Short-Term Changes of Basal Laminar Drusen on Spectral-Domain Optical Coherence Tomography

PurposeTo determine if small hard drusen in patients with basal laminar drusen show short-term changes.DesignProspective observational case series.MethodsTen subjects with basal laminar drusen were longitudinally followed during a period of 4 months by spectral-domain optical coherence tomography. Drusen that showed a spontaneous change in volume were further analyzed according to 5 morphologic parameters: shape, reflectivity, homogeneity, and concurring photoreceptor layer/retinal pigment epithelium damage. Odds ratios (OR) and risk for regression and progression of drusen volumes were calculated.ResultsOne hundred and five small hard drusen in 19 eyes showed a spontaneous change in volume over the period of follow-up. Drusen with a “pointed” shape were significantly associated (P = .031; OR 4.89; 95% confidence interval [CI] 1.16−20.67) with spontaneous progression in drusen volume, with a chance of 0.80 (95% CI 0.55−0.93) to progress. Drusen that showed a decreased reflectivity of overlying photoreceptor layer (P = .041; OR 7.67; 95% CI 1.09−54.24) or retinal pigment epithelium (P = .022; OR 12.38; 95% CI 1.44−106.57), showed a significant association with spontaneous regression in drusen volume, with chances of regression of 0.86 (95% CI 0.41−0.98) and 0.89 (95% CI 0.49−0.99), respectively.ConclusionSmall hard drusen in patients with the basal laminar drusen phenotype are subject to a process of short-term remodeling. The dynamic nature of this disease points to high biochemical activity that may be sensitive to future pharmacologic treatment strategies. In addition, these short-term changes of drusen may be a source of misclassification in disease staging.