Confluent drusen. A, Clinical photograph of confluent drusen. Note the pigment clumping overlying the confluent drusen in the central macula. B, Thick eosinophilic deposits (asterisks) between the RPE and Bruch membrane (H&E stain). The separation between the retina and RPE and the RPE and Bruch membrane is artifact. Note the marked attenuation of the photoreceptor cell nuclei in the outer nuclear layer and loss of the outer segments over the confluent drusen.