Systemic lipid abnormalities and choriocapillaris flow deficits in patients with hard drusen

The aim of this study was to explore alterations in serum biomarkers and ocular fundus blood flow in patients with hard drusen, and to examine the associations between these parameters. In this cross-sectional study, 48 patients with clinically OCTA-identified drusen and 51 healthy controls were recruited. All participants underwent serum biochemical testing, including prealbumin (PA), glucose (GLU), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDLC), and low-density lipoprotein cholesterol (LDLC), among others. Superficial and deep vascular density (SVD and DVD), as well as choriocapillaris flow deficits (CCFD), were assessed in all subjects using optical coherence tomography angiography (OCTA). Compared with controls, the drusen group exhibited significantly higher levels of GLU, TC, and LDLC, as well as greater CCFD density and mean size (all p < 0.05) In the drusen group, CCFD density was significantly positively correlated with LIMT, RIMT, and LDLC, while CCFD size was significantly positively correlated with RIMT, TC, and LDLC (all p < 0.05); additionally, TG showed negative correlations with DVDt, DVDs, DVDn, and DVDi, and PA was negatively correlated with DVDt and DVDi (all p < 0.05). This study demonstrated that patients with hard drusen had significantly higher plasma LDLC levels, accompanied by increased CCFD density and mean size, with LDLC levels positively correlated with CCFD severity. These findings provide further evidence linking systemic lipid metabolism abnormalities with choriocapillaris microvascular impairment in the pathogenesis of drusen.