14-Year Incidence, Progression, and Visual Morbidity of Age-Related Maculopathy The Copenhagen City Eye Study Helena Buch, MD, 1 Niels V. Nielsen, MD, DMSc, 1 Troels Vinding, MD, DMSc, 1 Gorm B. Jensen, MD, DMSc, 3,4 Jan U. Prause, MD, DMSc, 1 Morten la Cour, MD, DMSc 2 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 m; 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 develop- ing late ARM, the most frequent cause of legal blindness in this population. Ophthalmology 2005;112:787–798 © 2005 by the American Academy of Ophthalmology. In the industrialized world, it is well recognized that the lead- ing cause of blindness in elderly white persons is age-related maculopathy (ARM). 1–5 Globally, the number of elderly indi- viduals is increasing, and consequently, low vision resulting from ARM is expected to develop more frequently and to contribute to loss of independence in old age. Despite this, information on the natural history and consequences of this disease is sparse. Most studies derive their information from case series of patients with ARM, 6 –16 clinical trials, 6,7,17 or clinicopathologic studies. 18 –23 The incidence of ARM has been reported previously in 6 population-based studies from 3 continents that used similar highly standardized procedures. In Europe, the 2-year, 24 6.5-year, 25 and 7-year 26 incidences of age-related macular disease have been described. Two Australian population- based studies have reported on the 5-year 27,28 incidence, Originally received: June 14, 2004. Accepted: November 17, 2004. Manuscript no. 240452. 1 Department of Ophthalmology, National University Hospital (Rigshos- pitalet), Copenhagen, Denmark. 2 Department of Ophthalmology, Herlev Hospital, University of Copenha- gen, Herlev, Denmark. 3 The Copenhagen City Heart Study, Epidemiological Research Unit, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark. 4 Department of Cardiology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark. Poster presented at: Association for Research in Vision and Ophthalmology Congress, April 27, 2004; Fort Lauderdale, Florida. 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. Correspondence and reprint requests to Helena Buch, MD, Department of Ophthalmology, National University Hospital (Rigshospitalet), Blegdamsvej 9, DK-2100 Copenhagen, Denmark. E-mail: hbh@dadlnet.dk. 787 © 2005 by the American Academy of Ophthalmology ISSN 0161-6420/05/$–see front matter Published by Elsevier Inc. doi:10.1016/j.ophtha.2004.11.040