Late Age-related Maculopathy Research Articles

Dietary Fatty Acids and the 5-Year Incidence of Age-Related Maculopathy

To assess longitudinal associations between dietary fat and incident age-related maculopathy (ARM) in an older, population-based, historical cohort. A total of 3654 persons, 49 years or older, participated in the Blue Mountains Eye Study (1992-1994); 2335 (75.1% of survivors) were reexamined after 5 years (1997-1999). Dietary data were collected from 2895 people (79%) at baseline by means of a semiquantitative food frequency questionnaire to calculate dietary fat intakes. Presence of ARM was graded from retinal photographs (Wisconsin ARM Grading System). Logistic regression adjusted for age, sex, vitamin C intake, and smoking. Participants with the highest vs lowest quintiles of n-3 polyunsaturated fat intake had lower risk of incident early ARM (odds ratio [95% confidence interval], 0.41 [0.22-0.75). A 40% reduction of incident early ARM was associated with fish consumption at least once a week (odds ratio [95% confidence interval], 0.58 [0.37-0.90]), whereas fish consumption at least 3 times per week could reduce the incidence of late ARM (odds ratio [95% confidence interval], 0.25 [0.06-1.00]). We found no association between incident ARM and butter, margarine, or nut consumption. A regular diet high in n-3 polyunsaturated fat, especially from fish, suggests protection against early and late ARM in this older Australian cohort. Our study could not confirm deleterious effects of higher polyunsaturated fat intakes reported by other clinic-based studies.

The prevalence of age‐related maculopathy (ARM) in an urban Norwegian population: the Oslo Macular Study

To examine the prevalence of early and late age-related maculopathy (ARM) in citizens aged 51 years and older in the city of Oslo and its surroundings. We selected a random sample of 800 subjects, using a cross-sectional study design. A total of 459 of the 770 eligible subjects agreed to participate, giving an attendance rate of 59.6%. Stereoscopic colour digital photographs were obtained and graded at a certified reading centre using the International Classification Grading System for ARM. Early ARM in either eye was found in 43.1% (95% CI 38.5-47.7) of subjects aged 51 years and older. This was due to a much higher prevalence of pigmentary changes, predominantly hyperpigmentation in all age groups, than previously reported; 37.5% of people aged 51-60 years of age had pigmentary changes > or = 63 microm, increasing to 66.0% in the oldest age group. In people aged 71 years and older, geographic atrophy (GA) was found in either eye in 3.6% (95% CI 0.4-6.8) and exudative macular degeneration (AMD) was found in either eye in 2.9% (95% CI 0.0-5.7) of subjects. To our knowledge, this is the first published study to rely solely on digital photography for grading purposes in a population-based study. Early ARM was found to have a higher prevalence than previously reported in other populations. Exudative AMD and GA had similar prevalences to those described in the literature, although the prevalence of GA tended to be higher than previously reported in some surveys.

Plasma Lutein and Zeaxanthin and Other Carotenoids as Modifiable Risk Factors for Age-Related Maculopathy and Cataract: The POLA Study

To assess the associations of plasma lutein and zeaxanthin and other carotenoids with the risk of age-related maculopathy (ARM) and cataract in the population-based Pathologies Oculaires Liées à l'Age (POLA) Study. Retinal photographs were graded according to the international classification. ARM was defined by the presence of late ARM (neovascular ARM, geographic atrophy) and/or soft indistinct drusen (>125 microm) and/or soft distinct drusen (>125 microm) associated with pigmentary abnormalities. Cataract classification was based on a direct standardized lens examination at the slit lamp, according to Lens Opacities Classification System III. Plasma carotenoids were measured by high-performance liquid chromatography (HPLC), in 899 subjects of the cohort. After multivariate adjustment, the highest quintile of plasma zeaxanthin was significantly associated with reduced risk of ARM (OR=0.07; 95% CI: 0.01-0.58; P for trend=0.005), nuclear cataract (OR=0.23; 95% CI: 0.08-0.68; P for trend=0.003) and any cataract (OR=0.53; 95% CI: 0.31-0.89; P for trend=0.01). ARM was significantly associated with combined plasma lutein and zeaxanthin (OR=0.21; 95% CI: 0.05-0.79; P for trend=0.01), and tended to be associated with plasma lutein (OR=0.31; 95% CI: 0.09-1.07; P for trend=0.04), whereas cataract showed no such associations. Among other carotenoids, only beta-carotene showed a significant negative association with nuclear cataract, but not ARM. These results are strongly suggestive of a protective role of the xanthophylls, in particular zeaxanthin, for the protection against ARM and cataract.

Visual function and dysfunction in early and late age-related maculopathy

Late age-related maculopathy (ARM) is responsible for the majority of blind registrations in the Western world among persons over 50 years of age. It has devastating effects on quality of life and independence and is becoming a major public health concern. Current treatment options are limited and most aim to slow progression rather than restore vision; therefore, early detection to identify those patients most suitable for these interventions is essential. In this work, we review the literature encompassing the investigation of visual function in ARM in order to highlight those visual function parameters which are affected very early in the disease process. We pay particular attention to measures of acuity, contrast sensitivity (CS), cone function, electrophysiology, visual adaptation, central visual field sensitivity and metamorphopsia. We also consider the impact of bilateral late ARM on visual function as well as the relationship between measures of vision function and self-reported visual functioning. Much interest has centred on the identification of functional changes which may predict progression to neovascular disease; therefore, we outline the longitudinal studies, which to date have reported dark-adaptation time, short-wavelength cone sensitivity, colour-match area effect, dark-adapted foveal sensitivity, foveal flicker sensitivity, slow recovery from glare and slower foveal electroretinogram implicit time as functional risk factors for the development of neovascular disease. Despite progress in this area, we emphasise the need for longitudinal studies designed in light of developments in disease classification and retinal imaging, which would ensure the correct classification of cases and controls, and provide increased understanding of the natural course and progression of the disease and further elucidate the structure-function relationships in this devastating disorder.

Age‐related maculopathy and the impact of blue light hazard

The pathogenesis of age-related maculopathy (ARM), the most common cause of visual loss after the age of 60 years, is indeed a complicated scenario that involves a variety of hereditary and environmental factors. The pathological cellular and molecular events underlying retinal photochemical light damage, including photoreceptor apoptosis, have been analysed in experimental animal models. Studies of age-related alterations of the retina and photoreceptors, the accumulation of lipofuscin in retinal pigment epithelium (RPE) cells, and the formation of drusen have greatly contributed to our knowledge. A new concept of an inflammatory response to drusen has emerged, suggesting immunogenic and systemic reactions in Bruch's membrane and the subretinal space. Oxidative stress and free radical damage also impact on the photoreceptors and RPE cells in the ageing eye. Based on the photoelectric effect, a fundamental concept in quantum physics, the consequences of high-energy irradiation have been analysed in animal models and cell culture. Short-wavelength radiation (rhodopsin spectrum), and the blue light hazard (excitation peak 440 nm), have been shown to have a major impact on photoreceptor and RPE function, inducing photochemical damage and apoptotic cell death. Following cataract surgery, there is a dramatic change in ocular transmittance. In aphakic or pseudophakic eyes (with clear intraocular lenses), high-energy (blue) and ultraviolet-A radiation strikes the retina. Epidemiological data indicate a significantly increased 5-year incidence of late ARM in non-phakic eyes compared with phakic eyes. In recent years, putative prophylactic measures against ARM have emerged. The implantation of 'yellow' intraocular lenses (IOLs) that absorb high-energy blue radiation is, from a theoretical point of view, the most rational approach, and, from a practical point of view, is easy to accomplish. With increasing age, RPE cells accumulate lipofuscin (chromophore A2E). It is noteworthy that the yellow IOL not only protects A2E-laden human RPE cells from blue light (peak 430 nm) damage, but also alleviates the detrimental effects of green (peak 550 nm) and white light. A prophylactic treatment using antioxidants is aimed at counteracting oxidative stress and free radical cellular damage. The Age-Related Eye Disease Study (AREDS), a randomized clinical trial, showed a significantly lower incidence of late ARM in a cohort of patients with drusen maculopathy treated with high doses of antioxidants than in a placebo group. In recent years, considerable progress in retinal research has been achieved, creating a platform for the search for new prophylactic and therapeutic measures to alleviate or prevent photoreceptor and RPE degeneration in ARM.

Apolipoprotein E Gene and Early Age-Related Maculopathy: The Atherosclerosis Risk in Communities Study

To examine the association between the apolipoprotein E (APOE) gene and early age-related maculopathy (ARM) in middle-aged persons. Population-based cross-sectional study. Participants from the Atherosclerosis Risk in Communities Study (n = 10139; age range, 49-73 years). Retinal photography was performed on 1 randomly selected eye, and grading for presence of ARM was carried out using a modification of the Wisconsin ARM Grading System. Early ARM was defined as the presence of either soft drusen alone, retinal pigment epithelial depigmentation alone, or a combination of soft drusen with increased retinal pigment and/or depigmentation. DNA extracted from blood samples of participants were analyzed for common allelic variants of the APOE gene (epsilon2, epsilon3, and epsilon4). Presence of early ARM on retinal photographs. The prevalence of early ARM was similar in participants with different APOE genotypes: epsilon2/epsilon2 (5.9%), epsilon2/epsilon3 (5.2%), epsilon2/epsilon4 (3.2%), epsilon3/epsilon3 (5.2%), epsilon3/epsilon4 (4.9%), and epsilon4/epsilon4 (4.1%). After controlling for age, gender, race, cigarette smoking, and other factors, early ARM was not associated with APOE genotypes, with an odds ratio (OR) of 1.35 (95% confidence interval [CI], 0.54-3.38) for epsilon2/epsilon2 genotype, an OR of 1.06 (95% CI, 0.80-1.40) for epsilon2/epsilon3 genotype, an OR of 0.63 (95% CI, 0.32-1.24) for epsilon2/epsilon4 genotype, an OR of 0.99 (95% CI, 0.80-1.24) for epsilon3/epsilon4 genotype, and an OR of 0.88 (95% CI, 0.47-1.63) for epsilon4/epsilon4 genotype, as compared with epsilon3/epsilon3 genotype (reference). No associations were found for specific early ARM signs or in analyses stratified by age, gender, race, or cigarette smoking status. These data provide no evidence of a strong association between the APOE gene and early ARM in middle-aged persons. This suggests that APOE is not likely a major determinant of the early stages of ARM in younger people. However, our study does not exclude the possibility of a weaker association or that APOE may influence only the development of late ARM in older populations, as reported in other studies.

Ankle-Brachial Index and the Prevalence of Age-Related Maculopathy

To examine the association of ankle-brachial blood pressure index (ABI) with prevalence of age-related maculopathy (ARM). A cross-sectional cohort study. ABI was measured in 2447 subjects aged 53 to 97 years. ARM was determined from 30-degree color stereoscopic fundus photographs. Low ABI (< or =0.9) was present in 5.4% of subjects. Early ARM was present in 22.1% of subjects with and 18.8% without low ABI. Late ARM was present in 5.3% of subjects with and 1.7% without low ABI. This result was not statistically significant. Low ABI does not appear to be a risk factor for ARM.

Inflammatory Markers in Age-Related Maculopathy

To evaluate recent reports indicating that plasma levels of fibrinogen and high-sensitivity C-reactive protein (CRP) are associated with age-related maculopathy (ARM). From the baseline examinations of the Muenster Aging and Retina Study, a cohort of 1060 subjects aged 59 to 82 years was assembled. Of these, 873 persons (82%) with bilateral gradable fundus photographs and complete data on fibrinogen, CRP, and potential confounders were included in a cross-sectional analysis. The main outcome measure was the association among fibrinogen, CRP, and ARM as assessed by multivariate logistic regression analysis. Fibrinogen and CRP levels were higher among participants with early and late ARM than among those without ARM. The crude odds ratios for ARM between the highest vs the lowest quartile were 1.90 (95% confidence interval [CI], 1.29-2.80) for fibrinogen and 1.43 (95% CI, 0.97-2.10) for CRP. After adjustment for cardiovascular risk factors, these odds ratios were 1.37 for fibrinogen (95% CI, 0.91-2.06) and 1.12 (95% CI, 0.73-1.73) for CRP. After adjustment for cardiovascular risk factors, we found no statistically significant association between fibrogen, CRP, and ARM. Therefore, our results do not indicate a role of systemic inflammation in ARM beyond what is already present owing to concurrent cardiovascular disease.

Impact of aging and age-related maculopathy on inactivation of the a-wave of the rod-mediated electroretinogram

This study examined the impact of aging and age-related maculopathy (ARM) on the inactivation of phototransduction in rod photoreceptors by measuring the recovery of the a-wave using a paired flash electroretinogram technique. Measurements were made on 32 older adults in normal retinal health, 25 with early ARM, 7 with late ARM, and 20 young adults for comparison purposes. ARM presence and severity were defined by the Wisconsin Age-Related Maculopathy Grading System based on grading of fundus photographs. The inactivation of rod phototransduction exhibited an aging-related slowing. Those with early ARM did not exhibit inactivation slowing over and above what would be expected based on normal retinal aging. Persons in the late stages of ARM exhibited dramatic slowing in inactivation kinetics.

Visuelle Funktion und Lebensqualität bei Patienten mit altersabhängiger Makulopathie: Ergebnisse der Münsteraner Altern- und Retina-Studie (MARS)

The aim of this study was to examine the association between increasing severity of age-related maculopathy (ARM) stages, visual function and quality of life. Using the 25-item version of the National Eye Institute Visual Function Questionnaire (NEI VFQ) in the Münster age and retina study (MARS), 974 patients (normal fundus: n = 208; early ARM: n = 466; late ARM: n = 300) with bilateral gradable fundus photographs were asked about their visual function and quality of life. The NEI VFQ scales with regard to general health, general vision, near vision, distance vision and peripheral vision were assessed. According to the ARM stages, age- and gender-adjusted mean scores were calculated and tested for statistically significant differences. The perception of general health, general vision, near vision, distance vision and peripheral vision was getting worse with increasing severity of ARM stages. Comparing the maculopathy groups, significant differences in age- and gender-adjusted mean scores were found between patients with late ARM and healthy subjects and patients with late and early ARM. Furthermore, we observed for the dimension general vision a significant difference of the mean score between early ARM and healthy control group [mean score; early ARM: 68.7 (0.7) vs. control group: 72.2 (1.1); p = 0.005]. The results of the NEI VFQ reflect the clinical expectation of an inverse relation between increasing severity of ARM stages and visual function and quality of life.

Risk factors for age‐related maculopathy in a 14‐year follow‐up study: the Copenhagen City Eye Study

To examine the association between potential risk factors and the 14-year incidence of age-related maculopathy (ARM). Population-based cohort study. At baseline, 946 volunteers participated in the study during 1986--88. These subjects were between 60 and 80 years of age and lived in the Østerbro district of Copenhagen. Excluding participants who had died since baseline, 359 subjects (97.3% of survivors) were re-examined 14 years later, during 2000--2002. A total of 31.8% (301/946) of the original material was included in the risk factor analyses. Participants underwent an ophthalmological examination at Rigshospitalet, the National University Hospital of Copenhagen. Similar standardized protocols for physical examination were used at the baseline and follow-up examinations. Age-related maculopathy lesions were determined by the same grader grading colour fundus photographs from both examinations using a modification of the Wisconsin Age-related Maculopathy Grading System protocol. Of the 359 participants, 94 had incident early ARM and 52 had incident late ARM at follow-up in either eye. In logistic regression, the risk factors for early ARM or worse were as follows: cataract (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.2-6.2); family history of ARM (OR 4.5, 95% CI 1.3--15.5), and alcohol consumption >250 g/week (OR 4.6, 95% CI 1.1-19.2). High levels of apolipoprotein B (>100 mg/l) decreased the risk of development of early ARM or worse (OR 0.4, 95% CI 0.2-0.8), while high levels of apolipoprotein A1 (>or= 150 mg/l) increased the risk of late ARM (OR 2.5, 95% CI 1.2-5.3). Advanced age at baseline was also associated with the incidence of late ARM (OR 2.0, 95% CI 1.4-2.9). These findings indicate a direct correlation between age, cataract, family history, alcohol consumption, the apolipoproteins A1 and B and the 14-year incidence of ARM.

Cataract surgery in patients with age‐related maculopathy: preoperative diagnosis and postoperative visual acuity

To report the reliability in detecting age-related maculopathy (ARM) lesions before cataract surgery and postoperative visual acuity (VA) in cataract surgery patients with ARM. Medical records of surgical patients in a large public hospital, west of Sydney, were reviewed retrospectively. Detection of ARM lesions was compared before and after surgery to determine sensitivity and specificity of preoperative diagnoses. Postoperative VA was assessed 4 weeks after surgery. Data were available for 721/784 eyes (92.0%) of 656 patients aged 60 years or older. ARM lesions were detected in 98 eyes (13.6%) before and 92 eyes (12.8%) after surgery. Sensitivities for detecting late ARM lesions, soft drusen and retinal pigment epithelium abnormalities preoperatively were 100%, 94% and 69%, respectively. Corresponding specificities were 100%, 100% and 77%, respectively. Postoperative VA achieved or remained 6/12 or better in 81.6% of eyes. A high sensitivity and specificity in detecting late ARM lesions and soft drusen preoperatively, and a good postoperative VA outcome is achievable in patients with preoperative early ARM lesions.

Esterified and unesterified cholesterol in drusen and basal deposits of eyes with age-related maculopathy

To address the potential for an outer segment (OS) contribution to the sub-retinal pigment epithelium (RPE) lesions of age-related maculopathy (ARM), we quantified esterified and unesterified cholesterol (EC, UC) with the sterol-specific fluorescent probe filipin in cryosections of ARM eyes. Twenty six eyes from 20 donors were preserved <5 hr after death in 4% paraformaldehyde ( n=16) or 2.5% glutaraldehyde/1% paraformaldehyde ( n=10). Eyes had exudative late ARM ( n=6), geographic atrophy ( n=15), and drusen ≥125 μm ( n=11). Sections were stained with filipin for UC or were extracted and hydrolysed with cholesterol esterase before filipin staining for EC. Drusen varied in cholesterol content, with a rough correlation between EC and UC. Dome-shaped drusen contained distinctive, loosely packed UC-rich loops. In basal deposits, EC and UC were more prominent near Bruch's membrane than near the RPE. A UC-rich material was localized within the subretinal space ( n=4). Maximum filipin fluorescence due to UC was quantified in 47 lesions (19 drusen, 24 basal deposits, and 4 sub-retinal) from 12 ARM eyes and compared to OS and inner plexiform layer (IPL) of uninvolved retina in the same sections. Relative to IPL, UC fluorescence was higher in lesions (mean± s. d: 1.63±0.69) and lower in OS (0.64±0.18). If only the packing of membranes explained fluorescence intensity, then one would expect much higher intensities in membrane-rich OS than in lesions. Because the converse is true, the membranous material in lesions must be more highly enriched in cholesterol on a per unit area basis. UC in sub-RPE deposits cannot be derived directly from OS without considerable intracellular processing within RPE, additional cholesterol sources, or both.

Frailty and Age-related Macular Degeneration: The Beaver Dam Eye Study

To investigate the associations of measures of frailty to prevalent age-related maculopathy (ARM). Cross-sectional population-based study. Time to walk a measured course (gait-time), handgrip strength, peak expiratory flow rate, ability to stand from a sitting position without using arms, self-reported co-morbidities, and ARM were assessed at the third examination of the Beaver Dam Eye Study (n = 2,962). ARM was determined by grading stereoscopic color fundus photographs. While controlling for age, smoking, and the number of co-morbid conditions, weaker handgrip strength was associated with early ARM (odds ratio [OR]/10 kg decrease 1.28, confidence interval [CI] 1.08, 1.52, P = .004) and late ARM (OR 1.55, 95% CI 1.02, 2.36) in men but not women. Other measures of frailty were not related to ARM. A weak cross-sectional association of handgrip strength with ARM (in men) was found after controlling for co-morbid conditions. These data suggest that ARM is due to a specific disease process, albeit age-related, rather than to biologic aging, as reflected by measures of frailty.

The 5-Year Incidence and Risk Factors for Age-Related Maculopathy in a General Japanese Population: The Hisayama Study

To estimate the 5-year incidence and risk factors for age-related maculopathy (ARM) in a representative older Japanese population. A population-based cohort study was conducted in 1998 on 1482 Hisayama residents aged 50 years or older, and 961 of these subjects attended the 5-year follow-up examinations in 2003. At both time points, the characteristics of ARM were determined by grading color fundus photographs according to the Wisconsin Age-Related Maculopathy Grading System. Using these cohort data, logistic regression analyses were performed to determine the risk factors for ARM. Nine possible risk factors were examined: age, sex, hypertension, diabetes, hyperlipidemia, smoking, alcohol intake, body mass index, and white blood cell count. The 5-year incidence of early ARM was 8.5%, and that of late ARM was 0.8%. Men were found to have a significantly higher incidence of late ARM than did women. The incidence of both early and late ARM increased significantly with age. Multiple logistic regression analysis showed that age and smoking were significantly associated with early and late ARM. The results suggest that the overall 5-year incidence of early ARM is 8.0% and that of late ARM is 0.8% in the general Japanese population and that higher age and smoking are relevant risk factors for early and late ARM in the Japanese.

Serum levels of macular carotenoids in relation to age-related maculopathy

It has been hypothesized that the macular carotenoids, lutein and zeaxanthin, may protect against age-related maculopathy. We evaluated the association between blood concentrations of lutein (L) and zeaxanthin (Z) and age-related maculopathy (ARM) in a case-control analysis of the baseline examination of the Muenster Ageing and Retina Study (MARS). Of the 1060 participants aged 59-82 years at baseline, 910 (85.9%) with bilateral gradable fundus photographs and complete data for the carotenoids and potential confounders were included. The Rotterdam classification system was used for definition of ARM stages. Multivariate linear regression methods were applied to model the relationship between macular carotenoids and the presence of ARM. The participants' mean age was 70.9+5.5 years, 59.9% were female, 20.8% had a normal bilateral fundus, and 48.5% showed signs of early ARM (uni- or bilateral) and 30.7% of late ARM (in at least one eye). In study participants with L and/or Z supplementation (15.6%), the median serum levels for L (Z) were approximately 2 times (1.5 times) higher than in subjects with no supplementation. After exclusion of subjects with L and/or Z supplementation, no statistically significant bivariate relationship was observed between the serum levels of L or Z and the presence of ARM. Multivariate regression models, adjusting for age, gender, smoking, body-mass index, and HDL-cholesterol blood levels, produced adjusted mean serum levels of 0.124, 0.112, and 0.131 microg/ml for L and 0.019, 0.020, and 0.022 microg/ml for Z in subjects with normal fundus, early ARM, and late ARM, respectively. In this large study, the serum concentrations of L and Z were not related to the prevalence of ARM. However, the large proportion of study participants taking L and/or Z supplementation may have affected these results.

Fourteen‐year incidence of age‐related maculopathy and cause‐specific prevalence of visual impairment and blindness in a Caucasian population: the Copenhagen City Eye Study

AbstractThe purpose of this PhD thesis was to analyse: (1) the prevalence and causes of visual impairment and blindness among adult Danes (papers I–III); (2) the 14‐year incidence of age‐related maculopathy (ARM) (paper IV); (3) the 14‐year incidence of visual loss with special attention to ARM (paper IV); (4) the risk factors for development of ARM (papers IV and V); and (5) the association between ARM and survival (paper VI). The studies were based on data from the Copenhagen City Heart Study (CCHS), the baseline eye study conducted by Troels Vinding MD, and the follow‐up eye study conducted by Helena Buch MD. The CCHS is a population‐based cohort study that included initially a random population sample of almost 20 000 people. This cohort includes the basis population of the Copenhagen City Eye Study, which includes two subsamples: (1) 1000 individuals between the ages of 60–80 years from the second CCHS population who were studied twice with a mean time interval of 14.5 years (range, 12.6–16.1 years) to determine the prevalence (papers I and II) and incidence rates (papers IV–VI) among elderly Danes, based on standardized clinical and grading procedures; and (2) 9980 individuals aged 20–84 years from the third CCHS population who were studied to determine cause‐specific prevalence rates of visual loss with a wide age range based on a validated questionnaire‐response method (paper III).(1) The prevalence of visual loss rose significantly with age. Using the national criteria, the age‐standardized prevalence rates of visual impairment and blindness for people aged 20–64 years were 0.21% and 0.10%, respectively. However, for people aged 65–80 years the age‐standardized prevalence rates of visual impairment and blindness were 3.89% and 1.14%, respectively. The distributions of the causes of visual loss varied by age. The most important contributors to poor vision occurring before the age of 65 years were optic neuropathy, diabetic retinopathy, retinitis pigmentosa, excessive myopia and other retinal diseases. After the age of 64 years, late ARM and cataract were the primary causes of the age‐related increase in the prevalence of visual loss. Late ARM was the major cause of prevalent blindness. The potential impact of therapeutic intervention is great; when the causes of visual impairment and blindness were grouped for Danish people aged 20–84 years, 29% had the potential for improved vision via surgical intervention, and 15% had potentially preventable eye diseases.(2) The cumulative 14‐year incidence of early and late ARM in either eye was 37.8% and 16.9%, respectively. The cumulative incidence of exudative ARM in either eye was 12.0% and that of pure geographic atrophy was 4.9%, and the rates increased with age (P &lt; 0.01).(3) The cumulative 14‐year incidences of visual impairment or legal blindness in the better eye were 16.7% and 5.1%, respectively, and those of visual impairment or legal blindness from late ARM were 6.0% and 3.4%, respectively. Late ARM, the leading cause, resulted in 66.7% of all incident blindness.(4) Our findings indicate that severe drusen type, large drusen and pigmentary abnormalities were predictors for progression to late ARM and associated visual loss. Additionally, a direct correlation was found between age, cataract, family history, alcohol consumption and the apolipoproteins A1 and B and the 14‐year incidence of ARM.(5) Finally, the association between ARM and survival was analysed, because 60.9% of the participants of the baseline study had died. When adjusting for survival‐related factors, ARM was statistically significant, associated with 59% increased mortality in women but not in men.These data may mirror the actual occurrence of vision loss and ARM in the Danish population, and hopefully they may assist health‐care planners prepare for the future eye‐care needs of the general population.

14-Year Incidence, Progression, and Visual Morbidity of Age-Related Maculopathy: The Copenhagen City Eye Study

To describe the 14-year incidence of age-related maculopathy (ARM) lesions and the related visual loss. Population-based cohort study. Nine hundred forty-six residents (age range, 60-80 years) of Copenhagen participated in the study from 1986 through 1988. Excluding participants who had died since baseline, 359 persons (97.3% of survivors) were reexamined from 2000 through 2002. Participants underwent extensive ophthalmologic examinations. Age-related maculopathy lesions were determined by grading color fundus photographs from the examinations using a modified Wisconsin Age-Related Maculopathy Grading System. Incidence of drusen type and size, pigmentary abnormalities, pure geographic atrophy, exudative ARM, visual impairment, and blindness. The 14-year incidences of early and late ARM were 31.5% and 14.8%, respectively. Individuals 75 to 80 years of age at baseline had significantly (P< or =0.05) higher 14-year incidences of the following lesions than those aged 60 to 64 years: medium or large drusen (> or =125 microm; 34.2% vs. 12.8%, respectively), soft drusen (45.2% vs. 21.4%), pigmentary abnormalities (31.4% vs. 17.0%), pure geographic atrophy (17.4% vs. 1.0%), and exudative ARM (23.3% vs. 5.7%). Severe drusen type, large drusen, and retinal pigmentary abnormalities at baseline were important predictors of incident late ARM. The 14-year incidences of visual impairment (<20/40 but >20/200) or legal blindness from late ARM were 6.0% and 3.4%, respectively. Late ARM caused 35.7% of all visual impairment and 66.7% of all blindness. There is a high incidence of ARM lesions in this elderly white population. Severe drusen type and size or a combination of drusen and pigmentary abnormalities significantly increases the risk of developing late ARM, the most frequent cause of legal blindness in this population.

Pterygium/pinguecula and the five-year incidence of age-related maculopathy

To assess the relationship between baseline pterygium and pinguecula and the five-year incidence of age-related maculopathy (ARM). Population-based longitudinal study. The Blue Mountains Eye Study examined 3654 residents aged 49+ years during 1992 to 1994 and then re-examined 2335 (75.1% of survivors) after five years. Retinal photographs were graded using the Wisconsin Age-Related Maculopathy Grading System. Slit-lamp examination recorded pterygium and pinguecula. Eye-specific data were analyzed using generalized estimating equation models. After adjusting for age, gender, and smoking, eyes with pterygium or previous pterygium surgery had a higher risk of incident late ARM, odds ratio (OR) 3.3, 95% confidence interval (CI) 1.1 to 10.3, early ARM (OR 1.8, CI 1.1 to 2.9) and soft drusen (OR 2.0, CI 1.9 to 3.4), than eyes without pterygium. We found no association between pinguecula and incident ARM. This study found that pterygium was associated with a two- to threefold increased risk of incident late and early ARM.

Age-related maculopathy: A risk indicator for poorer survival in women: The Copenhagen City Eye Study

To examine patient survival in age-related maculopathy in a 14-year follow-up study. Population-based 14-year cohort study. Nine hundred forty-six residents, aged 60 to 80 years, living in the Osterbro district of Copenhagen, Denmark, participated in the first examination conducted from 1986 to 1988. These participants were followed until death or until May 1, 2002, whichever came first. Participants underwent an extensive ophthalmologic examination at Rigshospitalet, the National University Hospital of Copenhagen. Standardized protocols for physical examination, blood samples, and data from the National Central Person Register, the National Death Register, and the National Patient Register were used. Mortality and age-related maculopathy. By May 1, 2002, 60.9% (577 of 946) of the participants of the baseline study cohort had died. The adjusted 14-year cumulative mortality hazard ratio for subjects with early and late age-related maculopathy at baseline was 1.26 (95% confidence interval [CI], 1.06-1.51). We identified a strong correlation between mortality and age-related maculopathy among women (relative risk, 1.59; 95% CI, 1.23-2.07) but not among men. When adjusting for survival-related factors, age-related maculopathy is a significant risk indicator for poorer survival in women and may be a marker of underlying serious systemic factors or aging processes specific to women.