A small percentage may evolve into a disciform degeneration with serous and hemorrhagic detachment. Drusen may also calcify. Bruch's membrane may also show signs of diffuse thickening. In long-standing cases, a secondary cystoid degeneration, schisis, or overlying retinal holes may develop. Classically it begins after age 60 and is often bilateral.
Patients often have antecedent non-disciform degenerative changes.
Clinically the patient may notice acute metamorphosis or loss of vision and may present suddenly with hemorrhagic detachment from neovascularization which extends from the choroid through Bruch's membrane into the sub-RPE space. They may also get exudative detachments. The blood may organize leaving a yellow-gray discoloration admixed with hemosiderin. The RPE may undergo hyperplasia and fibrous metaplasia leading to a thick, fibrous subretinal disciform scar.