Among patients with wet age-related macular degeneration (nAMD), the type of drusen deposit was linked to whether atrophy was already present but not to how well eyes responded to anti-VEGF injections, according to findings presented at the European Society of Retina Specialists (EURETINA) 2026 in Vienna, Austria.

Drusen are deposits under the retina that can be a hallmark of macular degeneration; while not treated directly, the classifications can be used to guide clinical decision-making and better assess a patient’s risk for vision loss.

The study was a retrospective, single-center analysis of 450 previously untreated eyes with nAMD, applying AI to measure fluid volumes at baseline and after three or more injections. Drusen types were classified manually as “soft,” “cuticular,” or “subretinal drusenoid deposits.”

Researchers at Tel Aviv Medical Center determined that soft drusen was the most frequent, at nearly 48%, followed by cuticular drusen and subretinal drusenoid deposits, at 26% each. The study also allowed for mixed-type classifications, at 58%.

Macular atrophy was present in 38% of eyes at baseline and was more common with cuticular drusen, at 51% vs 30% with soft drusen, according to the researchers.

“We usually ‘ignore’ the drusen once a patient has neovascular AMD,” said Dinah Zur, MD, head of the Center for Retinal Degenerations at Tel Aviv Medical Center in Tel Aviv, Israel, who helped conduct the study. “Our findings now show that drusen phenotypes are associated with distinct retinal fluid characteristics…and macular atrophy risk in neovascular age-related macular degeneration.”

“In this study, macular atrophy was already present at baseline in 37.8% of eyes, so the findings show an association rather than ‘predicting’ which patients will develop atrophy. That being said, cuticular drusen were associated with a substantially higher rate of macular/geographic atrophy than soft drusen,” said Jordan D. Deaner, MD, vitreoretinal surgeon at Wills Eye Hospital in Philadelphia, Pennsylvania.

“What is interesting is that the different drusen phenotypes were also associated with different fluid patterns on optical coherence tomography, suggesting there may be distinct phenotypes even within neovascular AMD,” said Sharon Fekrat, MD, the Robert Machemer MD Distinguished Professor of Ophthalmology and vice chair for Faculty Affairs at Duke University School of Medicine in Durham, North Carolina.

The response to treatment at 6 months did not vary by drusen type, meaning the results of the study are unlikely to influence current treatment protocols but could offer additional information for clinical management, Fekrat said.

“I don’t think these findings would change anti-VEGF treatment decisions at this point, particularly since treatment response did not differ significantly by drusen type. However, drusen phenotype may give us additional info about the eye and potentially about risk for atrophy. It will be important to see whether these findings hold up longitudinally,” Fekrat said.

“In clinical practice, this study helps me risk-stratify individual patients. In patients with cuticular drusen, I would have a more in-depth conversation about the potential risk of progression to atrophy and monitor them closely so that when they progress to GA it can be quickly identified and treatment discussed when appropriate,” Deaner said.

The study’s use of AI could also have broader implications for retina research, said Sunir J. Garg, MD, professor of ophthalmology and chief of the retina service at Wills Eye Hospital. “I think it’s interesting that an AI model was able to do this,” Garg said. “Manually grading all this stuff can be a little bit tedious…so I think that that’s useful.”

Zur disclosed financial relationships with Roche, Bayer, and Dexcel Pharma. Fekrat disclosed financial relationships with companies including Alcon Inc.; Amgen; Bausch Surgical; Conexiant; Evolve Medical Education; Harrow, Inc.; Jaeb; Ocular Therapeutix; Optos; Regeneron; SLACK; Teladoc Health; Vindico Medical Education; and Wolters Kluwer. Garg reported serving as a consultant for Apellis and Astellas. Deaner reported serving on the advisory board of AbbVie; Apellis; and EyePoint, Inc., and as a consultant for ANI Pharmaceuticals, Bausch + Lomb, Genentech, and Regeneron.

Sony Salzman is an Emmy Award-winning journalist covering science and medicine with bylines in The Atlantic, STAT News, NBC, MedPage Today, and The Boston Globe. Previously, she worked as coordinating producer of ABC’s Medical Unit.