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Cited by 352Retinal Diseases and TreatmentsRetinal Imaging and AnalysisRetinal and Macular Surgery

Drusen in Age-Related Macular Degeneration

Abdelsalam, Ahmed, Del Priore, Lucian, Zarbin, Marco A·1999·Survey of Ophthalmology
DOI 10.1016/s0039-6257(99)00072-7
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Abstract

Drusen are subretinal pigment epithelial deposits that are characteristic of but not uniquely associated with age-related macular degeneration (AMD). Age-related macular degeneration is associated with two types of drusen that have different clinical appearances and different prognoses. Hard drusen appear as small, punctate, yellow nodules and can precede the development of atrophic AMD. Areolar atrophy of the retinal pigment epithelium (RPE), choriocapillaris, and outer retina develop as the drusen disappear, but drusen can regress without evidence of atrophy. Soft drusen appear as large (usually larger than 63 microm in diameter), pale yellow or grayish-white, dome-shaped elevations that can resemble localized serous RPE detachments. They tend to precede the development of clinically evident RPE detachments and choroidal neovascularization. Drusen characteristics correlated with progression to exudative maculopathy include drusen number (five or more), drusen size (larger than 63 microm in diameter), and confluence of drusen. Focal hyperpigmentation in the macula and systemic hypertension also are associated with an increased risk of developing choroidal new vessels (CNVs). Large drusen are usually a sign of diffuse thickening of Bruch's membrane with basal linear deposit, a vesicular material that probably arises from the RPE, constitutes a diffusion barrier to water-soluble constituents in the plasma, results in lipidization of Bruch's membrane, and creates a potential cleavage plane between the RPE basement membrane and the inner collagenous layer of Bruch's membrane through which CNVs can grow. Disappearance of drusen spontaneously and in areas adjacent to laser photocoagulation scars was first noted by Gass (Gass JD: Arch Ophthalmol 90:206-217, 1973; Trans Am Acad Ophthalmol Otolaryngol 75:580-608, 1971). Subsequent reports have confirmed these observations. Photocoagulation-induced drusen regression might prevent patients with drusen from developing exudative maculopathy. The mechanism for spontaneous drusen regression probably involves RPE atrophy. The mechanism for photocoagulation-induced drusen regression is unknown. If photocoagulation-induced drusen regression is anatomically similar to atrophy-associated drusen regression, then the former will be associated with dissolution of basal linear deposit and a residuum of basal laminar deposit. Sarks and coworkers (Sarks JP, Sarks SH, Killingsworth MC: Eye 11:515-522, 1997) proposed that this in turn will eliminate the potential cleavage plane between the RPE basement membrane and inner collagenous layer of Bruch's membrane through which CNVs grow, thus retarding the growth of CNVs.

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Authors
Abdelsalam, A., Del Priore, L., & Zarbin, M. A.
Affiliations
Rutgers New Jersey Medical School (US)
Corresponding author
Zarbin, Marco A
ORCID
Zarbin, Marco A
Venue
Survey of Ophthalmology
Publisher
Elsevier BV
Published
1999-07
Volume
44
Issue
1
Pages
1-29
ISSN
0039-6257 (ISSN-L)
DOI
10.1016/s0039-6257(99)00072-7
OpenAlex
W1990558727
Cited by
352
References
156
Citations by year
2026: 9 · 2025: 20 · 2024: 18 · 2023: 10 · 2022: 10 · 2021: 14 · 2020: 12 · 2019: 13 · 2018: 11 · 2017: 17 · 2016: 16 · 2015: 15 · 2014: 13 · 2013: 23 · 2012: 18
FWCI
2.47
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Survey of Ophthalmology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal Imaging and Analysis
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal and Macular Surgery
Keywords
drusen, age-related macular degeneration, soft drusen, choroidal neovascularization, exudative maculopathy, drusen regression, laser photocoagulation, retinal pigment epithelium atrophy, basal laminar deposits
MeSH terms
Exudates and Transudates, Fluorescein Angiography, Fundus Oculi, Humans, Macular Degeneration, Pigment Epithelium of Eye, Retinal Drusen, Bruch Membrane, Laser Coagulation, Disease Progression, Choroidal Neovascularization

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