In age-related macular degeneration (AMD), the PRIMARY risk factor for conversion from dry (atrophic) AMD to wet (neovascular) AMD is:

• A Hard drusen in the macula
• B Drusen in the peripheral retina
• C Reticular pseudodrusen only
• D Large (>125 μm) soft confluent drusen ✓

Explanation

Large soft drusen (>125 μm diameter, equivalent to large venous cross-sections) and confluent soft drusen in the macula are the strongest risk factors for progression to geographic atrophy or neovascular (wet) AMD. They represent lipid and protein deposits beneath the RPE that disrupt RPE function, activate complement, and promote VEGF upregulation. Hard drusen (<63 μm) are low risk. Reticular pseudodrusen (subretinal drusenoid deposits) also confer elevated risk but are less classically tested. The AREDS risk score stratifies patients based on drusen size, type, and extent plus pigment changes.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.