This 72YO female has been followed for years with intermediate AMD. On 3/26/25, she remained asymptomatic with 20/40 vision.
Color photography shows confluent central drusen creating a drusenoid PED with a radiating pigment figure, surrounded by large soft drusen. The drusenoid RPE detachment (PED) is confirmed on swept-source OCT. The RPE and outer retinal bands are obscured by subretinal hyperreflective material. She returned 6 months later with stable vision and no new symptoms. The PED is mostly flattened with some resolution of the hyperreflective material.
Learning Points:
Drusen commonly remodel over time and their collapse, as in our patient, can lead to drusenoid atrophy of the RPE (Filho et al, Retina 2013;33;1558-1566). Vision may or may not decrease following drusen regression. In our experience, drusenoid atrophy remains stable, unlike primary age-related macular atrophy, whose radius enlarges linearly over time (Shen et al, Ophthalmology Retina 2020;4;899-910). We therefore do not consider intravitreal complement inhibitors for these patients.
