Basal Laminar Deposits and Pseudodrusen: Rethinking Their Role in Age-Related Macular Degeneration Progression

PURPOSE: To explore the association between basal laminar deposits (BLamD) and pseudodrusen and its clinico-prognostic significance in the context of age-related macular degeneration (AMD). METHODS: A comprehensive narrative review of the literature was conducted, focusing on histopathological, clinical, and imaging studies that examine BLamD and subretinal drusenoid deposits (SDD) in AMD. Histopathological and clinical studies were analyzed to understand the composition, distribution, and clinical significance of these deposits. RESULTS: Imaging and histologic studies suggest that BLamD may serve as an indicator of AMD severity. BLamD is consistently observed in eyes with pseudodrusen and is characterized by a thin double-layer sign in vivo with a hyporeflective interior. On fundus autofluorescence, BLamD retain an intrinsic autofluorescence, leading to a dark grey appearance of the nascent atrophic lesions. The association with SDD, also known as reticular pseudodrusen, can synergically affect the outer retina and retinal pigment epithelium, leading to a rapidly progressive atrophy. CONCLUSION: BLamD is a key pathologic feature in AMD, particularly in eyes with pseudodrusen. Their presence may contribute to disease progression, highlighting the need for further research into their prognostic significance and potential as therapeutic targets. A critical consideration is the need to improve multimodal imaging recognition, facilitating their identification in future clinical studies.