Drusen are small deposits that can form under the retina, the light-sensitive tissue at the back of the eye. Their presence is often associated with age-related macular degeneration (AMD), a common eye condition that can affect central vision. This article will explore what drusen are, how they develop, and the current understanding of whether they can resolve, along with strategies to support overall eye health.
Understanding Drusen
Drusen are tiny yellow or white accumulations of extracellular material that build up between the retina and the choroid, a layer of blood vessels that supplies the retina. They are primarily composed of lipids and proteins. These deposits are visible during a comprehensive eye examination.
There are two main types of drusen: hard drusen and soft drusen. Hard drusen are typically small, distinct, and spread out, and their presence is considered a normal part of aging. Conversely, soft drusen are larger, less distinct, and tend to cluster together. The presence of numerous or large soft drusen indicates a higher risk for developing age-related macular degeneration and potential vision loss.
Factors Contributing to Drusen Formation
Drusen accumulation is believed to be a consequence of the eye’s natural aging processes, particularly a “garbage disposal” problem within the retinal pigment epithelium (RPE) cells. These cells are responsible for clearing waste products from the retina, but their efficiency can decline with age.
This buildup is also linked to chronic oxidative stress and inflammation within the eye. While aging is the primary factor, other elements can increase the likelihood of drusen formation. These include a family history of drusen or AMD, smoking, high blood pressure, high cholesterol levels, and obesity.
Current Understanding: Can Drusen Disappear?
Drusen, particularly the soft type, generally do not disappear once formed. While there have been rare instances of spontaneous regression of drusen, it is not a common or reliable outcome, especially for the larger, soft drusen associated with AMD. When soft drusen do disappear, it is sometimes associated with a progression to more advanced forms of AMD, such as geographic atrophy.
Some research has explored interventions like laser treatments to shrink or reduce drusen. Although such treatments can sometimes reduce the size or number of drusen, clinical trials have not consistently shown that these methods prevent the progression to advanced AMD or improve vision. The focus of managing drusen is therefore not on their disappearance, but on preventing their growth and slowing the progression of associated eye conditions.
Strategies for Managing Drusen and Eye Health
Managing eye health focuses on slowing the potential progression to advanced age-related macular degeneration (AMD). Regular, dilated eye exams are important for early detection and ongoing monitoring of drusen and any changes in eye health.
Lifestyle modifications also play an important role. Adopting a healthy diet rich in fruits, vegetables, and omega-3 fatty acids can support overall eye health. It is also beneficial to quit smoking, maintain a healthy body weight, and engage in regular physical activity, as these factors contribute to systemic health and can reduce the risk of AMD progression.
For individuals with intermediate AMD or advanced AMD in one eye, specific nutritional supplements may be recommended. The Age-Related Eye Disease Study 2 (AREDS2) formulation, containing vitamins C and E, zinc, copper, lutein, and zeaxanthin, has been shown to slow the progression to advanced AMD by about 25%. Protecting the eyes from harmful ultraviolet (UV) light by wearing sunglasses that block 100% of UVA and UVB rays can contribute to long-term eye health.