Drusen are commonly found in many individuals that have macular degeneration. Do all patients with drusen have macular degeneration? The answer is no.
There are characteristic findings in patients with macular degeneration. Patients may have white dots located in the deeper layers of the retina. These excrescences are called drusen. There are two types of drusen, hard and soft. Both may be found in macular degeneration and both, especially hard drusen, can also be a normal. Other findings characteristic of macular degneration are pigment changes, either increased pigement or decreased pigment, fluid and/or blood.
How then do we distinguish normal from abnormal? The hardest scenario in which to diagnose macular degeneration is when a patient has only hard drusen. There are no pigment changes. No fluid or blood. You must then add other pieces of the puzzle together. Is there vision loss? Is the vision symmetric and consistent with the findings in the retina (from experience you can kind of estimate how good or bad someone should be seeing by looking at the retina)? Are there reasons other than macular degeneration for loss of vision, such as cataract? What is the age of the patient?
Finally, (and this is according to the world of “Randy”) if a patient has drusen, no other findings, and either no loss of vision, or loss of vision that can be explained by something else (such as cataract), I have a hard time diagnosing them with macular degneration.
Many doctors diagnose macular degeneration everytime they see drusen. It is not correct, it is not fair. There are too many people wandering around just waiting to go blind from macular degeneration just because of a few drusen.
Randall V. Wong, M.D.