Elusive drusen and changing terminology of AMD

Abstract

The first descriptions of ageing macula disorder (AMD), be it under other names, appeared in 1855 and 1868. The earliest accounts of AMD linked the presence of drusen with visual loss. It took a century before these connections between drusen and AMD were generally accepted by medical science and in clinical articles. The first signs of AMD appear in the region of the choriocapillaris, Bruch's membrane and the retinal pigment epithelium. The pathogenesis of drusen and of AMD is still uncertain. This is reflected in the wide variation in nomenclature of both, since the first publications.

Fig. 1

(a) Drusen of the vitreous membrane of the choroid. Haab wrote: These drusen, also a change in old age, have nothing to do with the macular disorder depicted here and should be distinctly separated from this. [20] (b) Images of senile macular disease. [20] 1. a b Macula of right and left eye from a 70-year-old person; 2. No legend given. 3. a Beginning signs of disease; 3. b 6 months later; 4. a b Right and left eye from a 74-year-old female

Fig. 2

First color image of drusen. These were called: Nodular exudates in the choroid. Table 1 [23]

Fig. 3

(a) Inferred association between 'posterieur' glaucoma with total disc cupping and circumpapillary drusen. [27] (b) Drusen and pigmentary changes in the fundus

Fig. 4

First color images ever of the eye fundus [39] from thesis by Van Trigt [67]

Fig. 5

Large drusen (5) pressing against the retina (c) [14]. aa is choroid, b probably Bruch’s membrane, c retina in which drusen protrude

Fig. 6

(a) Central guttate choroiditis [42] (b) Central senile areolar choroidal atrophy [43]

Fig. 7

Disciform macular degeneration. Male, 79 years old. Round center, over 2.5 diopter prominence [60]