PMC6324114_01
(a) Color fundus photograph of the right eye showing refractile drusen as yellow, glistening deposits in the macular and perimacular area (thick white arrow), and soft drusen circumferentially (thin white arrow) with an area of central retinal pigment epithelium atrophy (arrowhead). Hyper-reflectant structure seen superonasal to the fovea is artifactual (black arrow). (b) Multicolor composite image highlights the refractile drusen as small, yellow, glistening deposits (thick white arrow), whereas the soft drusen appears as green with an orange border (thin white arrow). (c and d) Magnified conventional fundus photography and multicolor composite image view of refractile drusen (thick white arrow), soft drusen (thin white arrow), and artifact (black arrow)
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F1
Color fundus photograph showed multiple glistening yellow lesions in fovea and surrounded circumferentially by multiple soft drusen (SD) [Fig. 1a (1c magnified)]. RD stands out as glistening, light yellow structures [Fig. 1b (1d magnified)]. RD were distinctly hyper-reflectant in green [Fig. 3e] and blue reflectance [Fig. 3d] images, whereas SD appeared to be mildly hyper-reflectant.
(a and b) Spectral domain optical coherence tomography scan of the right eye passing through the refractile drusen (thick white arrow in the optical coherence tomography scan), with significant back shadowing. Soft drusen (thin white arrow) appears as bumpy elevations in the optical coherence tomography with uniform hyper-reflective material inside without any back shadowing
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F2
Spectral domain optical coherence tomography (Heidelberg Spectralis, Heidelberg Engineering, Germany) showed RD as hyper-reflective deposit at the RPE level with significant back shadowing, in contrast to SD that appeared as dome-shaped elevations of the RPE with uniform hyper-refractile material inside with no back shadowing [Fig. 2].
(a and b) Near-infrared autofluorescence (a) and blue autofluorescence (b) highlight the area of retinal pigment epithelium atrophy. (c) Infrared reflectance fails to highlight the drusen. (d) Blue reflectance image shows refractile drusen as hyper-reflectant lesions (thick white arrow). Soft drusen appears mildly hyper-reflectant with surrounding dark borders (thin white arrow). Arrowhead shows the area of retinal pigment epithelium atrophy. (e) Green reflectance image distinctly highlights the refractile drusen as hyper-reflectant material (thick white arrow), whereas soft drusen as mildly hyper-reflectant with dark borders (thin white arrow) surrounding it with distinct retinal pigment epithelium atrophic area (arrowheads)
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F3
RD stands out as glistening, light yellow structures [Fig. 1b (1d magnified)]. RD were distinctly hyper-reflectant in green [Fig. 3e] and blue reflectance [Fig. 3d] images, whereas SD appeared to be mildly hyper-reflectant. The infrared reflectance image was not much informative [Fig. 3c]. The blue autofluorescence [Fig. 3b] and near-infrared autofluorescence [Fig. 3a] highlight the area of central GA.