The Morphology Of “Soft Drusen” Or RPE Detachments

Case Lesson #5

Ingebret Mojord, MSc FAAO Wednesday, 27 March 2013

EYELESSONS.COM Disclaimer: The content provided herein is for educational and informational purposes only; nothing provided herein should be intended to create a physician-patient relationship or an offer for a contract and does not constitute medical diagnosis or advice. The opinion relating to a review of any issue presented or discussed is the sole responsibility of the healthcare provider or medical advisor. The doctor or patient must assume all liability, including, but not limited to, any direct, indirect, incidental, consequential, or any other monetary or other damages, or liabilities arising out of or relating in any way to the content  or information provided herein.

- 65 YO

- HX DRY ARM BCVA 0.63 OD AND 0.80 OS DOWN FROM 1.0/1.0 18 MONTHS AGO

- MORE CONFLUENCE OF “SOFT DRUSEN” NOTED ON EXAMINATION

EYELESSONS.COM Disclaimer: The content provided herein is for educational and informational purposes only; nothing provided herein should be intended to create a physician-patient relationship or an offer for a contract and does not constitute medical diagnosis or advice. The opinion relating to a review of any issue presented or discussed is the sole responsibility of the healthcare provider or medical advisor. The doctor or patient must assume all liability, including, but not limited to, any direct, indirect, incidental, consequential, or any other monetary or other damages, or liabilities arising out of or relating in any way to the content  or information provided herein. 

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Drusen

Cook HL, Patel PJ, Tufail A. Age-related macular degeneration:diagnosis and management.  Br Med Bull 2008;85:127-149

APPROXIMATELY 90% OF THE WHITE POPULATION AGED >40 YEARS WILL HAVE ONE OR TWO SMALL HARD DRUSEN (<63 MM IN DIAMETER) IN THE MACULA OF EITHER EYE. THERE IS ALMOST NO RISK OF PROGRESSION TO ADVANCED AMD IN THESE EYES. HOWEVER, IN EYES WITH >8 SMALL HARD DRUSEN , THERE IS A 2–3-FOLD INCREASED RISK OF DEVELOPING LARGE SOFT DRUSEN >125 MM IN DIAMETER, LARGE SOFT DRUSEN ARE ASSOCIATED WITH A 6–7-FOLD INCREASED RISK OF PROGRESSION TO ADVANCED AMD. LARGE NUMBERS OF SMALL HARD DRUSEN ARE ALSO ASSOCIATED WITH PROGRESSION TO GEOGRAPHIC ATROPHY.  PATIENTS WITH NEO- VASCULAR AMD IN ONE EYE HAVE AN ≈50% RISK OF SECOND EYE CNV AT 7 YEARS FOLLOW-UP.

A Randomized, Placebo-Controlled, Clinical Trial of High-Dose Supplementation With Vitamins C and E, Beta Carotene, and Zinc for Age-Related Macular Degeneration and Vision Loss
AREDS Report No. 8
Age-Related Eye Disease Study Research Group Arch Ophthalmol. 2001;119:1417-1436.

PARTICIPANTS WITH EXTENSIVE SMALL DRUSEN, NONEXTENSIVE INTERMEDIATE SIZE DRUSEN, OR PIGMENT ABNORMALITIES HAD ONLY A 1.3% 5-YEAR PROBABILITY OF PROGRESSION TO ADVANCED AMD.

Ophthalmology. 2010 Mar;117(3):489-99. Epub 2010 Jan 15.
Natural history of drusenoid pigment epithelial detachment in age-related macular degeneration: Age-Related Eye Disease Study Report No. 28.
Cukras C, Agrón E, Klein ML, Ferris FL 3rd, Chew EY, Gensler G, Wong WT; Age-Related Eye Disease Study Research Group.

THE NATURAL HISTORY OF EYES CONTAINING DRUSENOID PIGMENT EPITHELIAL DETACHMENT ( DPED ) IS CHARACTERIZED BY A HIGH RATE OF PROGRESSION TO BOTH CGA AND NV-AMD. AMONG EYES NOT PROGRESSING TO ADVANCED AMD, PROGRESSIVE DEVELOPMENT OF PIGMENTARY CHANGES AND CALCIFIED DRUSEN WERE OBSERVED. DECLINE OF VISUAL ACUITY IS A COMMON OUTCOME, WITH OR WITHOUT PROGRESSION TO ADVANCED FORMS OF AMD.

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Caveat: When using any guidelines one must consider correlation with other patient characteristics and other clinical tests such as but not limited to: chief complaint, age, gender, ethnicity, refractive status, family history, associated medical conditions, current medications, pachymetry, visual field testing, angle assessment.

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About the Author(s)

Ingebret Mojord, MSc FAAO

Ingebret Mojord, MSc FAAO

Norwegian-based and trained optometrist. Graduated from basic optometry studies in 1976, and a MSc in clinical Optometry in 2000 from PCO. Ingebret spends most of his time in the private practice Mojord & Thoresen, but also lectures internationally in the area of contact lenses. Ingebret also lectures regularly in scandinavia about diseases of the anterior and posterior segment of the eye. Mojord & Thoresen is one of the most advanced complete optometric practices in Scandinavia.

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