The simply answer is, no, not all patients with drusen have macular degeneration. Drusen can be associated with macular degeneration, but are not diagnostic of the disease.
In other words, a person can have drusen AND macular degeneration which means that the two conditions are associated because they can occur together, but the presence of drusen by themselves without other signs or symptoms does not mean macular degeneration is going to occur or is in the process of occurring.
What are Drusen?
Drusen are spots (lesions) that form in the layers of the retina. There are two types and can be “hard” or “soft.” based upon appearance. The presence of a few small drusen is normal with advancing age.
Drusen can be found anywhere in the retina. When they are located outside the macula, they are usually of no consequence and are not related to any disease, especially macular degeneration. I am only concerned when they are located within the macula.
Unfortunately, most non-retina doctors do not mention that drusen away from the macula are of little consequence and can simply be a family trait.
When Should Macular Degeneration be Diagnosed?
Let’s take the scenario of a patient having only hard drusen and no other signs of macular degeneration such as pigment changes, fluid, or blood.
Is there vision loss? If there is vision loss, the next thing I do is determine if there are reasons for it other than macular degeneration, such as cataracts.
When a patient has no vision loss or a loss of vision that is explained by something such as cataracts, I do not necessarily diagnose macular degeneration.
I know that many doctors DO diagnose macular degeneration every time they see drusen, and in my opinion, this is not correct or fair. Unnecessarily pronouncing this diagnosis to patients causes many people worry, anguish, and stress as they wait to go blind from a disease they do not have.
Best Test for Macular Degeneration Diagnosis
If there is any question about the diagnosis of macular degeneration, have your doctor order a fluorescein angiogram.
A fluorescein angiogram (FA) is the best test for a definitive diagnosis of macular degeneration (ARMD). The test is performed by a retinal specialist and each eye is injected with a dye (not iodine based) called fluorescein. As the fluorescein dye travels through the retinas, pictures are taken which help the retinal specialist diagnose or rule out macular degeneration.
In cases of a positive diagnosis for macular degeneration, a fluorescein angiogram will also distinguish between wet ARMD and dry ARMD, so that the proper treatments can be undertaken as soon as possible.
All the best,