How to treat drusens (age-related macular degeneration deposits) in the eyes?

Treatment of Drusen in Age-Related Macular Degeneration

The AREDS2 supplement formulation (vitamin C, vitamin E, zinc, copper, lutein, and zeaxanthin) is the most effective evidence-based intervention to slow progression of drusen and reduce risk of advanced AMD in high-risk patients. 1

Understanding Drusen and AMD

• Drusen are yellowish deposits that form under the retina and are the characteristic early sign of age-related macular degeneration (AMD) 2, 3
• There are two main types of drusen with different clinical implications:
  • Hard drusen: Small, punctate yellow nodules that can precede atrophic AMD 4
  • Soft drusen: Larger (>63μm), pale yellow or grayish-white elevations that tend to precede RPE detachments and choroidal neovascularization 4
• Drusen volume and area typically increase over time, with 48% of eyes showing increased drusen volume after 12 months 5
• Risk factors for AMD progression include increasing age, bilateral soft drusen, large drusen, confluent drusen, family history, genetic polymorphisms, smoking, and poor diet/nutrition 2

Treatment Algorithm for Drusen Management

1. Nutritional Supplementation

• For patients with intermediate or advanced AMD in one eye, the AREDS2 formulation is recommended, containing: 1, 2
  • Vitamin C
  • Vitamin E
  • Zinc
  • Copper
  • Lutein (10mg)
  • Zeaxanthin (2mg)
• This formulation has been shown to reduce the risk of progression to advanced AMD by approximately 25% 1

2. Lifestyle Modifications

• Smoking cessation is strongly recommended as smoking has been consistently identified as a risk factor for AMD progression 2, 1
• Maintain a healthy diet rich in green leafy vegetables, fish, and foods containing lutein and zeaxanthin 1
• Regular exercise and maintaining a healthy body mass index are recommended 2

3. Regular Monitoring

• Use of the Amsler grid for self-monitoring to detect early metamorphopsia (distorted vision) 1
• Regular comprehensive eye examinations for early detection of progression 1
• Optical coherence tomography (OCT) imaging to monitor drusen volume and area changes over time 5

Special Considerations

• Early AMD is usually asymptomatic, making regular eye examinations crucial for early detection 2, 1
• The presence of five or more drusen, drusen larger than 63μm in diameter, and confluence of drusen are associated with increased risk of progression to exudative maculopathy 4
• If drusen progress to wet AMD (neovascular AMD), anti-VEGF therapy with agents like ranibizumab should be initiated promptly 1, 6

Common Pitfalls and Caveats

• There is currently no treatment to directly eliminate existing drusen 4, 7
• Spontaneous regression of drusen can occur but is often associated with RPE atrophy, which itself can lead to vision loss 4
• Laser photocoagulation for drusen regression has been studied but is not currently recommended as standard treatment due to potential complications 4
• Beta-carotene, which was in the original AREDS formulation, should be avoided in smokers and former smokers due to increased risk of lung cancer; lutein and zeaxanthin are appropriate substitutes 1

Importance of Early Intervention

• Early treatment is associated with better visual outcomes and preservation of quality of life 1
• If all patients at risk were given appropriate supplements, more than 300,000 could delay disease progression and associated vision loss 2
• Patients with advanced AMD report substantial decline in quality of life and increased need for assistance with daily activities as visual acuity worsens 2, 1