Subretinal drusenoid deposits: An update

Area of Science:

• Ophthalmology
• Retinal Diseases
• Macular Degeneration

Background:

• Age-related macular degeneration (AMD) presents diverse phenotypes.
• Drusen, beneath the retinal pigment epithelium (RPE), are a hallmark of AMD.
• Subretinal drusenoid deposits (SDDs), or reticular pseudodrusens, are located atop the RPE.

Purpose of the Study:

• To highlight the diagnostic challenges and clinical significance of SDDs in AMD.
• To emphasize the association of SDDs with rod function and retinal sensitivity.
• To underscore the predictive value of SDDs for late AMD development.

Main Methods:

• Review of clinical examinations and multimodal imaging techniques for SDD detection.
• Analysis of the topographical and functional relationship between SDDs and retinal rods.
• Longitudinal observation of SDD dynamics and progression to late AMD stages.

Main Results:

• SDDs are difficult to detect with standard clinical examination and fundus photography, necessitating multimodal imaging.
• SDDs are topographically and functionally linked to retinal rods, causing significant impairment in retinal sensitivity and dark adaptation.
• SDDs are dynamic, potentially growing, fusing, or regressing, and can precede acquired vitelliform lesions.
• The presence of SDDs is a strong predictor of progression to late AMD, including macular neovascularization, geographic atrophy, and outer retinal atrophy.

Conclusions:

• SDDs represent a distinct entity from drusen with significant implications for AMD progression.
• Multimodal imaging is essential for accurate diagnosis and risk assessment in patients with SDDs.
• SDDs are critical indicators of high risk for developing vision-threatening complications of late AMD.