Five-year incidence and disappearance of drusen and retinal pigment epithelial abnormalities. Waterman study
N. M. Bressler, B. Munoz, M. G. Maguire, S. E. Vitale, O. D. Schein, H. R. Taylor and S. K. West
Retinal Vascular Center, Wilmer Ophthalmological Institute, Johns Hopkins University School of Medicine and Hospital, Baltimore, Md.
PURPOSE: To obtain 5-year longitudinal data on age-related macular
degeneration (AMD) that might be useful for disease prognosis, public
health planning, and clinical trial development. PATIENTS AND METHODS:
Baseline (1985) and 5-year follow-up (1990) fundus photographs of 483
watermen over 30 years of age who participated in a cohort study conducted
on the eastern shore of Maryland were graded independently in a reliable,
standardized fashion. Eyes in which AMD appeared or disappeared also were
graded in a side-by-side fashion. RESULTS: Development of definite
choroidal neovascularization and/or disciform scarring occurred in one of
50 participants over 70 years of age, specifically one of 15 participants
over 70 years of age with AMD-3 (defined as large or confluent drusen focal
hyperpigmentation of the retinal pigment epithelium [RPE], and/or
nongeographic atrophy of the RPE). Appearance of large drusen, focal
hyperpigmentation, or AMD-3 was age related, occurring in 5%, 1%, and 7%,
respectively, of participants aged 50 to 59 years; 17%, 3%, and 14%,
respectively, of participants aged 60 to 69 years; and 17%, 9%, and 26%,
respectively, of participants aged 70 years or more. Disappearance of large
drusen, hyperpigmentation, or AMD-3 occurred in 16 (34%) of 47
participants, 11 (58%) of 19 participants, and 17 (28%) of 61 participants,
respectively, who had each feature photographically present in 1985. Among
the 47 eyes identified in which AMD-3 developed by independent gradings, 38
cases of AMD-3 (81%) were confirmed on side-by-side grading. Among the 16
eyes identified as having AMD-3 that disappeared, nine disappearances (56%)
were confirmed. Borderline differences in appearance of pigment, drusen
size, drusen location, or photographic quality may have accounted for
disappearance in seven cases (44%). CONCLUSIONS: Prospective studies on the
nonneovascular features of AMD (including large drusen and abnormalities of
the RPE) must account for the appearance and disappearance of these
features and support the idea that side-by-side gradings can complement
independent gradings identifying appearance or disappearance of features of
AMD.
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