This 70YO male was referred for age-related macular degeneration (AMD). He was visually asymptomatic, and vision was 20/25 OD and 20/50 OS.
Optos color RG imaging shows extensive, mostly small drusen centered outside the fovea. These lesions are well visualized on the green channel but disappear on the red channel. Triton swept-source OCT shows these ‘drusen’ to represent subretinal drusenoid deposits (SDD), with numerous hyperreflective deposits scattered above the RPE. En face imaging through the outer retina most dramatically shows these SDD.
Learning Points:
SDD are polymorphous, light-gray, interconnected accumulations located above the RPE and are thus best visualized with blue or green illumination, as in our patient. SDD are now considered the third clinical feature for progression to late AMD (Agron et al, Ophthalmology 2022;129:1107-1119), in addition to large drusen and pigment abnormalities as defined in the Beckman classification (Ferris et al, Ophthalmology 2013;120:844-851).
They are present in about one-quarter of older adults with healthy maculas and in more than half of those with early-to-intermediate dry AMD. Clinically, they are often mistaken for conventional drusen and consist of lipid-rich material similar yet distinct from that found in soft drusen.
SDD are localized to rods, unlike typical soft drusen, which are more central and cone-based. As with drusen, SDD are dynamic and can grow, shrink, resolve, or even recur. There is an increased risk for delayed dark adaptation, macular atrophy, and types 2 and 3 MNV. In fact, type 2 neovascularization in the setting of AMD occurs almost solely in eyes with SDD.
