7-YEAR FOLLOW-UP OF AGE-RELATED MACULOPATHY IN AN ELDERLY BRITISH POPULATION

Despite age-related macular degeneration (AMD) being the commonest cau se of blindness amongst the elderly in Western society, the incidence of new lesions is poorly documented and the natural history of existin g disease remains ill understood, Purpose: To document in an elderly p opulation the incidence of new AMD lesions and the progression of pre- existing AMD over time. Method: Baseline ophthalmic examinations were performed on a geographically defined random population sample of elde rly people in 1982-4, and retinal photographs taken, The present study re-examined and re-photographed survivors after approximately 7 years using the same fundus camera. Photographs were randomly encoded, and independently graded for AMD features by two masked observers using th e Wisconsin AMD grading system, Disagreements were resolved by review to reach a consensus. Results: Eighty-two of the 88 participating surv ivors had photographs of gradable quality on both occasions in at leas t one eye. Mean age at follow-up was 87 years (range 84-97 years) and 70.7% of subjects were female. Paired photographs were available on 15 8 eyes, and showed important differences in drusen type, drusen area a nd characteristics of the retinal pigment epithelium (RPE) between ini tial and subsequent examinations. The 7 year incidence (and regression ) of lesions was: drusen 30.6% (20.0%), RPE degeneration 54.5% (8.8%), increased pigment 11.6% (64.7%), subretinal haemorrhage 1.3%, subreti nal scar/fibrin 1.3% and geographic study 1.3%. Conclusion: These uniq ue population-based results provide new insight into the natural histo ry of AMD in an elderly population.