Elsevier

Ophthalmology

Volume 112, Issue 5, May 2005, Pages 787-798
Ophthalmology

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

Poster presented at: Association for Research in Vision and Ophthalmology Congress, April 27, 2004; Fort Lauderdale, Florida.
https://doi.org/10.1016/j.ophtha.2004.11.040Get rights and content

Purpose

To describe the 14-year incidence of age-related maculopathy (ARM) lesions and the related visual loss.

Design

Population-based cohort study.

Participants

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.

Methods

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.

Main Outcome Measures

Incidence of drusen type and size, pigmentary abnormalities, pure geographic atrophy, exudative ARM, visual impairment, and blindness.

Results

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≤0.05) higher 14-year incidences of the following lesions than those aged 60 to 64 years: medium or large drusen (≥125 μm; 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.

Conclusions

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.

Section snippets

Population

The study was approved by the Ethical Committee of Copenhagen, and informed consent was obtained from all participants. The Copenhagen City Eye Study is a population-based survey of vision and common eye diseases in a representative urban elderly population residing in the Copenhagen metropolitan area. The study population is an age-stratified and gender-stratified, random subsample of 1000 persons aged 60 to 80 years from the Copenhagen City Heart Study population that comprised a random

Statistical Analysis

The Statistical Analysis System40 was used for tabulations and most statistical analyses. Additionally, Stata software41 was used to calculate 1-step agreement (%), weighted κ estimates, and related standard errors.

The interobserver and intraobserver estimates were obtained by a 3-level comparison of ARM. The percentages of agreement, exact and within 1 step, were calculated, and unweighted and weighted κ scores were computed.42 Weights assigned were 1.0 for full agreement, 0.75 for

Inclusion and Exclusion of Participants Based on Fundus Photograph Gradability

To evaluate changes in lesions between visits, retinal photographs were necessary from corresponding eyes at both visits. Of the 359 subjects who participated in the baseline and follow-up studies, 330 had gradable photographs of 1 or both eyes at baseline (319 for both eyes, 11 for 1 eye). Of these, 327 subjects had gradable photographs at the follow-up visit (313 for both eyes, 14 for 1 eye).

Photographs of 82 eyes of 50 persons were unavailable. Of these, 66 eyes of 39 subjects lacked

Participants

The mean and median times between the baseline and the 14-year follow-up examinations were 14.5 years and 14.7 years, respectively. Of the 946 participants in the baseline examination, 577 died before the follow-up examination. Of the surviving 369 persons, 359 participated in the follow-up examination and 10 persons declined to participate. Of those examined at both visits, 87.2% (313/359) were included in the analyses with at least 1 eye gradable at both examinations (288 bilateral, 25

Discussion

No previous study has reported on a population this old with as long a follow-up period and low rates of declined participation. We used a standardized objective system for grading color fundus photographs for ARM.37, 38 Photos from the baseline and the follow-up examination were graded in a masked and randomized fashion by a single grader (HB). The mean period of time between gradings of photos of each participant was 20.3 days (SD, ±30.9 days). This makes bias an unlikely result of the same

Acknowledgments

The authors thank senior grader Maria Swift for her assistance in WARMGS manual training and reproducibility grading, and Dr Ronald Klein and Stacy Meuer for providing valuable advice, all individuals affiliated with the Ocular Epidemiology Reading Center as part of the Department of Ophthalmology and Visual Sciences at the University of Wisconsin. The authors also thank Henrik Scharling for providing extensive data handling and statistical assistance and The Copenhagen City Heart Study Group

References (58)

  • R. Klein et al.

    Changes in visual acuity in a population over a 10-year periodthe Beaver Dam Eye Study

    Ophthalmology

    (2001)
  • R. Klein et al.

    The Wisconsin Age-Related Maculopathy Grading System

    Ophthalmology

    (1991)
  • R. Varma et al.

    Prevalence of age-related macular degeneration in Latinosthe Los Angeles Latino Eye Study

    Ophthalmology

    (2004)
  • R. Klein et al.

    Changes in visual acuity in a populationthe Beaver Dam Eye Study

    Ophthalmology

    (1996)
  • R. Klein et al.

    Prevalence of age-related maculopathy. The Beaver Dam Eye Study

    Ophthalmology

    (1992)
  • M.R. VanNewkirk et al.

    The prevalence of age-related maculopathythe Visual Impairment Project

    Ophthalmology

    (2000)
  • J.J. Wang et al.

    Bilateral involvement by age related maculopathy lesions in a population

    Br J Ophthalmol

    (1998)
  • K. Attebo et al.

    Visual acuity and the causes of visual loss in Australia. The Blue Mountains Eye Study

    Ophthalmology

    (1996)
  • S. Foran et al.

    Five-year change in visual acuity and incidence of visual impairment. The Blue Mountains Eye Study

    Ophthalmology

    (2003)
  • W. Smith et al.

    Risk factors for age-related macular degenerationpooled findings from three continents

    Ophthalmology

    (2001)
  • S.C. Tomany et al.

    Risk factors for incident age-related macular degeneration. Pooled findings from 3 continents

    Ophthalmology

    (2004)
  • H. Buch et al.

    The prevalence and causes of bilateral and unilateral blindness in an elderly urban Danish population. The Copenhagen City Eye Study

    Acta Ophthalmol Scand

    (2001)
  • R. Klein et al.

    The relationship of age-related maculopathy, cataract, and glaucoma to visual acuity

    Invest Ophthalmol Vis Sci

    (1995)
  • M. la Cour et al.

    Age-related macular degenerationepidemiology and optimal treatment

    Drugs Aging

    (2002)
  • The Framingham Eye Study monographan ophthalmological and epidemiological study of cataract, glaucoma, diabetic retinopathy, macular degeneration, and visual acuity in a general population of 2631 adults, 1973–1975

    Surv Ophthalmol

    (1980)
  • J.M. Tielsch
  • Five-year follow-up of fellow eyes of patients with age-related macular degeneration and unilateral extrafoveal choroidal neovascularization

    Arch Ophthalmol

    (1993)
  • Risk factors for choroidal neovascularization in the second eye of patients with juxtafoveal or subfoveal choroidal neovascularization secondary to age-related macular degeneration

    Arch Ophthalmol

    (1997)
  • O. Baun et al.

    Natural course in fellow eyes of patients with unilateral age-related exudative maculopathy. A fluorescein angiographic 4-year follow-up of 45 patients

    Acta Ophthalmol (Copenh)

    (1993)
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    Manuscript no. 240452.

    Supported by the Carl and Nicoline Larsens Foundation, Copenhagen, Denmark; The Danish Eye Research Foundation, Copenhagen, Denmark; and the Danish Velux Foundation of 1981, Copenhagen, Denmark.

    The authors have no financial or commercial interests in the subject matter or materials mentioned herein.

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