Why are more and more ophthalmologists and physicians talking about drusen in discussions with patients about macular degeneration? It’s because drusen makes up the most common early sign of macular degeneration. Yet, what is drusen?
According to Joshua Dunaief, M.D., Ph.D. of the Scheie Eye Institute at the University of Pennsylvania, drusen are deposits that form and accumulate under the retina. Accumulation of drusen can result in cell death and the loss of clear, straight-ahead vision.
According to Dr. Dunaief, “drusen are the defining feature of macular degeneration. These small yellow or white spots on the retina can be detected by an ophthalmologist during a dilated eye exam or with retinal photography. People with more than a few small drusen are said to have early age-related macular degeneration (AMD). Often, the drusen, have no symptoms, but represent a risk for some degree of vision loss in the future.”
Dunaief goes on to explain that drusen is derived from a German word that means “rock” or “geode.” drusens are like tiny pebbles of debris under the retina. “They represent a type of “garbage” disposal problem,” says Dunaief. “Retinal cells dump unwanted material, and immune cells normally clean up most of it. However, if too much is dumped, or it is not properly packaged for disposal, or the immune cells don’t function efficiently, it can pile up. The drusen contain proteins and lipids (naturally occurring molecules that include fats).” Some of the proteins are pro-inflammatory, indicating that the immune system is coating the drusen. One protein in drusen is beta amyloid, which is also found in deposits within the brains of people who have Alzheimer’s disease and may contribute to both diseases. Fortunately, having AMD is not a major risk factor for developing Alzheimer’s disease.
Dunaief’s research has shown that the risk of future vision loss is related to the number and size of the drusen present behind the retina. People with more drusen, and larger drusen, are at higher risk than those with fewer, smaller drusen. Drusen are categorized as small, intermediate and large. This is important, because patients with about 20 or more intermediate drusen or at least one large “druse” were found to benefit from taking antioxidants and vitamins (lutein, vitamin C, vitamin E, zinc and copper). Taking these antioxidant vitamins significantly reduces the risk of vision loss.
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