What Is a PED (Pigment Epithelial Detachment)?
Understanding PEDs: Why They Matter in AMD Care
A pigment epithelial detachment (PED) occurs when the retinal pigment epithelium (RPE)—a single layer of cells essential for nourishing and supporting the retina—lifts away from the underlying Bruch’s membrane. PEDs can appear in both dry AMD and wet AMD, and their behaviour helps clinicians understand your risk and guide your management.
At Peter Ivins Eye Care in Bearsden, Scotland, PED detection and monitoring are carried out using some of the most advanced retinal imaging platforms available in the UK: the ZEISS CIRRUS 6000 OCT, OCT‑Angiography, ZEISS CLARUS 500 true‑colour ultra‑widefield imaging, and multimodal AI‑enhanced analysis through ZEISS Retina Workplace and Altris AI. Under the clinical leadership of Craig McArthur, internationally recognised lecturer and co‑founder of Scotland’s first macular screening clinic (2008), each PED finding receives expert interpretation and personalised follow‑up.
What Exactly Is a PED?
A PED is a localised elevation of the RPE caused by material, fluid, or abnormal blood vessels accumulating underneath it.
The three most common PED types:
1. Drusenoid PED (found in dry AMD)
- Caused by large, confluent drusen pushing the RPE upwards.
- Typically associated with intermediate dry AMD.
- Can remain stable, but may progress to:
- Geographic atrophy (GA)
- Wet AMD (though slower than other PED types)
2. Serous PED
- Fluid—often from compromised RPE pump function—collects under the RPE.
- Seen in both early AMD and some inflammatory/central serous conditions.
- May improve or worsen depending on underlying cause.
3. Fibrovascular PED (seen in wet AMD)
- Caused by abnormal new vessels (choroidal neovascular membrane) growing under the RPE.
- Strongly associated with wet AMD.
- Often requires urgent anti‑VEGF treatment.
Key point: Not all PEDs behave the same. OCT imaging is essential for determining the PED type and associated risk.
Symptoms of a PED
Many PEDs cause no symptoms and are discovered during routine imaging. However, depending on the PED type, symptoms may include:
- Metamorphopsia: straight lines looking wavy
- A central blur or smudge
- Reduced contrast sensitivity
- A grey patch or distortion in central vision
Symptoms usually reflect associated changes, such as drusen progression or the onset of wet AMD.
How We Diagnose PEDs at Peter Ivins Eye Care
Accurately identifying and monitoring PEDs requires a multimodal, high‑resolution imaging approach.
1. CIRRUS 6000 OCT with FastTrac
- Reveals the PED’s height, width, borders, and internal reflectivity.
- Measures drusen volume, RPE thickness, and signs of atrophy.
- FastTrac eye‑tracking ensures precise, repeatable scans.
- Shows whether neovascular blood flow is present.
- Critical for detecting conversion to wet AMD.
3. Fundus Autofluorescence (FAF)
- Blue/green FAF imaging on the ZEISS CLARUS 500 highlights:
- RPE stress (hyper‑autofluorescence)
- RPE loss (hypo‑autofluorescence)
- Early GA around drusenoid PEDs
4. True‑colour ultra‑widefield imaging
- Captures pigment changes, drusen patterns, and any associated haemorrhage.
5. AI‑Enhanced Monitoring
- Retina Workplace registers multiple imaging modalities for visit‑by‑visit comparisons.
- Altris AI supports detection of subtle changes in PED shape and behaviour.
This multi‑layered approach allows for early identification of progression and tailored intervention planning.
Why PEDs Matter in Dry and Wet AMD
In dry AMD:
- Drusenoid PEDs signal intermediate AMD, a stage where progression risk increases.
- They may lead to geographic atrophy, especially if FAF reveals zones of RPE stress.
- Monitoring is essential to detect conversion to wet AMD.
In wet AMD:
- Fibrovascular PEDs often indicate active neovascularisation.
- Anti‑VEGF injections are the standard of care.
- OCT‑A helps determine whether vessels remain active or stabilise over time.
Where Valeda Photobiomodulation Fits (for Dry AMD and Drusenoid PEDs)
Valeda photobiomodulation (PBM) is a non‑invasive, light‑based therapy used for dry AMD, particularly in patients with:
- Soft drusen
- Drusenoid PEDs
- Reduced contrast sensitivity
- Early functional symptoms not fully explained by acuity
PBM delivers specific wavelengths—590 nm (yellow), 660 nm (red), 850 nm (near‑infrared)—that help support mitochondrial health, reduce oxidative stress, and enhance retinal metabolism.
Potential benefits in drusenoid PED patients:
- Improved visual function (contrast, dark adaptation)
- Support of RPE metabolic activity
- Stabilisation of macular function in early/intermediate dry AMD
PBM does not treat fibrovascular PEDs and is not used in wet AMD.
What Happens During a Valeda PBM Session?
- Completely non‑invasive
- Approximately 10 minutes per session
- Delivered over a course of multiple visits
- No eye drops, discomfort, or downtime
- Baseline and follow‑up imaging ensure objective tracking of any changes
Who Is Suitable for PBM at The Valeda Clinic?
PBM may be recommended if you have:
- Early or intermediate dry AMD
- Soft drusen or drusenoid PEDs
- Reductions in contrast or dark‑adaptation performance
- Desire for a non‑invasive, evidence‑supported adjunct therapy
It is not recommended for:
- Wet AMD
- Fibrovascular PEDs
Eyes requiring urgent anti‑VEGF therapy
Valeda treatment – Book Now
…we can help you understand your baseline, your risk, and your options.
📞 Call us: 0141 943 3300
📍 Visit our clinic in Bearsden, Glasgow
📅 Book a Valeda Assessment online
Learn more at www.valedascotland.co.uk
For more information about Valeda treatment visit:
FAQ’s
Is a PED the same as AMD?
No, but PEDs are common in AMD and help predict progression.
Can a PED go away?
Some serous PEDs can flatten, but most drusenoid PEDs persist and must be monitored.
Does a PED mean I’ll get wet AMD?
Not always—risk depends on PED type, OCT‑A findings and FAF patterns.
Is PBM safe for PEDs?
For drusenoid PEDs in dry AMD, PBM is considered safe with monitoring. It’s not suitable for fibrovascular PEDs.