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

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