Hold the Drusen - I Want to Get Off
Do you know the details of your personal journey with macular degeneration? Do you have large soft drusen? Or do you have the small hard drusen? Do you know the difference? Do you know what that means for your future with this disease? Does your retinal specialist take the time to discuss it with you? Or show you the pictures of your retina on the computer explaining exactly where and what those drusen are? And why it matters? I didn’t. But I do now.
What is drusen?
As we age, most people will form some small hard drusen, especially in blue eyes. They are defined as round, yellowish deposits with well-defined borders, which are usually spread out. A few of this kind is not as likely to cause problems as the larger, soft drusen. But even these need to be monitored as there is the possibility they could break down and form the more dangerous soft drusen.
Types of drusen
Alternatively, soft drusen are larger, usually clustered closer together, have poorly defined edges and a softer look. People with large soft drusen will often notice more problems than those with hard drusen. Early problems such as needing more light or that little grey smudge right in the middle of everything. Contrast sensitivity starts to be impaired as well. I know most of us in this community can relate to the difficulty of reading a story which is printed in grey on a white background. To all the publishers out there: please, please give us the darkest black font available.
How does drusen impact our vision?
Thinking back to high school, we learned about rods and cones, those photoreceptor cells in the retina that allow us to see in low light (the rods) or finer detail in better light (the cones). The closer we get to the centre of the macula, the more cones, so when drusen displace these specialized cells, we start to lose our central vision. Science lesson over!
Large, soft drusen can cause more rapid progression
This could lead to the beginning of geographic atrophy, and so far, there are no approved treatments to reverse, prevent, or reduce the rate of progression. But amazing things like stem cell therapy are on the horizon. Did any of us know that eyes with large, soft drusen develop choroidal neovascularization or “wet” AMD at higher than average rates? And as we know by now, vision loss from the wet form usually progresses more quickly, if we don’t get, or don’t respond to the anti-VEGF injections.
The information I needed from my retina specialist
When I was first diagnosed, my retina specialist didn’t tell me which kind of drusen I had and I didn’t know enough to ask the question. As I discovered more about this disease, and then discussed it with him, I learned I had the large soft drusen. No surprise there. Apparently, a lot of patients don’t want to know the details, only what can be done and what will be the outcome. But this was information I needed. How could I find the latest and greatest research if I didn’t know the details? I learned the terms such as hard drusen, soft drusen, geographic atrophy, and choroidal neovascularization. Things I didn’t really want to know, but which I now already have. Which kind do you have?
Do you still drive?