Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Does Drusen Help Treat Dry AMD?
Question: Does Dry AMD always accompanied with Drusen? Would RPE changes alone be diagnosed as AMD? Would it possibly be other eye diseases?
Brief Answer:
Dry AMD
Detailed Answer:
Welcome to HealthCareMagic.Com
For the diagnosis of Non-exudative or Dry AMD we take into account the following changes:
1. Numerous intermediate to large soft drusen which can become confluent.
2. Focal Hyper or Hypo pigmentation Of the retinal pigment epithelium(RPE)
3. Well circumscribed areas of RPE atrophy.
4. Areas of Geographic atrophy
5. Drusenoid RPE detachment.
All these changes are a cascade of events in chronological order.
So a severe case of AMD may have areas of Geographic atrophy or Drusenoid RPE detachment, but we may or may not find simple drusens. The reason being that these changes are a severe form of drusens. But essentially all cases of Dry AMD have drusens.
RPE changes alone cannot be diagnosed as AMD. RPE changes are associated with various disorders.
kindly elaborate what kind of RPE changes you are referring to. RPE changes can be found in various diseases and may be harmless as well.
please get back to me if you have any further query
Dry AMD
Detailed Answer:
Welcome to HealthCareMagic.Com
For the diagnosis of Non-exudative or Dry AMD we take into account the following changes:
1. Numerous intermediate to large soft drusen which can become confluent.
2. Focal Hyper or Hypo pigmentation Of the retinal pigment epithelium(RPE)
3. Well circumscribed areas of RPE atrophy.
4. Areas of Geographic atrophy
5. Drusenoid RPE detachment.
All these changes are a cascade of events in chronological order.
So a severe case of AMD may have areas of Geographic atrophy or Drusenoid RPE detachment, but we may or may not find simple drusens. The reason being that these changes are a severe form of drusens. But essentially all cases of Dry AMD have drusens.
RPE changes alone cannot be diagnosed as AMD. RPE changes are associated with various disorders.
kindly elaborate what kind of RPE changes you are referring to. RPE changes can be found in various diseases and may be harmless as well.
please get back to me if you have any further query
Above answer was peer-reviewed by :
Dr. Raju A.T
Hi Dr Misra,
Thanks for your detailed answer, I am just curious and a bit shock when my doctor told me I have early dry AMD, I am 47 years old, nobody in my family have AMD, I don't drink or smoke, BMI 22 and cholestrol under control. I had Lasik done in 2005 to fix my myopia of about 6D and have had a few retina holes fixed in between. When checking on the Amsler grid I did notice a few minor bent lines at 7 o'clock. Attached my OCT report and retina photos, they are not of very good quality and hope you can help to give a second opinion. While I am trying to deal with the possible AMD with supplement, I don't want to miss the opportunity to treat other diease I might have which mimics my current conditions.
Thanks for your detailed answer, I am just curious and a bit shock when my doctor told me I have early dry AMD, I am 47 years old, nobody in my family have AMD, I don't drink or smoke, BMI 22 and cholestrol under control. I had Lasik done in 2005 to fix my myopia of about 6D and have had a few retina holes fixed in between. When checking on the Amsler grid I did notice a few minor bent lines at 7 o'clock. Attached my OCT report and retina photos, they are not of very good quality and hope you can help to give a second opinion. While I am trying to deal with the possible AMD with supplement, I don't want to miss the opportunity to treat other diease I might have which mimics my current conditions.
Brief Answer:
Further Informarions.
Detailed Answer:
Thank you for getting back to me.
Age related macular degeneration, as the name suggests is part of the ageing process. Indeed in your case it might have manifested earlier than expected. But still It's just a matter of being aware of the condition rather than getting panicked.
Regarding the scans that you have send me, In the wide field fundus photograph the posterior pole of the funds is not in focus, which is the area most affected by AMD. I can see some lasered holes, which are stable. There are definitely some RPE alterations, but they cannot be bracketed within the confines of a specific diagnosis. The OCT scans show no signs of drusens which are indicated by the typical 'lumpy-dumpy' appearance between the RPE and the Bruch's membrane. Rather, in the right eye I can see a mild epi-retinal membrane developing. Which can be seen as a thin line of separation on the right side of the second high mode scan.
To investigate that further, kindly provide me your best corrected visual acuity of both the eyes and which eye is showing abnormal results on AMSLERs?
Kindly download the Amsler grid Application of google play store by LVPEI-MITRA Innovation and send me the results.
Hoping to hear from you soon.
Further Informarions.
Detailed Answer:
Thank you for getting back to me.
Age related macular degeneration, as the name suggests is part of the ageing process. Indeed in your case it might have manifested earlier than expected. But still It's just a matter of being aware of the condition rather than getting panicked.
Regarding the scans that you have send me, In the wide field fundus photograph the posterior pole of the funds is not in focus, which is the area most affected by AMD. I can see some lasered holes, which are stable. There are definitely some RPE alterations, but they cannot be bracketed within the confines of a specific diagnosis. The OCT scans show no signs of drusens which are indicated by the typical 'lumpy-dumpy' appearance between the RPE and the Bruch's membrane. Rather, in the right eye I can see a mild epi-retinal membrane developing. Which can be seen as a thin line of separation on the right side of the second high mode scan.
To investigate that further, kindly provide me your best corrected visual acuity of both the eyes and which eye is showing abnormal results on AMSLERs?
Kindly download the Amsler grid Application of google play store by LVPEI-MITRA Innovation and send me the results.
Hoping to hear from you soon.
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Dr Misra, really aporeciated your speedy reaponse, I couldnt found the app you mentioned in App store, maybe it is not availabke for Apple or not in this region, i have however uploaded a hand marked uo where I see the crooked lines from the affected eye (left)
My recent eye test has the following reading from the doctor. Unaided left (affected)=1.1, Unaided right=1.2.
From optometrist
Right +025/-025x165 add +150
Left +125/-125x145 add +150
So I see pretty good still for far distance except floaters woukd simetimes interfering. But reading glasses is a must.
Hope these clear my situation a bit
My recent eye test has the following reading from the doctor. Unaided left (affected)=1.1, Unaided right=1.2.
From optometrist
Right +025/-025x165 add +150
Left +125/-125x145 add +150
So I see pretty good still for far distance except floaters woukd simetimes interfering. But reading glasses is a must.
Hope these clear my situation a bit
Brief Answer:
Thank you
Detailed Answer:
Thank you for all the additional information.
See, you are doing pretty good right now and no need to worry or panick. I personally cannot diagnose your case as AMD, but still I will give the benefit of doubt to your treating Ophthalmologist. The floaters are due to the vitreous liquefaction and part of the ageing process.
In my opinion, you should continue AMD supplements and keep going for 6monthly to 1 year regular eye examinations to the keep a tap on the situation. You have to keep an eye on the Epiretinal membrane developing in the right eye. Though, it's of no significance right now.
I do not see signs of any other disease which should lead to the RPE alterations.
So don't worry, keep a positive outlook to the whole disease process and do get back to me for any future queries or concerns.
Thank you
Detailed Answer:
Thank you for all the additional information.
See, you are doing pretty good right now and no need to worry or panick. I personally cannot diagnose your case as AMD, but still I will give the benefit of doubt to your treating Ophthalmologist. The floaters are due to the vitreous liquefaction and part of the ageing process.
In my opinion, you should continue AMD supplements and keep going for 6monthly to 1 year regular eye examinations to the keep a tap on the situation. You have to keep an eye on the Epiretinal membrane developing in the right eye. Though, it's of no significance right now.
I do not see signs of any other disease which should lead to the RPE alterations.
So don't worry, keep a positive outlook to the whole disease process and do get back to me for any future queries or concerns.
Above answer was peer-reviewed by :
Dr. Raju A.T
Dr Misra,
Thank you for your response and advice, so to summarize, if I am suffering from AMD I will eventually develop some drusen to "confirm" the dry AMD or my eye's RPE is slowly degenerating without the help of drusen as indicated by the current RPE alternation? My underlying question remains if dry AMD is possible without any drusen?
Would this sort of RPE change be observed as part of normal aging and to which point this change be diagnosed as AMD?
I am following all the directions given by the doctors on supplements but also want to get an understanding the chronological order of the disease.
Lastly a silly question I have to ask, how long does it normally take for the eyesight to deteriorate?
Many thanks.
Dr Misra,
I have uploaded another 2 sets of retina photos to see if it helps the assessment.
Thank you for your response and advice, so to summarize, if I am suffering from AMD I will eventually develop some drusen to "confirm" the dry AMD or my eye's RPE is slowly degenerating without the help of drusen as indicated by the current RPE alternation? My underlying question remains if dry AMD is possible without any drusen?
Would this sort of RPE change be observed as part of normal aging and to which point this change be diagnosed as AMD?
I am following all the directions given by the doctors on supplements but also want to get an understanding the chronological order of the disease.
Lastly a silly question I have to ask, how long does it normally take for the eyesight to deteriorate?
Many thanks.
Dr Misra,
I have uploaded another 2 sets of retina photos to see if it helps the assessment.
Brief Answer:
AMD
Detailed Answer:
Yes I believe you will eventually develop Drusens if the disease process of AMD has started.
According to the guidelines set by the International Committee we have to document Drusens or its sever forms before we can label a case as AMD. Nevertheless, if the patient develops sympotoms consistent with AMD then supplementation for AMD should be started. As it has been done in your case.
No, A you have a faulty Amslers test result I dont think the RPE changes are part of normal ageing process.
The chronological order remains the same as I mentioned before. Drusens, RPE Pigmentation, Geographic Atrophy, Drusenoid RPE detachment.
Visual loss is patient specific and quiet variable. But it takes on an average 5-6 years before the visual loss is significant enough to be noticed.
Regards,
AMD
Detailed Answer:
Yes I believe you will eventually develop Drusens if the disease process of AMD has started.
According to the guidelines set by the International Committee we have to document Drusens or its sever forms before we can label a case as AMD. Nevertheless, if the patient develops sympotoms consistent with AMD then supplementation for AMD should be started. As it has been done in your case.
No, A you have a faulty Amslers test result I dont think the RPE changes are part of normal ageing process.
The chronological order remains the same as I mentioned before. Drusens, RPE Pigmentation, Geographic Atrophy, Drusenoid RPE detachment.
Visual loss is patient specific and quiet variable. But it takes on an average 5-6 years before the visual loss is significant enough to be noticed.
Regards,
Above answer was peer-reviewed by :
Dr. Prasad
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
