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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]
In fact, the majority of people over age 60 have drusen with no adverse effects. The risk of developing symptoms is higher when the drusen are large and numerous, and associated with the disturbance in the pigmented cell layer under the macula. Large and soft drusen are thought to be related to elevated cholesterol deposits. [citation needed]
Cotton wool spots present as opaque fluffy white spots, sometimes with feather-like edges, on the retina when seen on a funduscopic exam. [1] [2] These opaque white areas are typically asymptomatic, but may cause some vision loss due to the underlying disease state. [5]
Signs include polypoidal lesions, orange-red lesions in fundus, subretinal fluid, retinal detachment, subretinal hemorrhages, subretinal fibrinous material, hard exudates and drusen. [ 1 ] Classification
Advanced retinopathy lesions, such as microaneurysms, blot hemorrhages and/or flame hemorrhages, ischemic changes (e.g. "cotton wool spots"), hard exudates and in severe cases swelling of the optic disc (optic disc edema), a ring of exudates around the retina called a "macular star" and visual acuity loss, typically due to macular involvement.
The causes of macular edema are numerous and different causes may be inter-related. It is commonly associated with diabetes.Chronic or uncontrolled diabetes type 2 can affect peripheral blood vessels including those of the retina which may leak fluid, blood and occasionally fats into the retina causing it to swell.
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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]