This is a picture of a gentleman in his late 30's. If you enlarge the photograph you can see little white dots. This is a photo of the macular area of the eye, that area that serves the central vision.
These little white dots are called drusen, and in a person past 60 years old, we would consider this macular degeneration. But in a younger person like this, the most likely cause is familial dominant drusen, which is hereditary lipid (or fat-like) deposits in the layers of the retina. It typically does not affect the vision and only a very small number of these patients eventually develop age-related macular degeneration.
There is one interesting condition called mesoangiocapillary membraneoproliferative glomerulonephritis that causes a similar look on the retina. But those patients have blood and excessive protein in the urine and renal family. This patient was healthy with 20/20 vision in each eye.
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