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Image courtesy of Dr. Mohammad Rafieetary.
Drusen are a hallmark of early age-related macular degeneration (AMD), which can be observed by direct examination of CFP or
OCT.2-5 Drusen come in various sizes—the larger the drusen, the greater the chance of progression to an advanced form of AMD such as GA.2,3
Early AMD—marked by white arrows—is associated with multiple small (<63 µm) and a few intermediate (63-124 µm) drusen, or retinal pigment epithelium (RPE) abnormalities.6
Image courtesy of Dr. Arshad Khanani.
Image courtesy of Dr. Arshad Khanani.
Intermediate AMD is associated with extensive intermediate drusen (63-124 µm) or more than 1 large druse (≥125 µm).6 Pigmentary changes are also indicative of intermediate disease. Degenerative changes in the choriocapillaris, RPE, and photoreceptors may also be observed.1,6
Intermediate drusen (white arrows) can be visualized clearly on OCT and CFP.4,7 Pigmentary changes (wedges) visualized on CFP may precede atrophic changes.1,8
Images are from separate patients.
The progression to GA is characterized by the development of atrophic lesions, expansion of individual areas, or coalescence of multiple lesions in the retinal layers. GA can be detected using various imaging modalities, such as OCT, which are commonly available in most clinics.2,3,6
Image courtesy of Dr. Mohammad Rafieetary.
Image courtesy of Dr. Arshad Khanani.
Image courtesy of Dr. David Lally.
Atrophic lesions represent a loss of the RPE, overlying photoreceptors, and underlying choriocapillaris.2 Atrophic regions (white arrows) are represented on CFP, OCT, and FAF.
Images are from separate patients.
Early diagnosis of GA is critical, as anatomical changes precede visual acuity or visual function changes.1
Image courtesy of Dr. Arshad Khanani.
Intermediate AMD
Image courtesy of Dr. Arshad Khanani.
Advanced AMD (GA)
Key Features1,3
(1) Degeneration of overlying photoreceptors increases reflectivity below Bruch’s membrane
(2) Hyper-reflective foci correspond to attenuation or disruption of the RPE
(3) Atrophy of the RPE
(4) Area of choroidal
hypertransmission
Images are from separate patients.
Image courtesy of Dr. Arshad Khanani.
Intermediate AMD
Image courtesy of Dr. Mohammad Rafieetary.
Advanced AMD (GA)
Key Features1,4,5
(1) Drusen and (2) fundus abnormalities are identifiable as hyperpigmented areas
(3) GA lesion borders are sharply demarcated with increased choroidal vessel visibility (dashed circle)
Images are from separate patients.
Image courtesy of Dr. Arshad Khanani.
Intermediate AMD
Image courtesy of Dr. David Lally.
Advanced AMD (GA)
Key Features3,9
(1) Reticular pseudodrusen appearing as multiple, clustered, regularly networked, round areas of low-contrast hyperautofluorescence may be prognostic of advancing AMD
(2) Abnormal patterns of hyperautofluorescence surrounding atrophic lesions
(3) Areas of hypo-autofluorescence with sharply demarcated borders indicate atrophic lesions
Images are from separate patients.
Lesion patterns can be predictive of slower or faster progressing disease and provide key data to inform management strategies.2,6 Patients can present with a wide range of visual symptoms; therefore, it is critical to monitor patients for disease progression.1,9
References: