Do most older people have drusen? A complete guide to age-related eye deposits

According to the National Eye Institute, small drusen are a common finding in many people over the age of 60. This fact highlights why so many wonder, "Do most older people have drusen?" Understanding what these deposits are and their potential link to age-related macular degeneration (AMD) is a vital aspect of healthy aging and senior eye care.

Quick Summary

It is very common for many older people to have small, benign drusen as a normal part of the aging process. However, the size, number, and type of drusen are important indicators that can signal a higher risk for developing age-related macular degeneration (AMD), which requires ongoing monitoring by an eye care professional.

Key Points

• Prevalence: Small drusen are common in older people and are often not a cause for concern.

• Risk Factor: Large, soft, and numerous drusen are an early sign of age-related macular degeneration (AMD), which can lead to vision loss.

• Types Matter: Hard drusen are small and benign, while soft drusen indicate a higher risk for AMD.

• Monitoring is Key: Regular, dilated eye exams are crucial for tracking any changes in drusen and detecting potential AMD progression early.

• No Treatment, but Management: There is no direct treatment for drusen, but specific nutritional supplements (AREDS2) and lifestyle changes can slow the progression of AMD in high-risk individuals.

• Early Detection: Early detection through eye exams is vital for managing AMD and preserving vision.

What Exactly Are Drusen?

Drusen are small, yellow deposits of extracellular material that accumulate under the retina, specifically between the retinal pigment epithelium (RPE) and Bruch's membrane. Think of the RPE as a crucial cell layer that supports the retina's photoreceptors, and Bruch's membrane as a thin layer of tissue that separates the RPE from the blood vessels beneath. These deposits are made up of lipids (fats), proteins, and other cellular waste products. While they are a very common finding in the aging eye, their characteristics are what determine their significance for your vision.

Hard vs. Soft Drusen: The Critical Distinction

Drusen are not all the same. Eye care professionals classify them into different types based on their size, shape, and location, which helps predict the risk of progression to AMD. The two main types are hard and soft drusen.

Characteristic	Hard Drusen	Soft Drusen
Appearance	Small, distinct, and well-defined.	Larger, with blurred or indistinct borders.
Distribution	Often widely scattered.	Tend to cluster together and grow.
Significance	Considered a normal part of aging; low risk.	An early sign of intermediate AMD; higher risk.
Progression	Less likely to cause vision issues.	Can lead to vision loss if they continue to grow and coalesce.
Location	Can appear anywhere on the retina.	Concentrated in the macula.

The Link Between Drusen and Age-Related Macular Degeneration (AMD)

While hard drusen are generally benign, soft drusen are a different story. The presence of larger and more numerous drusen—especially soft drusen—is a significant indicator of early- or intermediate-stage AMD. AMD is a progressive eye disease that damages the macula, the central part of the retina responsible for sharp, central vision. It is the leading cause of irreversible vision loss in people over 65 in the United States. Drusen are the hallmark of dry AMD, the more common form of the disease.

Dry vs. Wet AMD

• Dry AMD: In dry AMD, the macula thins over time, and light-sensitive cells gradually die off. Drusen play a key role in this process. While it progresses slowly, it can lead to severe vision loss. Geographic atrophy (GA) is an advanced form of dry AMD that involves the death of retinal cells and further loss of central vision.
• Wet AMD: Less common but more severe, wet AMD develops when abnormal blood vessels grow under the retina. These vessels can leak blood and fluid, causing rapid and severe central vision loss. While wet AMD is not directly caused by drusen, large and numerous drusen are a risk factor for its development. The drusen can be a sign that the retina is under stress, which can trigger the growth of these new, fragile blood vessels.

Diagnosing Drusen: What to Expect at an Eye Exam

Detecting drusen requires a comprehensive eye exam, usually including a dilated fundus exam. Here is what happens:

1. Dilation: Eyedrops are used to widen your pupils, giving the ophthalmologist a clear view of the retina at the back of your eye.
2. Fundoscopy: The doctor uses a specialized tool called an ophthalmoscope to look for drusen and other signs of eye disease.
3. Amsler Grid Test: You may be given an Amsler grid to check for signs of AMD, such as wavy or distorted lines, which can indicate swelling in the macula.
4. OCT (Optical Coherence Tomography): In some cases, an OCT scan may be used to provide a cross-sectional view of the retina, allowing for more detailed assessment of drusen size and location.

Managing Drusen and Protecting Your Vision

Currently, there is no specific treatment to eliminate drusen. The focus is on monitoring the deposits and, for those at high risk of progressing to advanced AMD, adopting preventative strategies.

Lifestyle and Nutritional Changes

• Vitamins and Supplements: For individuals with intermediate AMD or advanced AMD in one eye, the Age-Related Eye Disease Studies (AREDS and AREDS2) found that a specific combination of vitamins and minerals can help slow the progression of the disease. This formulation includes vitamins C and E, zinc, copper, lutein, and zeaxanthin. Consult your eye doctor to see if this supplement is right for you.
• Healthy Diet: A diet rich in leafy green vegetables, fish high in omega-3 fatty acids, and colorful fruits can support overall eye health.
• Quit Smoking: Smoking is one of the most significant risk factors for developing advanced AMD. Quitting is one of the most effective ways to protect your vision.
• UV Protection: Wear sunglasses that block 100% of UV-A and UV-B radiation to protect your eyes from harmful sunlight.

The Importance of Regular Eye Exams

For those with diagnosed drusen, regular, dilated eye exams are essential. Your eye doctor will monitor any changes in the size, number, or location of the drusen. Early detection of any progression towards advanced AMD is critical for timely intervention, especially for the treatable wet form of the disease.

For more detailed information on macular degeneration and research into drusen, consult the American Macular Degeneration Foundation at https://www.macular.org/.

Conclusion

In summary, it is common for older adults to have small drusen, and in many cases, they are a benign part of the aging process. However, when drusen become larger, more numerous, or cluster together, they can be a warning sign of age-related macular degeneration (AMD). The critical takeaway is that while not all drusen are cause for alarm, consistent monitoring through regular, dilated eye exams is the only way to accurately assess risk and protect your long-term vision.

Frequently Asked Questions

Are drusen always a sign of a serious eye problem?

Not necessarily. Small, hard drusen are a normal finding in the aging eye and usually don't cause any vision problems. However, larger, softer, or more numerous drusen can be an early indicator of age-related macular degeneration (AMD).

Can drusen go away on their own?

Drusen generally do not go away on their own. While some deposits may resolve, this can sometimes be associated with a progression to more advanced stages of AMD. The size and number of drusen are typically monitored over time by an eye doctor.

What are the symptoms of drusen?

Drusen themselves usually do not cause any symptoms. They are typically discovered during a routine dilated eye exam. Symptoms like blurred or distorted central vision, difficulty seeing in low light, or a dark spot in your central vision are signs of age-related macular degeneration (AMD), not the drusen themselves.

How are drusen detected?

Drusen are detected during a comprehensive, dilated eye exam. Your eye care professional will use a special instrument to look at the retina at the back of your eye. Sometimes, they may also use optical coherence tomography (OCT) to get a more detailed image.

Can I prevent drusen from forming?

While you cannot entirely prevent drusen, as they are a natural part of aging, certain lifestyle factors can help manage your risk of developing associated complications like AMD. Quitting smoking, maintaining a healthy diet rich in leafy greens and fish, and protecting your eyes from UV light are all beneficial.

What is the difference between drusen and floaters?

Drusen are stationary, yellow deposits under the retina that can only be seen during an eye exam. Floaters are small specks or strings that drift across your field of vision and are caused by debris in the vitreous gel inside the eye. Floaters can be seen by the patient, while drusen cannot.

Is it true that most older people have drusen, and what does it mean for them?

Yes, many older people have some form of drusen. For many, this means they have a low-risk, age-related condition that needs to be monitored. For others with large, soft drusen, it means they are at a higher risk of developing AMD and should follow a management plan recommended by their eye doctor.