Reticular Pseudodrusen

In 1990, our group first described reticular pseudodrusen as a peculiar yellowish pattern in the macula of age-related macular degeneration (AMD) patients, whose visibility was enhanced using blue light. More recently, using spectral-domain optical coherence tomography (SD-OCT), Zweifel et al demonstrated that discrete collections of hyperreflective material located not under (as typical of drusen in AMD), but above the retinal pigment epithelium (RPE), were associated with reticular pseudodrusen. Interestingly, the analysis of integrated imaging allowed our group to show that the peculiar yellowish pattern was responsible for reticular hyperreflectivity on infrared (IR) reflectance; in several cases, the center of reticular pseudodrusen appeared, on IR reflectance, as hyperreflective lesions surrounded by hyporeflective halos (responsible for the “target aspect”), and on SD-OCT as well-defined round or triangular hyperreflective deposits localized between, externally, the RPE layer, and, internally, the external limiting membrane or the outer plexiform layer. In the last years, there was much debate regarding the origin, composition, and localization of reticular pseudodrusen; some authors have even questioned whether these round/triangular hyperreflective deposits (also known as stage 3 subretinal drusenoid deposits) may actually represent optical (SD-OCT) artifacts (Hageman G, personal communication, January 2013).