The prevalence of age-related maculopathy: the Visual Impairment Project

Abstract

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.