Macular Degeneration

What if I Have Drusen?

 Drusen and the diagnosis of macular degeneration.  Randall Wong, M.D., Retina Specialist, Fairfax, Virginia 22031


Drusen are not diagnostic of macular degeneration.  These whitish/yellow spots of the retina can be a normal finding and their presence does not mean you will develop macular degeneration (ARMD).  There are other criteria necessary to make the diagnosis of ARMD.

“Druse” may occur in 3 locations within the eye;

  • The Macula
  • The Peripheral Retina (non-macular)
  • and the Optic Nerve

In the Optic Nerve Head (ONHD)

These are not even found in the retina.  These are calcified and found within the optic nerve, but can be diagnosed when looking into the eye during a retinal examination.

These drusen have nothing to do with macular degeneration.  Loss of the peripheral vision is possible.  Patients with ONHD are probably best evaluated by a glaucoma specialist as the mechanism of vision loss is similar to that of glaucoma.

Diagnosis is usually pretty straight forward.  Often these tiny round globules can be seen during a dilated eye exam and can also be detected with ultrasound and CT scan due to the calcification.  They can run in families.

Outside of the Macula

These whitish spots are found in the retina, but not in the macular area.  These are usually whitish/yellow looking flecks found within the layers of the retina and are visible during examination.

When outside of the macula, they are commonly feared to be related to ARMD, but there is no association.  Non-macular lesions are sometimes called “familial drusen” and are a normal finding with no predisposition to the development of ARMD.

Macular Druse: Can Be Associated with ARMD

These are the most confusing and also the most worrisome.  Drusen in the macula can be NORMAL and do NOT necessarily mean you have or will develop macular degeneration.

Those lesions located within the macula are worrisome due to the association with macular degeneration, or ARMD.  There are two types:  hard and soft.  Both may be found in patients with macular degeneration

Hard and soft types differ in appearance and probably have a different association with macular degeneration.  In general, the “hard” variety are more common, especially as we age.  The “soft” lesions are probably found more often in wet ARMD.

Both types of druse may be found in patients with macular degeneration, but the mere presence of  either drusen does not make the diagnosis of macular degeneration nor are they prognostic indicators for the development of the disease.

What If You Have Drusen?

If your doctor diagnosis you with drusen, do the following;

  1. Relax.
  2. Are the within the macula?  If not, probably nothing to worry about.
  3. If they are located in the macula, do you have any symptoms such as decreased vision, distortion or blind spots?  By decreased vision, I mean, with correction, do  you have any of these symptoms?  If not, probably okay to monitor, but make sure you visit your eye specialist if any symptoms develop.

Retina specialists, like me, are the most appropriate to make the diagnosis.  If there is any question, make an appointment to see a specialist.

What Does This Mean?

There are several criteria needed to make the diagnosis of macular degeneration.  You have to look like you have the disease, have the right genetic makeup, be the right age and have evidence of decreased vision.

A retina specialist might consider additional testing, such as a fluorescein angiogram, to determine if there is any evidence of deterioration or degeneration of the retina.

Drusen only are commonly normal.


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