Where does focal hyperpigmentation occur in dry AMD?

Focal hyperpigmentation in dry age-related macular degeneration (AMD) primarily occurs at the level of the retinal pigment epithelium (RPE). This phenomenon is often a result of the accumulation of lipofuscin and other degenerative changes as the RPE cells become stressed or damaged over time. In dry AMD, with the gradual loss of photoreceptors in the outer retina, the RPE can exhibit both atrophy and areas of hyperpigmentation.

While the outer retina is where photoreceptor cells reside, the RPE plays a critical role in supporting these cells and maintaining the health of the entire retinal structure. Therefore, when we refer to focal hyperpigmentation, we are specifically looking at changes occurring in this crucial layer, where the health of the RPE directly impacts the outer retina's function.

This focus on the RPE fits seamlessly with how dry AMD manifests, as changes in pigment can be indicative of the underlying pathophysiological processes that define the disease. Recognizing this specific pathology is key to understanding the progression of dry AMD and potential treatment strategies.