Drusen Not Associated with Macular Degeneration

Drusen are associated with macular degeneration but are not diagnostic of the disease.  Too many feel that these “spots”  are indicative of ARMD, but they can, and often are, normal.

What Are These White Lesions?

Drusen are white spots, or lesions,  seen within the layers of the retina.  There are two types; hard and soft.  The differences between the two are somewhat subtle.

Hard drusen are small and well defined with sharp borders.  A poppy or sesame seed is an example of an object with sharp margins.  “Hard”  can be associated with macular degeneration, usually dry.

Soft drusen are larger and have fluffier borders.  A cotton ball has fluffy margins.  “Soft” can be normal, but are usually seen more often with exudative, or wet, ARMD.

Familial Drusen

Drusen, by definition, can be found anywhere in the retina.  When they are located outside the macula, they are usually of no consequence and not related to any disease, especially macular degeneration.  I am usually concerned when they are located within the macula.

But most non-retina people (i.e. doctors) are afraid to mention this – drusen away from the macula are of little consequence and can just be a family trait – if anything.

Other “Findings” of Macular Degeneration

“Findings” are the signs or physical characteristics of disease.  These are things we look for as signs of disease.

Symptoms of ARMD are ways you describe changes in your vision.

Other signs of ARMD include, atrophy of pigment, increased pigmentation, fluid and blood.  There may be fibrosis – a sign of old choroidal neovascularization.

Many doctors will term anything abnormal in the macula as “scars.”

Making the Diagnosis of Macular Degeneration

Patients have to have 3 criteria;

  • Patients have to be over 50-55 years old
  • Patients have to “look” like they have the disease (that is, they have  signs)
  • Patients have to have “symptoms” of the disease (that is, they have decreased vision)

Having just drusen, for example, but no change in vision or other signs of the disease, probably do NOT signify macular degeneration.  It may be a sign of early disease and careful monitoring may be prudent.

Many times macular degeneration is diagnosed based solely upon the physical findings, but unless there is any evidence of decreased vision, I’d hold off on making the diagnosis.

Best Test for Diagnosis

If there is any doubt about the diagnosis of macular degeneration, the single best test, in my opinion, is a fluorescein angiogram.  This test can show any damage to the macula that can not be seen by the usual methods.  More subtle damage can be detected in this manner.

Drusen, unassociated ARMD, will not show any macular damage.

What Does This Mean? This means there are far fewer patients that actually have the disease than are diagnosed.  In other words, there are instances where ARMD shouldn’t really be diagnosed.  Many docs feel that it is safer to give the diagnosis for liability reasons.

I don’t understand this.

If there is any question about the presence, or absence, of macular degeneration, have your doctor order a fluorescein angiogram.

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Comments

  1. Elizabeth says:

    I am 61 years of age and have been diagnosed with dry drusen to the left of the macula. Will this developer into macular degeneration. I am so worried

  2. Elizabeth,

    Drusen are often normal and an incidental finding. Get examined periodically. Ask your retina specialist to perform a fluorescein angiogram. This should help calm your fears. Make sure to see your doctor if you sustain and persistent changes in vision, including disortion.

    Randy

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

    http://www.vitrectomyforfloaters.com

  3. Dr. Wong

    I am 26 years old and have had drusen outside of my macula for several years. My optometrist said he has been monitoring them for 4-5 years and they haven’t changed and my vision is 20/20. After doing my own research online I freaked out and went to see a retinal specialists. He said that I have fine drusen and he considers these low risk. He said said the way AMD type drusen are made are not exactly how these are formed and not to lose sleep over it. He said the layers in my retina are not thinning. He wants me to come back in 18 month just to make sure there are no changes. I guess my question is do you think it is inevitable I will develop AMD? Are my chances higher than normal? Can anything be done?

  4. Brittany,

    I can’t predict, but many times drusen are normal when not involving the macula and are in young patients. Each case/person varies and I can’t say for sure in you due to my inability to examine you.

    You are doing the right thing by getting frequent exams and following your doctor’s advice.

    Sorry for being so vague,

    Randy

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

    http://www.vitrectomyforfloaters.com

  5. I hope you can answer this for me. I’m 32 years old female. I went to an eye doctor in December. Had a regular check up like always and he said everything was fine. He didn’t see anything. Well I went to an eye doctor in February….so two months apart. And he says I have some drusen, most likely from having pre eclampsia from when I was pregnant. He said I have an early form of macular degeneration. Which is crazy for a woman of my age. So I have an appt this Wednesday for an ophthalmologist. I’m just wondering if you think this is macular degeneration or what? I’m so nervous and making myself soooo sick worrying about this. My vision is fine ornery than I wear contacts. I have never had any problems with my vision. Please help me!!!

  6. Megan,

    Hoping you got some good news this week after seeing the other doctor. To be sure, you may want to see a retina specialist.

    Randy

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

    http://www.vitrectomyforfloaters.com

  7. Hi: my optometrist says I have bumps behind my macula and in his opinion it does not look like macular degeneration, however I was sent to an ocular health centre for further examination. Tests were taken to determine if there are leaking blood vessels and I go in June to hear the specialist’s analysis. I am 59 and am having some trouble with seeing numbers. Sometimes the digits are switching places and it’s hard to figure out what the numbers are at times. My optometrist says its because of the bumps which he called drusen. I am worried sick about this because I am close to retiring in 3 years and I want to pursue my second life as an artist. My father had macular degeneration but not until his mid seventies. So fearful about this. I have been taking lutein for some time now and all of the good food that helps prevent AMD.

  8. Hey,
    I am 17 years old and corrently diagnoised with fammilis drusen,
    I have blured vision on lt eye and I was wondering is there any treatment.
    Thanks
    Negin

  9. Barb,

    No way for me to know for certain, but get the opinion of the retina specialist and hopefully a fluorescein angiogram is performed. My best guess is that you are fine if you’ve not noticed anything wrong with your vision.

    Get the opinion of the retina specialist.

    Best of luck,

    Randy

  10. Negin,

    Usually there is no change in vision associated with familial drusen. I’d get a second opinion. Have you seen a retina specialist?

    Randy

  11. Hilary Ham says:

    Hello Dr. Wong, I am 30 years old as was recently diagnosed with familial drusen by a retinal specialists. My regular eye dr. Thought I had macular degeneration. What is familial drusen and does it mean I will eventually have macular degeneration?

  12. I recently saw a retinal specialists who confirmed that I had drusen in my macula, he then said I do not have macular degeneration and that I may have been born with this. Then he sent me a “visit over view” that said his first immpression is amd ou (familial drusen,) drusen and changes in rpe…. I am so confused. I am only 30 and he told me whole I was there that I may never get macular degeneration. Does this seem consistent with my visit over view? I don’t know what I have. Thank you!

  13. Hilary,

    My best guess is that he told you that you didn’t have macular degeneration, but you were given patient information biased toward patients with ARMD.

    Seems like the message he gave you fact-to-face is the most worthwhile.

    r

  14. Hilary,

    Sound like your retina specialist and I see “eye to eye.”

    Listen to the specialist.

    r

  15. I’m 63 and just had my yearly exam. Dry drusen showed in one eye and in the macula with everything in the test coming out normal.
    The optometrist said do not worry, he’s not seeing degeneration of the macula. He said to begin Icaps
    Vitamins as a precaution. Is there a high percentage of these dry drusen doing damage or can they remain stable.
    Obviously,it will be monitored going forward.
    No family history, my eye artery and veins in good shape, and vision is normal with corrective glasses.
    Thanks for any input.
    John

  16. John,

    63 is a legitimate age to be concerned about dry AMD. Usually not diagnosed until after 55. Family history is hit or miss. I don’t agree with ICAPS unless you have intermediate or high risk factors – based upon size of drusen, vision and other characteristics of the exam.

    You probably need a fluorescein angiogram to answer the rest of your questions. I simply don’t have the ability to answer accurately without examining you.

    If you experience any sustained loss of vision or distortion – see your eye doc.

    Randy

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