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Drusen, from the German word for node or geode (singular, "Druse"), are tiny yellow or white accumulations of extracellular material that build up between Bruch's membrane and the retinal pigment epithelium of the eye. The presence of a few small ("hard") drusen is normal with advancing age, and most people over 40 have some hard drusen. [1]
AMD can be divided into 3 stages: early, intermediate, and late, based partially on the extent (size and number) of drusen. [ 1 ] AMD-like pathology begins with small yellow deposits (drusen) in the macula, between the retinal pigment epithelium and the underlying choroid.
Choroidal nevus with drusen can be considered as a sign of chronicity since drusen take years to develop and appear. [14] Drusen are composed of lipids and can actually be an indicator that a tumour is a benign nevus as opposed to a cancerous melanoma. [15] In nevi imaged by OCT, about 41% are found to have drusen. [16]
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In children, optic disc drusen are usually buried and undetectable by fundoscopy except for a mild or moderate elevation of the optic disc. With age, the overlying axons become atrophied and the drusen become exposed and more visible. They may become apparent with an ophthalmoscope and some visual field loss at the end of adolescence. [7]
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Bruch's membrane thickens with age, slowing the transport of metabolites. This may lead to the formation of drusen in age-related macular degeneration. [4] There is also a buildup of deposits (Basal Linear Deposits or BLinD and Basal Lamellar Deposits BLamD) on and within the membrane, primarily consisting of phospholipids.