AGE-RELATED MACULAR DISEASE IN RURAL SOUTHERN ITALY

Objective: To report the prevalence of age-related maculopathy (ARM) i n Salandra, a small, isolated southern Italian community, to test the hypothesis that an environmental factor, scarce in such a remote commu nity but ubiquitous in modern industrial societies, might modify the r isk of developing ARM. Design: Population-based cross-sectional survey . Main Outcome Measures: Prevalence of advanced age-related macular de generation (ARMD) (geographic atrophy or exudative maculopathy) and AR M (large, soft drusen or retinal pigment epithelium changes, or both) defined by fundus biomicroscopy and 30 degrees stereoscopic macular ph otography. Self-sustenance was assessed by interview of participants a nd local shop retailers. The degree of genetic isolation was computed using a model that fits the genetic population structure with the freq uency distribution of surnames in the community. Results: A full ophth almic examination was undertaken in 366 (63.5%) of 576 eligible partic ipants, 354 (96.7%) of whom had clinical or photographic assessment fo r the presence of ARMD and 310 (84.6%) of whom had drusen characterist ics graded on color transparencies for ARM. The overall prevalence of ARMD was 1.1%. Drusen larger than 50 mu m and more numerous than 10 we re found in 4.5% of subjects. Salandra was the birthplace of 87.2% of participants and for 77.3% of bo th parents of each subject. People in the community tended to consume homegrown products. Conclusion: The p revalence of ARM may be lower in this self-sustained farming community than elsewhere in the industrialized world.