Soft Indistinct Drusen Research Articles

The prevalence of age-related maculopathy: The visual impairment project

Purpose To determine the prevalence of age-related maculopathy (ARM) lesions in residents of the state of Victoria, Australia. Design Population-based cross-sectional study. Participants Total of 5147 residential and institutionalized persons aged 40 years and older, living in Victoria. Methods Participants were recruited through a cluster, stratified, random sampling from nine urban clusters and four rural clusters. The presence of ARM lesions was graded from color stereo fundus photographs as well as slit-lamp stereo biomicroscopy according to the International Classification and Grading System. Main outcome measures The presence of ARM lesions. Results The mean age of participants was 60.2 years, and 55% were females. Gradable fundus photographs were available for at least one eye in 4345 (92%) of the participants. The weighted prevalence of neovascular age-related macular degeneration (AMD) was 0.39% (95% confidence limits [CL] = 0.20, 0.58), atrophic AMD was 0.27% (95% CL = 0.04, 0.50), and total AMD was 0.68% (95% CL = 0.30, 1.1). Prevalence of AMD was strongly related to age ( P < 0.001). Prevalence of early ARM was 15.1% (95% CL = 13.7, 16.4). Large drusen, 125 μm or more, were present in 6.3% of the participants. There was a higher prevalence of soft distinct drusen (7.5%) than soft indistinct drusen (4.3%). Retinal pigmentary abnormalities were present in 8.2% (95% CL = 7.2, 9.2). The prevalence of large drusen, soft drusen, and pigmentary abnormalities increased with age ( P < 0.001). Prevalence of retinal pigmentary abnormalities increased with increasing drusen size ( P < 0.001). Soft indistinct drusen were more common in women aged 70 years or older ( P < 0.001). Bilaterality of any ARM was strongly age related, and women appeared to have a higher risk of both bilateral early ARM and AMD. Conclusions These data provide age- and gender-specific prevalence of ARM and its component lesions in an ethnically diverse Australian population. Early ARM and AMD prevalence rates increased sharply from ages 70 and 80 years, respectively, in all ethnic groups. These higher rates will continue to increase the importance of AMD as our population ages.

Early drusen formation in the normal and aging eye and their relation to age related maculopathy: a clinicopathological study

AIMTo describe the early formation of drusen and their relation to normal aging changes at the macula and to the development of age related maculopathy (ARM).METHODHistopathological features of 353 eyes...

The VECAT Study: Methodology and statistical power for measurement of age-related macular features

PURPOSES: (1) To develop the methodology for the grading of macular one-frame stereoslides and to assess the reliability of the system. (2) To determine the prevalence of soft drusen (> 63 µm) and pigment abnormalities synonymous with age-related maculopathy (ARM) at baseline, in a clinical trial of volunteers aged between 55 and 80 years of age. (3) To ascertain the power of the study to detect the 4-year incidence and progression of ARM in vitamin E versus placebo treated participants, given the baseline prevalence. METHODS: The 1204 participants enrolled in the Vitamin E, Cataract, and Age-related Maculopathy Study (VECAT) had colour stereoslides of their fundus taken using the Nidek 3-DX mydriatic fundus camera. The stereoslides were graded by two masked graders according to the "International Classification System for ARM and AMD". Assessment of inter- and intra-observer reliability was carried out on a regular basis on 15% of randomly selected slides. Anticipated rates of incidence and progression were based on results reported by the Beaver Dam Eye Study and the Chesapeake Bay Waterman Study. Power estimations were determined using the "nQuery Advisor" software program. Analyses were carried out on the worse affected eye. RESULTS: Inter-observer reliability was moderate to substantial (Kappa 0.5-0.88) whilst intra-observer agreement was high (0.6-1.0). The prevalence of any soft drusen was 32%. Significant associations were found between soft large indistinct drusen, hypopigmentation, hyperpigmentation and age (p = 0.0001, 0.024 and 0.0001, respectively). The study has at least 87% power to detect an odds ratio equal to two for the progression of soft distinct, soft indistinct, hyperpigmentation and hypopigmentation. CONCLUSIONS: The VECAT study methodology appears to be highly reliable and to have sufficient power to detect the differences in the four-year progression of soft distinct and indistinct drusen and pigment abnormalities between the treatment groups.

Alcohol consumption and the 5-year incidence of age-related maculopathy: The beaver dam eye study

Objective This study evaluated alcohol consumption as a risk factor for incidence of age-related maculopathy (ARM). Design Persons aged 43 to 86 years in 1988 in Beaver Dam, Wisconsin, were examined from 1988 through 1990 and 1993 through 1995, n = 3684. The presence and severity of ARM at both examinations were determined from gradings of stereoscopic fundus photographs using the Wisconsin Age-related Maculopathy Classification System. Alcohol consumption was determined by self-report. Results Men drinking at least 78 g/week of alcohol from beer had a higher 5-year age-adjusted incidence of early ARM (10.6%) than did men who did not drink beer (6.9%), but the test for trend was only borderline significant ( P = 0.08). However, incidence of soft indistinct drusen ( P = 0.01), increased drusen area ( P < 0.01), and confluent drusen ( P = 0.02) are all associated with beer drinking in men. Increased retinal pigment and retinal pigment epithelial depigmentation are not associated with beer drinking in men or women nor are any lesions associated with total alcohol consumption or consumption from liquor or wine in either men or women. Conclusions Except for an association of beer drinking with retinal drusen in men, consumption of alcoholic beverages is not likely to be an important risk factor for incidence of ARM.

The Five-year Incidence and Progression of Age-related Maculopathy: The Beaver Dam Eye Study

The aim of the study was to describe the incidence and progression of retinal drusen, retinal pigmentary abnormalities, and signs of late age-related maculopathy. A population of 3583 adults (range, 43-86 years of age at baseline) living in Beaver Dam, Wisconsin, was studied during a 5-year period. Characteristics of drusen and other lesions typical of age-related maculopathy were determined by grading stereoscopic color fundus photographs using the Wisconsin Age-Related Maculopathy Grading System. There was a statistically significant increased incidence of age-related maculopathy lesions with age (P < 0.05). Individuals 75 years of age or older had a significantly (P < 0.01) higher 5-year incidence of the following characteristics than people 43 to 54 years of age: larger sized drusen (125-249 microm, 17.6% vs. 2.1%; > or = 250 microm, 6.5% vs. 0.2%), soft indistinct drusen (16.3% vs. 1.8%), retinal pigment abnormalities (12.9% vs. 0.9%), exudative macular degeneration (1.8% vs. 0%), and pure geographic atrophy (1.7% vs. 0%). After adjusting for age, the incidence of early age-related maculopathy was 2.2 times (95% confidence interval 1.6, 3.2) as likely in women 75 years of age or older compared with men this age. At follow-up, late age-related macular degeneration was more likely to develop in eyes with soft indistinct drusen (6.5% vs. 0.1%) or retinal pigmentary abnormalities (7.1% vs. 0.1%) at baseline than in eyes without these lesions. These population-based estimates document the high incidence of signs of age-related maculopathy in people 75 years of age or older, and in women compared with men that age. The findings demonstrate that the presence of soft drusen and pigmentary abnormalities significantly increases the risk for the development of geographic atrophy and exudative macular degeneration.

Sunlight and Age-Related Macular Degeneration

To investigate the relationship of sunlight exposure with age-related maculopathy. This was investigated in the population-based Beaver Dam Eye Study. In this cross-sectional population-based study, questionnaire data about sunlight exposure were obtained. Stereoscopic color fundus photographs were graded to determine the presence of age-related maculopathy. People aged 43 through 84 years who resided in Beaver Dam, Wis, between 1987 and 1988 were examined between 1988 and 1990. Light exposure was not associated with early age-related maculopathy in women. In men, after adjusting for age, the amount of time spent outdoors in summer was associated with increased retinal pigment (odds ratio [OR], 1.44; 95% confidence interval [CI], 1.01 to 2.04). Wearing eyeglasses was inversely associated with increased retinal pigment (OR, 0.75; 95% CI, 0.58 to 0.97), and the use of hats and sunglasses was inversely associated with soft indistinct drusen (OR, 0.61; 95% CI, 0.38 to 0.98). The amount of leisure time spent outdoors in summer was significantly associated with exudative macular degeneration (OR, 2.26; 95% CI, 1.06 to 4.81) and late maculopathy (OR, 2.19; 95% CI, 1.12 to 4.25). There were no associations between estimated ambient UV-B exposure and age-related maculopathy. These data suggest that exposure to sunlight may be associated with age-related maculopathy. However, longitudinal studies of these associations are needed.

Prevalence of Age-related Maculopathy: The Beaver Dam Eye Study

The relationships of retinal drusen, retinal pigmentary abnormalities, and macular degeneration to age and sex were studied in 4926 people between the ages of 43 and 86 years who participated in the Beaver Dam Eye Study. The presence and severity of various characteristics of drusen and other lesions typical of age-related maculopathy were determined by grading stereoscopic color fundus photographs using the Wisconsin Age-Related Maculopathy Grading System. One or more drusen were present in the macular area of at least 1 eye in 95.5% of the population. People 75 years of age or older had significantly higher frequencies (P less than 0.01) of the following characteristics than people 43 to 54 years of age: larger sized drusen (greater than or equal to 125 microns, 24.0% versus 1.9%), soft indistinct drusen (23.0% versus 2.1%), retinal pigment abnormalities (26.6% versus 7.3%), exudative macular degeneration (5.2% versus 0.1%), and geographic atrophy (2.0% versus 0%). These data indicate signs of age-related maculopathy are common in people 75 years of age or older and may pose a substantial public health problem.