was told was good. In fact they had to trst me twice because my eyes seemed to get better from what they had been. I have had some near sightedness and astigmatism since I was 20 and have worn glasses for 20 years. We just moved to Chicago and I wanted to get new glasses so I got my vision rechecked. It barely changed according to this Optometrist but he said he saw a small white dot in both eyes and sent me to a opthamologist here. He did a Fluorescein angiogram and looked and said I have a few small drusen and not to worry, it was just something to watch. He did mention that he thinks it could lead or was an early form of herditary macular degeneration. No one in my family from great grandparents down has/had this. My Mom said her sister thought she might have it at 70 but it never materialized. I’m 41, white male, brown eyes and my vision is good with glasses. When I was shown the exam I couldn’t even see the dots he was pointing at and when I mentioned this he dismissed it and said ti was because of the dark. So I guess I am wondering…should I be freaked out? I have 2 small kids and want too see them grow. I can’t believe this could be happening from his findings.

  13. Dear Chris,

    Don’t freak. From the sounds of it, you don’t have any indication of macular degeneration. If indeed you have drusen, they can be normal. The best thing to do is get examined regularly to check for any deterioration in your vision (not your prescription) and for someone to look at your retina.

    I would expect you’ll see more than you want of your children growing! (Remember I’ve got 5, you don’t want to see everything!)

    Randy

  14. Chris Miller says:

    Thank you so much Dr. Wong, I appreciate your response and great blog!

  15. Mark Pattenden says:

    Hi,

    2 weeks ago I noticed a relative scotoma in my left eye causing some distortion (wavy lampposts etc.) and slight blurring. I went to see a high-street optician (couldn’t get to my regular optician urgently enough) and he was really shocked to see the state of my retina’s in both eyes. Quite a lot of drusen are present so he advised I get a hospital referal as it looked like AMD. I’m only 45, so that really got me panicked and I rushed to A&E.
    I have since had loads of tests (OCR and fluoroscene angio). Bottom line is that they think my drusen have been around for ages… probably a genetic disorder…. but that I do have some fluid under the macula in my left eye.
    Problem is the tests cannot determine if this is CSCR or wet AMD. Do you know if there is a good definitive test to tell the difference that I could request?
    My consultant initially proposed a Lucentis injection, but we agreed to hold off for a few weeks to see if anything changes on its own…. so far my vision is pretty stable and I am checking on an Amsler grid every day (to make sure I’m not just kidding myself that its all ok!)
    Any thoughts on whether my “wait and see” plan is safe? How quickly would I notice wet AMD deterioration? Could delaying by a few weeks just make things worse?

    Cheers, Mark

  16. Dear Mark,

    Tough spot. I would think the FA (fluorescein angiogram) would have helped.

    Emperically, the Avastin/Lucentis option seems reasonable. In either case, neovascularization or not, you may benefit.

    r

  17. Dear Dr. Wong,
    This weekend, on my birthday I was told that I have drusen in both eyes, that my optic nerve is inflamed and its shame is changed and that I will not go blind NOW……….
    Needless to say, I have been crying my eyes out, losing sleep and being very depressed. I had those detailed pics of the eyes taken and will have the peripheral vision test done next. I just want some answers.
    What is the percentage of people with drusen that develops MD and / or go blind?
    How rapidly do these drusen grow?
    Yeah, I know we are all different but there is gotta to be some research on this topic and some statistics.
    What are my chances of going blind?
    What are some good questions to ask my doctor?
    Oh, how I wish I came to see you instead……
    PLEASE help me understand……….I need to know………….
    Also, should I go to check-ups every 6 months or is the yearly one sufficient?
    I am an emotional wreck……..I really am……….
    Thank you Sir for your help.

  18. Dear Daniela,

    Not all people with drusen develop AMD.
    How old are you? If you are young, the drusen are likely to be normal for you and not cause any issues.
    You aren’t giving me enough information about your optic nerve.

    Randy

  19. I am 36 years old. I have a peripheral vision test scheduled for this Monday and the doc will compare pics of my optic nerve from last year to this year. What should I ask him? What info would be useful to you to shed some light on my situation?
    Thank you so much Sir.

  20. Could you please answer some of my previous questions, if you don’t min?
    Thank you so much.

  21. Hi Doctor,
    Here is what I was told today: the drusen are on the optic nerve not the macula and are buried. The images from last year and this year don’t show changes. He said that I could go blind in 6 months or live to be 70 and not go blind. What do you think?
    Please answer back!
    Thank you.

  22. frances boyle says:

    Hi,
    I am thirty four, during a routine check my optician took a photo of the back of my eyes and showed me a few small hard drusen spots on the retina and a couple on each of the macula, I am seriously worried about my future sight.

  23. Dear Frances,

    The best was to alleviate your fears is a visit to a retinal specialist. A fluorescein angiogram should be helpful in determining if there is any “damage” associated with the drusen. In many cases, drusen are normal.

    Randy

  24. HI DOCTOR,

    I WENT TO THE EYE DOCTOR 2 YEARS AGO, AGE 48, SHE TOLD ME I HAVE DRUSEN AND WILL BE BLIND BY THE TIME IM 50. I BEEN STRESSED EVERYDAY, I DON’T KNOW WHAT TO DO. SHOULD I GET ANOTHER OPION? SHE DIDN’T SAY ANYTHING ELSE TO ME, I TRYED TO ASK QUESTIONS AND SHE WAS VERY RUDE. JUST TOLD ME TO EAT GREEN LEAFY STUFF AND TO SEE HER EVERY SIX MONTHS.

  25. Dear Tami,

    What a horrible burden! Macular degeneration does NOT cause complete blindness. It can make you unable to read or may cause loss of central vision, but not complete blindness. Also, with the advent of today’s treatments…..it is unlikely that you will lose significant vision if the drusen do indeed predispose you to develop wet ARMD (worst case scenario).

    Get a second opinion.

    r

  26. Good Afternoon,

    I am 25 years old and recently had an I exam to check my vision. My right eye is 20/20 while my left eye has minor latent hyperopia. The left eye needed +.50 correction. During the exam the doctor informed me of three small spots near my central vision and suggested I get a second opinion from a retina specialist. Based on my research the spots I saw in the picture look most similar to hard drusen. Do you think I should still get a second opinion this young as my vision is nearly perfect uncorrected? Would this require a fluorescein angiography? Thanks for your opinion!!

    Brian

  27. Dear Brian,

    Without my ability to examine you, I’d have to recommend that you see a retina specialist. I don’t think the hyperopia has anything to do with the spots.

    A fluorescein angiogram would be the best in determining if there is a true problem.

    Randy

  28. Hi there.I’m 55yr old male and recently had flashes and floaters in my right eye, a slight awareness of a misting which is noticed mainly on a bright day, (right eye only) Had the deep eye scan and retinal imaging scans, have been told that I have Drusen affecting both retinas, was asked if I am diabetic which I’m not! Not sure what to do next? My new glasses have 100%UV protection,am also taking ocuvite eye vitamins,could high cholesterol be the cause of Drusen? My Father has wet macular which he developed at the age of 90.
    Thank you.
    Geoff.

  29. Dear Geoff,

    Drusen are unassociated with the flashes and floaters and may be an incidental finding.

    The fact that your father had wet macular really has no bearing on your chances.

    Don’t know why you would be asked about diabetes based upon your comment.

    High cholesterol not associated with drusen.

    As I said in this article…drusen can be normal.

    No data exists supporting your use of Ocuvite…btw.

    Randy

  30. Mariannee says:

    please sign me up to receive these posts

  31. Marianne,

    Kindly navigate to the “Home” page and sign up in the blue “opt-in” window.

    Randy

  32. hi I have been told my a retinal specialist that I have an area of retinal pigment epithial atrophy near to the fovea but he didn’t tell me what could cause it could it be a form of armd, im 37 and live in the uk

  33. Sue,

    There are many, many times where we see loss of RPE in the retina and have no clue as to the cause. It could be congenital, secondary to viral infection, previous Central Serous Retinopathy, trauma/inflammation, hereditary/macular degeneration.

    It’s kind of like walking through the woods and you come upon a old campsite where you see evidence of an old fire and asking….what kind of wood was burning?

    My point is that while it may be difficult to determine an exact cause, ensuring that it not progressive is more important.

    Hope that helped and not confused.

    Randy

    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, Virginia 22030

    TotalRetina.com

  34. i am 48yrs old diagnosed with Drusen at 32yrs old. The Drusen is growing and getting worse and effecting my eye sight, but im told it is a Dry MD. But i fear i will go blind. Will I ???

  35. Del,

    Most patients with macular degeneration do NOT go blind.

    Randy

  36. Dear Dr. Wong,i

    Friday I went to D.O. For a referral to a surgeon for cataract surgery. I was told I have six small to medium size soft drusen in my left eye. I can see fine out of my eye. Does this mean I have macular degeneration? I started on reds2 and have added salmon and green leafy veggies to my diet. I am very anxious about all of this. I have red hair green eyes, hypertension (recently treated for 160/90 or 150/80)’ overweight and my mother had macular degeneration. I am really in a panic. Also, say I devlope AMD will I still be able see movieand TV? My mother could no longer read but she use to watcgh TV ….I don’t know if he could see it. She use to cry all the time. In advance thank you for your help.

  37. Diane,

    First, get an eye exam by a retina specialist. Retina specialists perform a test called a fluorescein angiogram. This should provide useful information about the health of your retina.

    Randy

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