Understanding Drusen — What They Mean for Your Eyes and Vision

What drusen actually are

Drusen are small yellow or pale deposits that develop beneath the retina, the light-sensitive tissue lining the back of your eye. They are made from proteins, lipids (fats), and cellular waste material that accumulate over time. The name comes from a German word meaning “node” or “geode,” reflecting their clustered appearance under examination.

Drusen are most commonly detected during a routine dilated eye examination. Many people first hear the word in their 50s or later. In small amounts, drusen can be part of normal ageing. Their presence does not automatically mean disease.

Where drusen form in the eye

Drusen develop between two important layers: the retinal pigment epithelium (RPE) and Bruch’s membrane. The RPE helps nourish the retina and remove metabolic waste. As we age, this waste-clearance system becomes less efficient. When debris accumulates faster than it can be cleared, drusen can form.

Understanding their location helps explain why drusen are closely monitored. They sit near the macula — the central area responsible for sharp, detailed vision used for reading and recognising faces.

Different types of drusen

Not all drusen carry the same meaning.

Hard drusen are small, well-defined, and commonly seen in healthy older adults. A few isolated hard drusen are often considered a typical age-related finding and usually do not affect vision.

Soft drusen are larger, have less distinct edges, and may cluster together. Soft drusen are more strongly associated with age-related macular degeneration (AMD), particularly when they increase in number or size.

There is also a separate condition called optic disc drusen, which occur on the optic nerve head rather than beneath the macula. These are usually present from early life and are unrelated to macular drusen. They can sometimes mimic optic nerve swelling but are generally a distinct and different issue.

Do drusen cause symptoms?

Most people with drusen notice no symptoms. Vision often remains stable, particularly when drusen are small and few in number.

If drusen progress in association with age-related macular degeneration, symptoms may include:

• Blurred or hazy central vision

• Difficulty reading or recognising faces

• Distortion where straight lines appear wavy

• Increased difficulty adapting to dim light

• Dark or blank patches in central vision

These symptoms relate to changes in the macula rather than the drusen themselves.

What increases risk?

Age is the strongest risk factor. Additional influences include:

• Smoking

• High blood pressure

• Obesity

• Family history of macular degeneration

• Cardiovascular risk factors

Lifestyle patterns that affect heart health often overlap with factors influencing macular health.

How drusen are managed

There is currently no procedure that removes drusen directly. Management focuses on monitoring and risk reduction.

Regular comprehensive eye examinations allow your optometrist or ophthalmologist to track changes in size and number. Imaging techniques such as optical coherence tomography (OCT) provide detailed cross-sectional views of retinal layers and help detect early structural changes.

For people with intermediate or advanced age-related macular degeneration, certain nutritional supplements — commonly referred to as the AREDS2 formulation — may reduce the risk of progression to more severe central vision loss. These supplements are not recommended for everyone and should be discussed with your eye specialist or GP in the context of your individual risk.

Stopping smoking, maintaining cardiovascular health, and eating a balanced diet rich in leafy green vegetables support overall retinal wellbeing.

Why monitoring matters

Drusen themselves are not automatically dangerous. Their significance lies in what they may signal about future macular health. Early detection allows careful observation and timely action if changes develop.

If you notice new visual distortion, difficulty reading, or changes in central vision, prompt review is important.

This article provides general health information only and does not replace medical advice. Please speak with your GP for personalised care.