Vitreous and Retina

Geographic Atrophy and Calcified Drusen

Several areas of geographic atrophy accompanied by dystrophic calcification of the drusen (calcified drusen) which appears as glistening, bright yellow specks within drusen
  • Represents the most advanced form of nonneovascular AMD.
  • Pathogenesis is unclear, but may raise from:
    • Areas of confluent large, soft drusen that undergone regression
    • Multiple reticulated areas of hyper- or hypopigmentation (non-geographic atrophy) which may progress to one large area of GA, spreads contiguously around the fovea and eventually surrounding it
    • Spontaneous flattening of a pigment epithelial detachment

Clinical Features

  • Symptoms:
    • Gradual or progressive loss of vision, depending on the extend and the location of the atrophy relative to the foveal center
    • Reduced contrast sensitivity
  • Signs:
    • Single or multiple discrete areas of hypopigmentation or depigmentation or absent of the RPE forming an areolar pattern 
    • Often appear as bilateral and symmetric disease, although they may have different onset and progression rates 
    • Visualization of the larger caliber choroidal vessels within the atrophied area
    • May be accompanied by calcified drusen which appears as glistening, bright yellow specks 
    • The areas of atrophy will continue to enlarge over time

Fluorescein angiography findings:

  • Early and discrete bright hyperfluorescence
  • Slowly or entirely absent of choriocapillaris filling within the GA zone
  • Persistent staining of the atrophied area with a maintaining border in the late phase