Clinical and Multimodal Imaging Features of Subretinal Drusenoid Deposits


Purpose: To describe the multimodal imaging (MMI) features of subretinal drusenoid deposits (SDD) in Indian population.

Methods: Patients diagnosed to have SDD from January 2016 to December 2018 at our tertiary care center were recruited. The diagnosis of SDD was made on the basis of MMI consisting of a combination of color fundus photography (CFP), optical coherence tomography (OCT), red-free (RF) imaging, blue autofluorescence (BAF), and near-infrared reflectance (NIR) imaging. The morphological type and distribution of SDD and the associated retinal lesions were reviewed.

Results: Twenty-three patients with SDD were included. The mean age of the patients was 68.1 ± 12.2 years. SDD were noted in 77.8% of eyes clinically (n = 35/45) and could be detected in 100% of these eyes with OCT. The morphology of SDD was nodular in 65.7% of eyes (n = 23/35), reticular in 5.7% (n = 2/35), and mixed pattern in the remaining cases. BAF and NIR showed hyporeflective nodular lesions often with a target configuration. The location was commonly in the perifoveal area, mostly involving the superotemporal quadrant (74.3%, n = 26/35). Associated retinal lesions were type-3 neovascularization or retinal angiomatous proliferation in 17.1% (n = 6/35), disciform scar in 11.4% (n = 4/35), type-1 neovascularization in 8.5% (n = 3/35), and geographic atrophy in 5.7% (n = 2/35) of eyes. The mean subfoveal choroidal thickness was 186.2 ± 57.8 μm.

Conclusion: SDD commonly have a nodular morphology and their identification often requires confirmations with OCT. Advanced age-related macular degeneration features are frequently present in eyes with SDD and the fellow eyes.


Subretinal Drusenoid Deposits, Pseudodrusen, Multimodal Imaging, Optical Coherence Tomography, Age-related Macular Degeneration

1. Bird AC, Bressler NM, Bressler SB, Chisholm IH, Coscas G, Davis MD, et al. An international classification and grading system for age-related maculopathy and age-related macular degeneration. The International ARM Epidemiological Study Group. Surv Ophthalmol 1995;39:367–374.

2. Bressler SB, Maguire MG, Bressler NM, Fine SL. Relationship of drusen and abnormalities of the retinal pigment epithelium to the prognosis of neovascular macular degeneration. The Macular Photocoagulation Study Group. Arch Ophthalmol 1990;108:1442–1447.

3. Klein ML, Ferris FL, Armstrong J, Hwang TS, Chew EY, Bressler SB, et al. Retinal precursors and the development of geographic atrophy in age-related macular degeneration. Ophthalmology 2008;115:1026–1031.

4. Spaide RF, Ooto S, Curcio CA. Subretinal drusenoid deposits AKA pseudodrusen. Surv Ophthalmol 2018;63:782–815.

5. Sivaprasad S, Bird A, Nitiahpapand R, Nicholson L, Hykin P, Chatziralli I, et al. Perspectives on reticular pseudodrusen in age-related macular degeneration. Surv Ophthalmol 2016;61:521–537.

6. Rabiolo A, Sacconi R, Cicinelli MV, et al. Spotlight on reticular pseudodrusen. Clin Ophthalmol Auckl NZ 2017;11:1707–1718.

7. Ueda-Arakawa N, Ooto S, Tsujikawa A, Querques L, Bandello F, Querques G. Sensitivity and specificity of detecting reticular pseudodrusen in multimodal imaging in Japanese patients. Retina 2013;33:490–497.

8. Zweifel SA, Spaide RF, Curcio CA, Malek G, Imamura Y. Reticular pseudodrusen are subretinal drusenoid deposits. Ophthalmology 2010;117:303–312.e1.

9. Schmitz-Valckenberg S, Alten F, Steinberg JS, et al. Reticular drusen associated with geographic atrophy in age-related macular degeneration. Invest Ophthalmol Vis Sci 2011;52:5009–5015.

10. Finger RP, Wu Z, Luu CD, Jaffe GJ, Fleckenstein M, Mukesh BN, et al. Reticular pseudodrusen: a risk factor for geographic atrophy in fellow eyes of individuals with unilateral choroidal neovascularization. Ophthalmology 2014;121:1252–1256.

11. Sawa M, Ueno C, Gomi F, Nishida K. Incidence and characteristics of neovascularization in fellow eyes of Japanese patients with unilateral retinal angiomatous proliferation. Retina 2014;34:761–767.

12. Chang YS, Kim JH, Yoo SJ, Lew YJ, Kim J. Felloweye neovascularization in unilateral retinal angiomatous proliferation in a Korean population. Acta Ophthalmol 2016;94:e49–e53.

13. Spaide RF. Outer retinal atrophy after regression of subretinal drusenoid deposits as a newly recognized form of late age-related macular degeneration. Retina 2013;33:1800–1808.

14. Querques G, Canouï-Poitrine F, Coscas F, Massamba N, Querques L, Mimoun G, et al. Analysis of progression of reticular pseudodrusen by spectral domain-optical coherence tomography. Invest Ophthalmol Vis Sci 2012;53:1264–1270.

15. Xu L, Blonska AM, Pumariega NM, ohrab MA, Hageman GS, Smith RT. Reticular macular disease is associated with multilobular geographic atrophy in age-related macular degeneration. Retina 2013;33:1850–1862.

16. Marsiglia M, Boddu S, Chen CY, Jung JJ, Mrejen S, Gallego-Pinazo R, et al. Correlation between neovascular lesion type and clinical characteristics of nonneovascular fellow eyes in patients with unilateral, neovascular agerelated macular degeneration. Retina 2015;35:966–974.

17. Buitendijk GHS, Hooghart AJ, Brussee C, de Jong PT, Hofman A, Vingerling JR, et al. Epidemiology of reticular pseudodrusen in age-related macular degeneration: the Rotterdam Study. Invest Ophthalmol Vis Sci 2016;57:5593–5601.

18. Joachim N, Mitchell P, Rochtchina E, Tan AG, Wang JJ. Incidence and progression of reticular drusen in agerelated macular degeneration: findings from an older Australian cohort. Ophthalmology 2014;121:917–925.

19. Suzuki M, Sato T, Spaide RF. Pseudodrusen subtypes as delineated by multimodal imaging of the fundus. Am J Ophthalmol 2014;157:1005–1012.

20. Curcio CA, Sloan KR, Kalina RE, Hendrickson AE. Human photoreceptor topography. J Comp Neurol 1990;292:497– 523.

21. Ooto S, Ellabban AA, Ueda-Arakawa N, Oishi A, Tamura H, Yamashiro K, et al. Reduction of retinal sensitivity in eyes with reticular pseudodrusen. Am J Ophthalmol 2013;156:1184–1191.e2.

22. Querques G, Querques L, Forte R, Massamba N, Coscas F, Souied EH. Choroidal changes associated with reticular pseudodrusen. Invest Ophthalmol Vis Sci 2012;53:1258– 1263.

23. Garg A, Oll M, Yzer S, Chang S, Barile GR, Merriam JC, et al. Reticular pseudodrusen in early age-related macular degeneration are associated with choroidal thinning. Invest Ophthalmol Vis Sci 2013;54:7075–7081.

24. Ueda-Arakawa N, Ooto S, Ellabban AA, Takahashi A, Oishi A, Tamura H, et al. Macular choroidal thickness and volume of eyes with reticular pseudodrusen using sweptsource optical coherence tomography. Am J Ophthalmol 2014;157:994–1004.

25. Corvi F, Souied EH, Capuano V, Costanzo E, Benatti L, Querques L. Choroidal structure in eyes with drusen and reticular pseudodrusen determined by binarisation of optical coherence tomographic images. Br J Ophthalmol 2017;101:348–352.

26. Cohen SY, Dubois L, Tadayoni R, Delahaye-Mazza C, Debibie C, Quentel G. Prevalence of reticular pseudodrusen in age-related macular degeneration with newly diagnosed choroidal neovascularisation. Br J Ophthalmol 2007;91:354–359.