In age-related macular degeneration (AMD), drusen that are MOST predictive of progression to neovascular (wet) AMD are:
- A Large soft drusen (≥ 125 µm), especially confluent or with pigmentary changes ✓
- B Small hard drusen (< 63 µm) clustered in large numbers
- C Calcified drusen appearing as sharply defined dense deposits
- D Reticular pseudodrusen distributed in the superior macula
Correct answer: A. Large soft drusen (≥ 125 µm), especially confluent or with pigmentary changes
Explanation
Large soft drusen (≥ 125 µm diameter), especially when confluent and accompanied by pigmentary changes (focal hyperpigmentation or hypopigmentation of RPE), are the strongest risk factors for progression to neovascular AMD or geographic atrophy. Small hard drusen alone confer minimal risk. Calcified drusen are a feature of regressed or stable drusen with lower progression risk. Reticular pseudodrusen (subretinal drusenoid deposits) are associated with progression to geographic atrophy more than to neovascular AMD.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
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