I have drusen: is it serious?
“You have a few drusen.” The phrase is worrying, often more than necessary. Drusen are common after the age of 50 and most will never progress. But their type and number change the outlook — and that is precisely what can be measured.
A routine fundus exam, and then this sentence: “you have a few drusen”. Many patients leave feeling that AMD has just been diagnosed. It has not. Drusen define a stage with its own name — age-related maculopathy — which, in most cases, will not progress.
What drusen are
They are small yellowish deposits that build up under the retina, between the pigment epithelium and Bruch's membrane. They are made of lipids and debris that the retina no longer clears as well with age. They are spotted on fundus examination, and OCT shows their size, shape and content in more detail.
They are very common: roughly one person in four after the age of 52, and nearly nine in ten after 80. The smallest ones are largely part of normal retinal ageing.
Not all drusen are the same
This is the point that changes everything, and the one most often missing from the information given to patients. The outlook depends on the type of drusen far more than on their mere presence.
- Miliary drusen — small (under 63 microns), round, with sharp edges. Present in a quarter to a half of people over 50. When isolated, they are usually stable and complications are rare and late.
- Serous drusen — larger, with blurred outlines, often associated with pigment changes. In the long term they are complicated by late AMD in about 30% of cases. These are the ones that warrant close monitoring.
- Reticular pseudodrusen, or “blue drusen” — better seen in blue light, located above the pigment epithelium. The risk of progression is high, particularly towards a neovascular form. They were first described by the team at the CHI de Créteil, where Dr Srour has worked.
- Cuticular drusen — numerous and small, they occur in younger people, around 57 years on average, with a risk of progression after 70.
Putting a number on the risk, rather than imagining it
Risk cannot be guessed: it is estimated. A simple score, derived from the large American AREDS study, gives each eye one point for drusen larger than 125 microns and one point for pigment migration — a total of 0 to 4. Each score corresponds to a quantified risk of progressing to a severe form.
Two ways to read this table. The first is reassuring: with a score of 0, the 10-year risk is around 0.5%. The second justifies follow-up: at 4, it approaches two thirds. Between the two, the role of the consultation is precisely to place where you stand.
What can and cannot be done
No treatment makes drusen disappear. At this stage, three things matter: stopping smoking, which is the most important avoidable risk factor; nutritional supplementation, discussed case by case in intermediate forms and not justified for simple miliary drusen; and monitoring adapted to the real risk.
What is treated are the complications — and the earlier they are caught, the better they are treated. A wet form is treated with intravitreal injections, the effectiveness of which depends largely on how early the diagnosis is made.
The assessment, in one visit
Assessing drusen requires a fundus exam and a macular OCT, supplemented if needed by OCT angiography, which looks for abnormal new vessels without any injection. All three examinations are carried out on site in Noisy-le-Grand, in the same consultation, and they are painless.
No referral letter is needed: you can book an appointment directly.
Need an ophthalmological opinion?
Book an appointment at the practice — full assessment, all examinations on site in Noisy-le-Grand.
The Grand Paris Ophtalmologie practice in Noisy-le-Grand provides consultations, screening and surgery for patients from neighbouring towns: