Clogging of Bruch's membrane is associated with progression of which conditions?

• A. Glaucoma
• B. Cataracts
• C. Diabetic retinopathy
• D. Age-related macular degeneration and retinitis pigmentosa

Answer: (D)

Bruch's membrane sits between the retinal pigment epithelium and the choroid, and it normally allows smooth exchange of nutrients and waste. When it becomes clogged with lipids and other deposits with aging, its permeability drops. That impairment leads to buildup beneath the RPE, stressful dysfunction of the RPE and photoreceptors, and the development of drusen and other changes that drive progression of age-related macular degeneration. In some cases, Bruch's membrane alterations can also be associated with progression in retinitis pigmentosa, where retinal support structures deteriorate and Bruch's membrane changes can contribute to worsening vision. Glaucoma and cataracts involve different parts of the eye (optic nerve and lens, respectively) and are not driven by Bruch's membrane clogging, so they aren’t the primary conditions linked to this change.