Disappearing Drusen – Case 1


I’d like to share a case with you today. Ken was a 70 year old white male, he’s
been a patient in my office for many years. His father was also a patient and
his father had lost almost all of his central vision, the last eight years of
his life, as a result of age-related macular degeneration in advanced
geographic atrophy stage in both eyes. Ken’s biggest fear is losing vision like
his father did. And it was in 2012 that I saw my first retinal finding which was
fine drusen perimacular in his left eye. So I had the tough discussion with Ken that drusen were oftentimes a precursor to
age-related macular degeneration and that we needed to intervene. And at the
time intervention, because he was a nonsmoker, was mostly AREDS1
therapy combined with good UV protection and good blood vessel health control
through his primary care doctor. In 2013 the results of AREDS2 became
available and we switched him over to the AREDS2 formula vitamin therapy. In
2014 when he returned, the drusen were gone. Disappearing drusen was a
remarkable finding. As you can see in these sequential photos: the drusen being
somewhat dense in the first image, less dense in the second image, and
completely gone in the third image. It was a historic case in my office to
see for the first time that actually drusen can disappear. And I think that’s
a historic finding really around the country and around the globe. We
have to understand that early intervention can make a difference and
retinas can actually improve. In 2014 the dark adaptation testing became available
for me to use with our patients. And so at Ken’s next regular examination, I had
him perform dark adaptation testing. In explaining to Ken about the test and how
significant it was, he related to me a story about his father and he said
“I’ll never forget this story”. The story goes as follows: his father and
mother were big RVers. In Pennsylvania, we have the Turnpike that goes through
three mountains and so there are three long tunnels. And on the way back from one of his RVing adventures, as his father was driving
through the tunnel, he alerted his wife “You’ve got to take the wheel! You’ve got
to take the wheel! I can’t see!” As he went from the light into the dark tunnel,
he became clinically blind. So his wife drove through the tunnel and they
made their way back home. Of course, at that time he had normal vision. That story is so remarkable because I explained to Ken the dark adaptation and its relationship at predicting future AMD and central vision loss. It was an example of how at the time (and this was in the 1980s), there was no doctor that
knew of that association. As he lost his vision going through the tunnel little,
did anybody know that he would be at high risk, a 90%
chance, of developing AMD. Which he unfortunately did in both eyes.
With the advent of the dark adaptation instrument, we know about that association. It
has been well verified. And so Ken could further understand and better appreciate
the dark adaptation test. As we tested his eyes, he went from an abnormal
dark adaptation after years of AREDS2 vitamin
therapy and maintaining good blood vessel health and good UV protection,
he actually had improved dark adaptation. It is quite remarkable that for all
these years, we did not have a screening test to identify our patients that are at risk
for AMD. And just as we’ve done tonometry for many years to identify those patients at risk for
peripheral field loss from glaucoma, now we need to be
screening our patients using the AdaptDx to identify those that will be at 90%
risk of having future central vision loss. So routine screening for our patients 50 and over
is the next new standard of care model that the AdaptDx will afford
all doctors of optometry and ophthalmology performing primary care.

6 comments

  1. Good afternoon. I just received a phone call from a doctor saying that I have calcification of the optic nerve. Im scared shitless because I was told I could lose my vision I’m 41 yrs old I need to know what my next step is? I was told I needed an MRI to look further into it is this a case of drusen?

  2. I am 21 and I have been told that I have drusen in both eyes. I have no other symptoms except having high myopia(-8.00 L, -10.00R) since young (started wearing glasses when I was 6) I read up about Age-related Macular Degeneration and Myopic Macular Degeneration, know a little bit about the stages and all. I just wanna ask how high is my chance of developing late-stage AMD when i get older? Are there any cases where ppl have drusen since young but their vision is still perfect?(even in their 60s-70s?) Is it for sure that I will have to deal with some macular problem as I grow older? I have dreams to pursue, I don't want to lose my vision. 🙁

  3. This just happened to me. I had Dryden since my 39’s. Now gone. Gone 15 years later. Amazing!!!!!!

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