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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Dear Tami,
I would get a second opinion from a retina specialist. A fluorescein angiogram might provide you with some great information about your long term prognosis.
Randy
I am 55 years old, scandinavian man with blue eyes. I have not heard about macular degeneration in my family tree. I don’t smoke, blood pressure is ok, Cholestrol is slightly on the bad side. Drusen was mentioned the first time during an eye exam about 10 years ago. My eyes have been checked every 2 years and there is no bad changes. I use sildenafil products (Viagra etc). I have heard about the risks with these medicals and macular degeneration. Is there any real proof that these medicals might raise the risk to get AMD if you already have drusen? Or can these medicals be the reason that I have drusen?
Dear Max,
I don’t believe the two to be related.
Randy
hi, iam 30 years old.i used to have near sighted vision since the end of primary school but i had laszik surgery 6 years ago and then i had strain in eyes started 2 years ago and i had eye glasses for reading and computer with +1changes in my eyes and astigmatism .1 year later i started to have another strain in eyes and another eye glasses descripied with a tiny difference. iam now pregnant for the first time after 2 miscaraiges and i started to have headaches so i had a vision exam, the optometrist said there is tiny difference and i don’t have to change eye glasses but he realized 2drusens adherent to my macula in left eye and one drusen away from my macula in right eye. then the retinal specialist said i may have macular degeneration (i don’t have a family history).what are the chances that i have macular degeneration? and if yes after how many years iam expected to suffer from vision problems? a should i have the flourescen angiogram now or should i wait for another 6 months as my doctor said?
Hi Dr. Wong,
I am 27 years old and just went to the eye doctor yesterday. When my eyes were dialated the doc saw a few white spots and then advised that a picture be taken. My left eye had 2 white dots in my macula. I had no idea what this meant and the doc said it was very rare to see those in someone my age. I have bad vision -6 in each eye. He said we would just take a picture next year and monitor it. I asked him what that was called and he just said spots on my macula. He did not diagnose me but just said that I was very young to show those spots. I have never had the symptoms he asked me about. I then got home and told my husband and he told me about the disease “macular degeneration” and I googled it and started freaking out. Do you think I should get a second opinion or just monitor it? Also, is there a possibility that there is nothing to worry about?
Dear Salwa,
If you are not having any problems with your vision, then consider waiting. If you are having decreased vision, including distortion, re-visit your eye doctor.
Randy
Dear Jenica,
I would absolutely not freak out. Get monitored if worried. Get examined if you notice any decrease in vision including distortion.
Randy
I have been concerned about AMD. I am 36 non smoker, in good health, no family history of amd , have retinal drusen not sure hard or soft have a dot and some shadows in my vision of my left eye. Currently my vision is fine 20/20. Do I need to be stressing my self out so much? Any info is appreciated.
Ben
Dear Ben,
Not sure I’d be concerned if you don’t have any symptoms of decreased, blurry or distorted vision.
I think I’ll write another post on this today!!!
Randy
Hi Dr.Wong,
Thank u for your advise, i went to the eye doctor in the first place because i realized eye strain and headache when i watch tv but the optometrist told me not to change my reading glasses and after a week i called him because headache and strain didnot disappear so he said i may need a distant glasses.do u think that i should go to the retinal specialist again? do u think that my history has a risk factor for the disease? plz answer me
I was just diagnosed with optic nerve drusen. My Mother has macular degeneration since the 80s . She is 93 and now legally blind. Is this going to happen to me? I am 55 and never smoked my weight is up and down. Generally in good health. I went for a routine eye exam as I was having more headaches and it had been 3 years since new lenses. Only started wearing glasses in mid 40′s. I was sent to Vanderbuilt to see a neuro opthamologist. I feel the diagnosis is right but still have many questions and what is the rate at which drusen grows or whatever it does. I see blind spots, have some nausea and balance issues. Is this related? I am really concerned. Single and self employed. Should I be checking on disability?
Dear Mary Jo,
Optic nerve drusen are not related to drusen of the macula nor are they related to macular degeneration.
While patients can lose vision with optic nerve drusen, I wouldn’t feel you need to check on disability. Stick with a neuro-ophthalmologist or someone who can monitor you.
Randy
Hi Dr Wong
I have never posted on a blog but hope you can put my mind at rest a little. I have just been for an eye test and the optician noticed some bumps on my macular in the right eye. She said this was quite unusual at my age, I am 34 years old and has made a referral to the hospital. My eye sight has changed from 1.25 to 2.00 in my left eye and remained the same on the right. I don’t smoke and have a reasonable diet. She did the Amsler test and there was no distortion. I’m really worried, do you think there is a chance it could be normal Drusen? Thank you!
Dear Lindsey,
The change in your prescription means nothing. I expect you see well with your lenses, despite the change in prescription?
For peace of mind, see a retina specialist….a fluorescein angiogram should provide a lot of information. While certainly you may drusen (and they are probably normal), a retina specialist can confirm this for you.
Let us know.
Randy
Hi Dr Wong
Just a quick note to say thanks for your response, it is a very kind thing to do and your site must benefit many. I will let you know the outcome.
Lindsey
Lindsey,
You are welcome, and thank you, too, for contributing.
r
I visited an optometrist roughly 2 months ago to get a new prescription for glasses. I have not had a new glasses prescription in almost 8 years but see a doctor for contact lenses almost 1-2 times a year. When I visited this optometrist, he dilated my pupils and examined my eyes and afterward asked me if “I had any trauma to my right eye?” I could not remember any trauma happening recently and he had me look at the Amsler Grid test and asked me if any lines looked different; nothing seemed odd to me. He said that I was showing signs of macular degeneration; I am only 24 years old with no family history of the disease. I look at the Amsler Grid test frequently and about 99% of the test looks normal for me with the exception of one line in one box looks distorted. What should I be expecting? Is there anyway this could be misdiagnosed as something different? If so, what kind of eye problem could this be?
Dear Patrick L,
No telling what he saw or why he said what he did.
I’d get peace of mind and seek a second opinion. Of course, I’d recommend a retinal specialist.
Randy
I already have a scheduled appointment and am going to see an ophthalmologist tomorrow morning. I do not have any decreased vision and haven’t changed my prescription for almost 6-7 years. The reason I began freaking myself out recently was because I was thinking about how he asked me if I had ‘trauma’ to my eye and thinking maybe he saw ‘bleeding’ on my retina. He said nothing about my other eye which seems to be fine. Thinking back, I believe that a small shard of steel may have hit my eye a couple years ago; do you think that could have anything to do with it?
In any event, I do appreciate any insight you can give and also appreciate this blog in general. If more doctors were as accommodating, people would spend much less time worrying while they are waiting to get an appointment.
I will let you know what they say and thanks again.
After getting back from the ophthalmologist, I thought that I would give an update to give others who read this comfort as well as letting you know what was the conclusions, Dr. Randy.
After examining the supposed eye show symptoms of macular degeneration, the doctor was quick to say that I do not show signs of macular degeneration and that the optometrist was in fact wrong. She did offer a conclusion as to why the optometrist said that he might have said that though: I had an infection in my right eye at some point which left retinal scarring near the macula and remnants of the infection around retina. The doctor said this would explain seeing possible curved or wavy lines when looking at the Amsler Grid test.
Anyway, I wanted to let you know because I believe this is excellent forum in order to ease persons minds when considering certain types of diseases. From this semi-serious experience, I walked away with 3 very important pieces of information: take care of your vision, never trust optometrists, and always get a second opinion.
Thanks again!
I am a 32 year old female i went for a eye test as i had noticed my eye sight had got worse and bright lights hurt my eye’s when driving in the dark. My optition said he had found large drusan deposites in my left eye which was very unusual for a girl my age, he refered me to my doctors for blood test then on to the opthamologist who diagnosed me with Macular degeneration and discharged me with an grid to check on a daily basis, no other informaiton whatsoever other than if parts of the grid go missing please come back as soon as possible. Do you think i need to get a second opinion as this is really worrying me.
He also said that this was passed onto me through genes?
Hi Dr Wong
I said I would come back to you once I went to the ophthalmologist. I don’t have macular degeneration and instead there are two scars caused by a virus at some point. He said I don’t need to be overly concerned and he doesn’t think they will change. I guess I just wanted to thank you for putting my mind ar rest during the wait and to hopefully let others know who may be experiencing something similar. Dr Wong is now famous in Northern Ireland as I have been telling people how great your site is
Lindsey
Dear Karen,
I would certainly get the opinion of a retinal specialist.
Randy
Dear Karen,
The drusen may be normal for you, hence the recommendation about seeing a retinal specialist. Not too sure what he meant about the genes: the drusen or the possible AMD?
Randy
Dear Lindsey,
Glad things worked out!
Thanks for the Irish support!
Randy