Br J Ophthalmol 1999;83:358-368 ( March )
Early drusen formation in the normal and aging eye and their
relation to age related maculopathy: a clinicopathological study
S H Sarks,a
J J Arnold,b
M C Killingsworth,c
J P Sarksa
a Department of
Ophthalmology, University of NSW, Sydney, Australia and Prince of Wales
Medical Research Institute, Randwick, Sydney Australia, b Department of
Ophthalmology, Aberdeen University, Aberdeen, c South Western Area Pathology Service, Sydney,
Australia
Correspondence to: Dr
S H Sarks, 15 Parnell Street, Strathfield, NSW 2135, Australia.
Accepted for publication 1 September 1998
AIM To describe the
early formation of drusen and their relation to normal aging changes at
the macula and to the development of age related maculopathy (ARM).
METHODHistopathological
features of 353 eyes without histological evidence of ARM are described
and correlated with the clinical appearance. In addition, 45 of these
eyes were examined by transmission electron microscopy.
RESULTSDrusen
were detected histopathologically in 177 (50%) eyes but were seen
clinically in only 34% of these. Drusen were mainly small hard drusen
with an occasional soft distinct drusen: no soft indistinct drusen were
seen. Only those drusen deposits larger than 25-30 µm in diameter
were detectable clinically. Preclinical drusen in eyes with only an
occasional drusen were seen on electron microscopy as entrapment sites
of coated membrane bound bodies which formed adjacent to the inner
collagenous zone of Bruch's membrane. In contrast, preclinical drusen
deposits in eyes with many drusen were seen as accumulations of
amorphous material which appeared hyalinised by light microscopy. A
distinct feature were rows of dense hyalinised microdrusen (1-2 µm
in diameter), over which larger globular hyalinised drusen formed.
CONCLUSIONHistological
and ultrastructural examination can recognise and distinguish the
earliest drusen formed as a result of normal aging from those
associated with ARM. In eyes without diffuse deposits, histologically
all drusen were of the hard hyalinised variety or their derivatives; no
soft drusen composed of membranous debris were found. These findings
support and explain those of other authors who do not consider the
presence of a few small hard drusen to be a risk factor for the
development of ARM.
Keywords:
aging;
macular degeneration;
retinal drusen;
entrapment
© 1999 by British Journal of Ophthalmology
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