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  • Cuticular Drusen and the Risk of Late AMD

    By Lynda Seminara
    Selected by Russell N. Van Gelder, MD, PhD
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    Journal Highlights

    Ophthalmology, June 2022

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    Drusen are hallmarks of early age-related macular degeneration (AMD). The subtype known as cuticular drusen was first described in 1977 as numerous small, round, yellow nodules scattered throughout the fundus that showed a hyperfluorescent “stars-in-the-sky” pattern by fluorescein angiography. The morphologic and clinical features of cuticular drusen have led some experts to believe that their presence may infer generalized retinal pigment epithelium (RPE) dysfunction, which could signal greater impairment of visual function. Goh et al. aimed to determine if the presence of cuticular drusen in patients with bilateral large drusen affects the rate of progression to late AMD or is linked to faster decline of visual sen­sitivity before the onset of late AMD. They found that the risk of late AMD and the rate of visual sensitivity decline were similar for eyes with cuticular drusen and conventional drusen.

    For this longitudinal study, the researchers enrolled 140 adults aged 50 years and older who exhibited bilateral large conventional drusen without late AMD. Participants were required to have at least one large conventional druse (>125 μm) within 1,500 μm of each fovea, meeting the definition of intermediate AMD. Multimodal imag­ing (MMI) and microperimetry were performed at baseline and semiannu­ally for up to three years. MMI-based presence or absence of cuticular drusen was determined at baseline. OCT was performed to calculate drusen volume. The associations between cuticular dru­sen and progression to MMI-defined late AMD and the effect on visual sen­sitivity were assessed before and after adjusting for confounders such as age, pigmentary abnormalities, and drusen volume. Main outcome measures were the time to MMI-defined late AMD and the change in mean visual sensitivity.

    Altogether, 280 eyes were included. Of these, 70 eyes (25%) had cuticular drusen at baseline. Before and after adjustment for confounding factors, there was no significant association between cuticular drusen and the progression rate to late AMD during the three years of follow-up. Similar­ly, an adjusted model showed no link between cuticular drusen and lower baseline visual sensitivity or quicker visual sensitivity decline.

    Based on these findings, the current monitoring strategies for cuticular drusen and conventional drusen should be similar, said the authors.

    The original article can be found here.