Drusen

Definition
Drusen (singular: druse) are extracellular deposits
located at the interface between the RPE and Bruch
membrane.

The material of which

they are composed has
a broad range of
constituents, and is
thought to be derived
from immunemediated and
metabolic processes in
the RPE

 Age-related drusen are rare prior to the age of 40, but

are common by the 6th decade.
The distribution is highly variable, and they may be
confined to the fovea, may encircle it or form a band
around the macular periphery.
They may also be seen in the peripheral and midperipheral fundus.
Clinically two types
Hard Drusen
Soft Drusen

HARD DRUSEN
Hard drusen are well-defined and
less than half a retinal vein width
(< 63m) in diameter.
Their presence as the only finding
probably carries little increased
risk of visual loss, and so they
frequently are not included in
definitions of ARM.

SOFT DRUSEN
Soft drusen are less distinct and
generally substantially larger than
hard drusen
Generally the presence of more
than five soft drusen might be
taken as a defining feature of ARM.
As soft drusen enlarge and
become more numerous, they may
coalesce giving a localized
elevation of the RPE, a drusenoid
RPE detachment
Dystrophic calcification may
develop in both types of drusen

Hard drusen

Soft drusen

Age-Related Macular Degeneration

(AMD)
Definition
Degenerative disorder of the macula affecting patients >50
years of age

Macula

Cross Section of Healthy

Macula

Retina
RPE
Bruchs Membrane
Choroid

Retina receives nutrients and oxygen

Cross Section of Healthy Macula

Retina
RPE
Bruchs Membrane
Choroid

Retina disposes waste material and fluids

Drusen

Retina
RPE
Bruchs Membrane
Choroid

Aging changes of Bruchs Membrane

Impaired transport of O2 in and waste materials out
Accumulation of drusen

Drusen

Dry AMD

Retina
RPE
Bruchs Membrane
Choroid

Dry AMD

Insufficient oxygen and nutrients

damages photoreceptor molecules

ith ageing, the ability of RPE cells to digest these molecules decreases

Excessive accumulation of residual bodies (drusen)

embrane and cells degenerate and atrophy sets in and central vision is

Wet AMD

Retina
RPE
Bruchs Membrane
Choroid

Wet AMD

Retina
RPE
Bruchs Membrane
Choroid

Wet AMD

Retina
RPE
Bruchs Membrane
Choroid

Wet AMD

Retina
RPE
Bruchs Membrane
Choroid

Wet AMD

Retina
RPE
Bruchs Membrane
Choroid

Wet AMD

Retina
RPE
Bruchs Membrane
Choroid

Wet AMD

Retina
RPE
Bruchs Membrane
Choroid

Wet AMD

Wet Macular Degeneration

Accumulation of fluid under retina causes

distortion of images
Straight lines become wavy
(metamorphopsia)

Wet AMD - Disciform Scar

Disciform scar end-stage of wet AMD
Severe irreversible
vision loss

Lesions related to drusen

Doyne honeycomb retinal
dystrophy

Condition that affects the eyes

and causes vision loss.
Charecterised by drusen that
accumulate beneath the retinal
pigment epithelium
Over time, drusen may grow and
come together, creating a
honeycomb pattern
It usually begins in early to mid
adulthood, but the age of onset
varies.
The degree of vision loss also
varies DHRD is usually caused by

 Cuticular drusen, also known as grouped

early adult-onset or basal laminar drusen
Nodular thickenings of Bruch membrane seen
in ARM), tend to be seen in relatively young
adults. lesions consist of small (2575m)
yellowish nodules which tend to cluster and
increase in number with time and can progress
to serous PED.
FA may give a stars in the sky appearance

Cuticular drusen;

FA shows hyperfluorescent spots

stars in the sky appearance

 Type 2 membranoproliferative glomerulonephritis

is a chronic renal disease that occurs in older children
and adults. A minority of patients develop bilateral
diffuse drusen-like lesions.

DD
Hard Exudates
Soft Exudates
Cotton Wool Spots

HARD EXUDATES:
LOCATION:in outer plexiform layer
SIGN : waxy,yellow with distinct margin often arrange in
clump/ring at posterior pole
Ring of h.exudate(circinate exudate) often exhibit
microaneurysm at its centre
With time ,number & size tend to increase & fovea
maybe threatened.
FLUORESCENT ANGIOGRAPHY:Show hypofluorescent dueto blockage of background
choroidal

COTTON WOOL SPOT:

REPRESENT: Focal infarct of NFL due to occlussion of precapillary arterioles

AXOPLASMIC STASIS Responsible for white appearance of lesion.

SIGN small,whitish,fluffy,superficial which obscure underlying blood vessel

FLUORESCENT ANGOIGAPHY: Show hypofluorescent dueto blockage of background choroidal

fluorescent