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MAT-CA-ACP-2025-00026 12/2025
Image courtesy of Dr. Mohammad Rafieetary.
Drusen are a hallmark of early age-related macular degeneration (AMD), which can be observed by direct examination of CFP or OCT.1,2 Drusen come in various sizes—the larger the drusen, the greater the chance of progression to an advanced form of AMD such as GA.1
Early AMD—marked by white arrows—is associated with multiple small (<63 µm) and a few intermediate (63-124 µm) drusen, or retinal pigment epithelium (RPE) abnormalities.1
Image courtesy of Dr. Arshad Khanani.
Image courtesy of Dr. Arshad Khanani.
Intermediate AMD is associated with extensive intermediate drusen (63-124 µm) or more than 1 large drusen (≥125 µm).1 Degenerative changes in the retinal layers may also be observed.1
Images are from separate patients.
Intermediate drusen (white arrows) can be visualized clearly on OCT and CFP.2 Pigmentary changes (wedges) visualized on CFP may precede atrophic changes.1
The progression to GA is characterized by the development of new atrophic lesions, expansion of individual areas, or coalescence of multiple lesions in the retinal layers. GA can be detected using various imaging modalities, such as OCT, which are commonly available in most clinics.1
Image courtesy of Dr. Mohammad Rafieetary.
Image courtesy of Dr. Arshad Khanani.
Image courtesy of Dr. David Lally.
Images are from separate patients.
Atrophic lesions represent a loss of the RPE, overlying photoreceptors, and underlying
choriocapillaris.1 Atrophic regions (white arrows) are represented on CFP, OCT, and FAF.
While GA progression is highly variable, lesions in the perifoveal macula are typically first to appear, expanding over time to include the fovea.1
Image courtesy of Dr. Arshad Khanani.
Intermediate AMD
Image courtesy of Dr. Arshad Khanani.
Advanced AMD (GA)
Key Features1
(1) Degeneration of overlying photoreceptors increases reflectivity below Bruch’s membrane
(2) Hyper-reflective foci correspond to attenuation or disruption of the RPE
(3) Atrophy of the RPE
(4) Area of choroidal hypertransmission
Images are from separate patients.
Image courtesy of Dr. Arshad Khanani.
Intermediate AMD
Image courtesy of Dr. Mohammad Rafieetary.
Advanced AMD (GA)
Key Features2
(1) Drusen and (2) fundus abnormalities are identifiable as hyperpigmented areas
(3) GA lesion borders are sharply demarcated with increased choroidal vessel visibility (dashed circle)
Images are from separate patients.
Image courtesy of Dr. Arshad Khanani.
Intermediate AMD
Image courtesy of Dr. David Lally.
Advanced AMD (GA)
Key Features1
(1) Reticular pseudodrusen appearing as multiple, clustered, regularly networked, round areas of low-contrast hypo-autofluorescence may be prognostic of advancing AMD
(2) Abnormal patterns of hyperautofluorescence surrounding atrophic lesions
(3) Areas of hypo-autofluorescence with sharply demarcated borders indicate atrophic lesions
Images are from separate patients.
Lesion patterns can be predictive of slower or faster progressing disease.1,3
References:
