Dots, Spots, and Other White Retinal Lesions – Page 20 of 61

The patient was previously diagnosed with ARMD. The OCT images reveal that the numerous elevations on the fundus are drusen. The accumulation of debris-like material and lipofuscin acts as a chronic inflammatory stimulus and initiates drusen formation. Largest single component of drusen is lipid; other components are polysaccarides, glycosaminoglycans and protein molecules that mediate inflammatory and immune processes. There are 3 types of drusen: hard, subretinal drusenod deposits, and soft drusen. In this case, these are hard drusen which present as small, yellow-white deposits of lipid-rich material between the RPE and Bruch’s membrane. In OCT images these hard drusen appear as discrete hyperreflective dome-shaped deposits. Note the PIL is still intact overlying many of the drusen, so they are referred to as non-infiltrative hard drusen. The other types of drusen will be shown later in this Retinal Revealed.