This 55YO female is being followed for asymptomatic dry AMD. Vision is 20/30 OD and 20/25 OS.
Optos color imaging shows extensive small drusen with foveal pigment clumping. Fluorescein angiography shows the classic ‘starry sky’ pattern of hyperfluorescent cuticular drusen. Swept-source OCT shows mostly cuticular drusen with arrowhead-like small elevations of the RPE.
Learning Points:
Originally described by Gass as basal laminar drusen (AJO 1985;99:445-459), cuticular drusen were initially thought to represent nodular thickening of the RPE basement membrane.
They appear clinically as numerous, round, yellow-white ‘hard drusen’, and on OCT as small, arrowhead-shaped drusen located above Bruch’s membrane and below the RPE (Spaide and Curcio, Retina 2010;30:1441-1454).
Our patient’s angiographic appearance echoes Dr. Gass’ original description of “a beautiful stars-in-the-sky or Milky-Way pattern” of hyperfluorescence. Cuticular drusen are classically associated with avascular vitelliform lesions, but can also develop macular neovascularization.
