Age-related macular degeneration is the number one cause of irreversible blindness in the United States and is more prevalent in older, Caucasian women. Although there have been several studies on the incidence of ARM, none of these studies has been able to provide accurate estimates on the incidence of late ARM and/or the progression of ARM in the oldest old, those individuals over 80 years of age, because of the limited sample sizes in these studies in this age group. The population in the Study of Osteoporotic Fractures (SOF) is an appropriate cohort in which to evaluate the incidence of late ARM and the progression of ARM, because the mean age of the women at the re-examination will be 84.4 years of age and the sample is mainly Caucasian. The proposed research study aims to determine the incidence of late ARM, the rate of progression of ARM, and the association of specific risk factors such as diabetes mellitus and prior cataract surgery with late ARM and the progression of ARM in elderly women. In addition, it aims to determine the trajectory of visual decline in older women over a 14- year period. Secondarily, it aims to determine the impact of late ARM on vision-targeted health-related quality of life and to determine whether or not an association exists between the progression of ARM and the risk of falling and hip/non-spine fractures. In 1997 to 1998 (Visit 6), 5482 women had an eye examination that consisted of a medical and ocular history, nine questions from the National Eye Institute Visual Function Questionnaire (NEI-VFQ), and measurements of visual acuity, contrast sensitivity, peripheral vision with automated perimetry, intraocular pressure, and uncorrected refractive error. These women also had a refraction and imaging of their lenses and fundi of both eyes through dilated pupils. Approximately 4.5% of these women have photographically validated late ARM, 41.5% have early ARM, and 54% have no ARM or hard drusen only. In the proposed re-examination, we will update their medical and ocular history and ask them the nine questions from the NEIVFQ. In addition, visual acuity and contrast sensitivity will be re-measured. Fundus photographs of both eyes through dilated pupils will be obtained. These photographs and the relevant photographs from 1997 to 1998 will be graded for ARM with the Wisconsin Age-Related Maculopathy Grading System (WARMGS) in a masked fashion so that the readers do not know which film is from which visit. The University of Wisconsin will also grade the fundus photographs on 30% of the eyes with ARM and 10% of the total sample. This will allow the identification of women in SOF who have had progression of their ARM and developed late ARM since 1997 and 1998.
