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Reticular pseudodrusen

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Graham Lakkis
BScOptom GradCertOcTher FACO
Lead Optometrist, University of Melbourne Eyecare Glaucoma Clinic

Reticular pseudodrusen (RPD) are yellow-white deposits in the outer retina, distributed in a reticular pattern typically in the superior retina (Figure 1). They are associated with an increased risk of progression to advanced age-related macular degeneration (AMD).

06 Fig 1 Pseudodrusen
Figure 1. Confocal scanning laser ophthalmoscope en face image of reticular pseudodrusen predominantly in the superior macula (Nidek RS 3000)

Regular drusen are deposits of lipid and lipoprotein waste products situated between the Bruch’s membrane and the retinal pigment epithelium (RPE). Reticular pseudodrusen are similar in composition to drusen but the deposits are situated between the RPE and the photoreceptors, rather than beneath the RPE.

Classification

A classification has been proposed where Stage 1 deposits are those that do not disturb the photoreceptor array, Stage 2 deposits cause an undulation in the photoreceptor outer segments and Stage 3 deposits break through the photoreceptor integrity line, also known as the inner segment/outer segment line.

Figure 2 demonstrates a patient with both regular drusen and reticular pseudodrusen in the one cross-sectional retinal OCT scan. On the left side are regular drusen causing undulation in the overlying RPE (solid arrows) while on the right side of the scan are three instances of RPD (hollow arrows), two of which are Stage 3 as they have broken through the photoreceptor integrity line.

06 Fig 2 Pseudodrusen
Figure 2. Spectral domain OCT retinal cross-section showing both regular drusen (solid arrows) and reticular pseudodrusen (hollow arrows) in the one scan (Nidek RS 3000). Two of the pseudodrusen have broken through the photoreceptor integrity line.


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