Drusen are small yellow deposits of fatty proteins (lipids) that accumulate under the retina.
The retina is a thin layer of tissue that lines the back of the inside of the eye, near the optic nerve. The optic nerve connects the eye to the brain. The retina contains light-sensing cells that are essential for vision.
Drusen are like tiny pebbles of debris that build up over time. There are two different types of drusen: soft and hard.
- “soft” drusen are large and cluster closer together
- “hard” drusen are smaller and more spread out
Having a few hard drusen is normal as you age. Most adults have at least one hard drusen. This type of drusen typically does not cause any problems and doesn’t require treatment.
Soft drusen, on the other hand, are associated with another common eye condition called age-related macular degeneration (AMD). It’s called “age-related” macular degeneration because it’s more common in people older than 60.
As soft drusen get larger, they can cause bleeding and scarring in the cells of the macula. Over time, AMD can result in central vision loss. In other words, the condition can affect what you’re able to see when you’re looking straight ahead.
Drusen can also occur in the optic nerve. Unlike drusen in the retina, optic nerve drusen can cause minor loss of peripheral (side) vision. Optic nerve drusen are not related to aging. They’re more commonly seen in children.
Drusen do not cause total blindness, but can result in central vision loss. Central vision allows us to focus on details straight ahead.
People with more soft and larger drusen, are at higher risk of experiencing this type of vision loss in the future than people with fewer and smaller drusen. This is because the presence of many soft drusen developing under the macula (the small area in the center of the retina) increase a person’s risk of having age-related macular degeneration.
AMD is a progressive disease, which means it gets worse over time. AMD can lead to retinal damage and central vision loss. It doesn’t cause complete blindness.
Hard drusen usually don’t cause any type of vision problems at all, but the more hard drusen there are, the higher your risk of developing soft drusen.
Optic nerve drusen can sometimes cause peripheral (side) vision loss. But the vision loss caused by optic nerve drusen is usually so minimal that it may not even be noticed.
Drusen don’t usually cause any symptoms. Most people don’t know they have drusen until they’re discovered by an eye doctor (ophthalmologist or optometrist) during a routine eye exam.
Drusen can be seen during a dilated eye exam using an ophthalmoscope, a device that allows the doctor to see the retina and back of the eye.
If your eye doctor detects many soft drusen on an eye exam, they’ll likely want to run additional tests for age-related macular degeneration. The ophthalmologist may also ask you questions about any other symptoms you might be experiencing.
Symptoms of AMD include:
- distortion of straight lines in your field of vision (metamorphopsia)
- difficulty adapting from bright lights to low lights
- hazy or blurry vision
- blank spot in your central vision
Some people with optic nerve drusen might experience loss of peripheral vision and occasional flickering or graying of vision.
Drusen develop as people age. People over the age of 60 are at the highest risk of having drusen. They’re more common in women and people of Caucasian descent.
Soft drusen are associated with AMD. Risk factors for AMD include:
Optic nerve drusen can sometimes blur the margins of the optic nerve. When this happens, it might resemble another eye condition called papilledema.
Papilledema is caused by swelling of the optic nerve. It indicates the pressure in the brain is too high. Papilledema can be a sign of an underlying condition, like meningitis, or a brain injury that requires immediate treatment. The condition can be serious depending on the underlying cause.
Though optic nerve drusen and papilledema may appear similar during an eye exam, they’re unrelated. It’s important that a doctor performs an ocular ultrasound and other tests to help differentiate between these two conditions before making a diagnosis.
If you’re diagnosed with drusen, it’s important to ask your doctor what type of drusen you have. Hard drusen don’t require treatment. Your ophthalmologist may want to monitor them on a regular basis to make sure they don’t turn into soft drusen.
There’s no treatment available for soft drusen, but if you have soft drusen, it’s possible you also have macular degeneration. Your doctor will work with you to find the most appropriate AMD treatment.
Drusen sometimes will disappear on their own. But if you have AMD and your drusen disappear, it doesn’t necessarily mean the AMD is cured.
One recent review found that that laser treatment of drusen can shrink drusen or lead to their disappearance. Even though laser treatment was able to reduce the size and number of drusen, it didn’t help prevent early-stage AMD from progressing into the advanced stages.
Drusen treatment vitamins
Vitamins won’t make drusen disappear, but research conducted by the National Eye Institute found a nutritional supplement formulation that may help stave off the advanced stages of AMD.
The formulation contains vitamin C, vitamin E, lutein, zeaxanthin, zinc, and copper.
There’s no need to take these vitamins if you have hard drusen, or if you have soft drusen and are at the early stages of AMD. Your ophthalmologist won’t recommend that you begin taking this vitamin formulation until you have reached the intermediate-stages of AMD.
You can’t prevent drusen from forming. Having some hard drusen is considered normal.
Early diagnosis of drusen with regular eye exams can help you find out if you’ve developed AMD. Not everyone with drusen will go on to develop AMD.
Treatment for drusen isn’t necessary unless you also have AMD. Early treatment of AMD can slow the progression of the disease and minimize vision loss.
Developing a few small drusen as you get older is usually a harmless and normal part of aging, but having large numbers of drusen could mean you have AMD.
Over time, AMD can degrade your central vision, making it difficult to see things that are right in front of you. In the United States, AMD is the leading cause of vision loss in people over age 50.
It’s important to have annual eye exams even if your vision seems normal. There’s no treatment available for drusen and they sometimes disappear on their own, but if an eye doctor notices drusen under your retina during an eye exam, they’ll likely want to monitor your eyes regularly for any changes.
If you’re diagnosed with drusen and AMD, you may be able to slow down the progression of the more advanced-stages by taking a high-dose antioxidant supplement.