Drusen are small, yellow deposits found beneath the retina, the light-sensitive tissue at the back of the eye. These accumulations are composed primarily of fatty proteins and lipids, representing waste material that the eye’s cellular machinery has failed to clear efficiently. The presence of drusen is a common sign of Age-related Macular Degeneration (AMD), a progressive condition affecting the macula, which is responsible for sharp, central vision. While a few small drusen are often a normal part of aging, their quantity and size are closely monitored because they indicate an increased risk for developing advanced stages of AMD.
What Exactly Are Drusen
Drusen form in the space between the retinal pigment epithelium (RPE) layer and Bruch’s membrane, which is the thin, underlying tissue layer. The RPE cells are tasked with nourishing the light-sensing cells of the retina and clearing away their metabolic byproducts. When this clearance process slows down, these waste materials build up, creating the deposits known as drusen.
Ophthalmologists distinguish between two main types of drusen based on their size and appearance. Hard drusen are small, distinct, and have well-defined borders. They are very common in older adults and typically pose a lower risk for future vision loss.
Soft drusen are larger, have blurred or “fuzzy” edges, and tend to cluster together. The presence of many soft drusen is considered a significant risk factor for the progression to advanced AMD, which can lead to a loss of central vision. The specific type and number of deposits guides the eye care professional’s assessment of future risk.
Reversibility and Changes Over Time
The central question of whether drusen can go away is complex: the deposits are usually considered permanent markers of retinal aging, but they can and do regress. The goal of management is not the complete removal of drusen, but rather the prevention of the underlying disease’s progression. While some small, hard drusen may occasionally shrink or disappear without consequence, the regression of large, soft drusen carries a significant nuance.
When soft drusen regress or disappear, it often signals a change in the underlying disease state, which is not always a positive development. This phenomenon, known as drusen regression, can sometimes precede the development of more severe, advanced forms of AMD. One theory suggests that as the RPE cells overlying the drusen die or migrate, the structure collapses, leading to the apparent disappearance of the deposit.
The disappearance of soft drusen may sometimes precede the onset of neovascular (wet) AMD, where abnormal blood vessels grow and leak fluid under the retina. In other cases, regression can be associated with geographic atrophy, a form of advanced dry AMD characterized by patches of RPE and retinal cell death. Therefore, the “disappearance” of soft drusen should be viewed not as a cure, but as a dynamic shift in the disease process that requires careful monitoring.
Proactive Steps for Macular Health
Although there is no treatment that reliably removes established drusen, patients can take proactive steps to slow the progression of AMD and protect their vision. Smoking cessation is one of the most impactful lifestyle changes, as smoking significantly increases the risk of developing and advancing AMD. Maintaining a healthy blood pressure and cholesterol level is also important, as these factors affect the delicate blood vessels supplying the retina.
For individuals with intermediate AMD or advanced AMD in one eye, specific nutritional supplements have been shown to be beneficial. The Age-Related Eye Disease Study 2 (AREDS2) formulation, a combination of high-dose vitamins and minerals, can reduce the risk of progression to advanced AMD by about 25%. This formula includes:
- Vitamin C
- Vitamin E
- Zinc
- Copper
- Lutein and zeaxanthin
A diet rich in antioxidants and omega-3 fatty acids supports overall macular health. Incorporating leafy green vegetables, fruits, and fatty fish like salmon and mackerel can provide beneficial nutrients. Regular monitoring by an ophthalmologist remains paramount, including routine dilated eye exams and the use of at-home central vision checks like the Amsler grid.