What is Drusen?
Druse is an accumulation of cellular debris underneath the retina. The plural of druse is drusen. Druse crystals appear as yellow-white crystalline deposits in the retina during examination. Drusen may be soft or hard, and they may be packed together or spaced apart. Drusen are largely associated with an eye disease called age-related macular degeneration. Other causes of drusen include malattia leventinese, North Carolina macular dystrophy, Stargardt disease, and familial drusen.
Key Takeaways
- Drusen crystals are buildup of cellular debris under the retina that appear as yellowish lesions.
- A significant amount of drusen might indicate age-related macular degeneration (AMD).
- Age-related macular degeneration (AMD) can deteriorate central vision over time, making it harder to see what is immediately in front of you. In the United States, AMD is the main cause of visual loss in adults over 50.
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Understanding Drusen
Drusen are yellow granules of extracellular debris that develop beneath the retina. Druse crystals are made up of lipids and proteins, which is why they appear yellow. In German, druse translates to ‘rocks’. Drusen in the retina are essentially tiny rocks of cellular waste that accumulate. Normal eyes are able to recycle and remove the druse cellular waste so that yellow druse crystals do not form. In diseased eyes, the drusen waste isn’t cleared and accumulates. The druse crystal can damage the retinal pigment epithelium and photoreceptors, leading to retina and vision problems.
Having many drusen present in the retina can be a red flag indicating the possibility of age-related macular degeneration (AMD). However, conditions other than age-related macular degeneration might also cause the presence of drusen crystals. Retinal drusen are of two kinds:
- Hard drusen: small, round deposits with sharp borders. Hard drusen are more common in young people and have less risk of leading to macular degeneration.
- Soft drusen: larger lesions with indistinct, soft borders. Soft drusen have a higher risk of leading to age-related macular degeneration.
Drusen are present in eye conditions such as:
- Age related macular degeneration (AMD)
- Stargardt disease
- North Carolina Macular Dystrophy
- Best Disease
- Malattia leventinese
- Familial drusen
Symptoms
Drusen are usually asymptomatic. Most people are unaware they have drusen until an ophthalmologist or optometrist identifies them during a normal eye checkup. A druse can be observed with a slit lamp biomicroscope, a device that lets the doctor examine the microscopic structures inside of the eye during a dilated eye exam.
If your eye doctor finds a lot of drusen during an eye checkup, they’ll probably want to do more testing for age-related macular degeneration. The ophthalmologist may also inquire about any other symptoms you are experiencing, or any family history of macular disease.
Symptoms of druse crystals may include:
- Visual distortion, including wavy lines in your field of vision
- Difficulties transitioning from bright to dim lighting
- Blurry vision, especially central vision
- A black spot in your central vision
Drusen Risk Factors
A druse forms when humans age. People over the age of 60 are more likely to have drusen. Women and people of Caucasian heritage are more likely to have drusen. The presence of many soft drusen is linked to age-related macular degeneration (AMD). Macular degeneration causes loss of central vision.
AMD risk factors include:
- Other family members, especially parents, with age-related macular degeneration (AMD)
- Being above the age of 50
- Fair skin, blue iris color, or Caucasian ancestry
- Smoking
- UV sunlight exposure
- High HDL cholesterol levels
- Diet high in fat
Diagnosis
Druse is discovered during a dilated eye examination in which your ophthalmologist will use dilating eye drops to dilate your pupils. If your eye doctor finds druse crystals, they may provide you with an Amsler grid to take home. An Amsler grid is a grid of horizontal and vertical lines that tests the central 10 degrees of vision. People with risk of macular degeneration should cover each eye and look at the Amsler grid once a week to monitor vision changes. If the grid appears to have wavy lines, fuzzy spots, or dark patches, it may indicate retinal changes. Depending on your vision and drusen, your eye doctor may order more imaging tests.
Drusen Treatment
Single and sparse drusen typically do not require treatment, and are usually monitored regularly by your eye doctor after diagnosis. If the drusen are large, soft and coalescing, this may warrant more imaging tests. Your eye doctor may also recommend an Amsler grid for at-home monitoring of age-related macular degeneration (AMD).
Patients can decrease their risk of vision loss by quitting smoking, maintaining a low fat diet with low cholesterol, and using UV protection sunglasses in sunlight. Patients with intermediate or advanced AMD will benefit from taking certain supplements, which contain high levels of antioxidants and zinc. Some forms of AMD may require medicine to be injected into the eye, and the decision to do this will be determined by the patient and a retina specialist.
