Purpose: To investigate the features of the retinal pigment epithelium (RPE) on optical coherence tomography in eyes with early age-related macular degeneration with subretinal drusenoid deposit. Methods: We classified the eyes into three types: nonundulating RPE, undulating RPE, and wedge-shaped RPE. We compared the retinal vessel densities, retinal thickness, and choroidal thickness of a 3-mm-diameter zone. Results: We classified 33, 27, and 20 as nonundulating RPE, undulating RPE, and wedge-shaped RPE eyes, respectively. The vascular densities of the superficial and deep capillary plexus showed differences; nonundulating RPE group (23.93 +/- 2.26% and 23.54 +/- 1.78%), undulating RPE group (22.29 +/- 2.80% and 21.94 +/- 2.42%), and wedge-shaped RPE group (21.93 +/- 2.70% and 20.63 +/- 2.42%, P = 0.010 and P < 0.001). The mean retinal thickness and choroidal thickness were also different, nonundulating RPE group (298.26 +/- 13.81 mu m and 180.08 +/- 55.49 mu m), undulating RPE group (285.29 +/- 21.88 mu m and 148.45 +/- 55.08 mu m), and wedge-shaped RPE group (274.86 +/- 20.62 mu m and 135.75 +/- 39.77 mu m) (P = 0.001 and P = 0.007). Conclusion: Altered features of the RPE on optical coherence tomography may indicate advancement in disease and be part of an overall degeneration process in these eyes.