Four-year incidence of macular changes in the Barbados Eye Studies

Objective To describe longitudinal macular changes in a black population after 4 years of follow-up. Design Population-based incidence study. Setting and participants The Barbados Incidence Study of Eye Diseases (BISED) reexamined the Barbados Eye Study cohort, which was based on a random sample of the country's residents, 40 to 84 years. The BISED included 3427 persons, or 85% of the eligible cohort. Main outcome measures Four-year incidence of macular changes, as determined by gradings of color stereoscopic macular photographs. Results Among black participants, the overall 4-year incidence of early macular changes (medium or large drusen or >20 small drusen with retinal pigment epithelium [RPE] atrophy or pigment) was 5.2% (95% confidence interval, 4.0%-6.6%) and tended to be higher in women (5.8%) than in men (4.1%). Incidence of related features was 5.2% for medium drusen (64-250 μm), 0.3% for drusen >250 μm, 1.1% for confluence, 0.5% for pigment, and 0.1% for RPE atrophy. Of the 2362 persons at risk for late macular changes (geographic atrophy, fluid, lipid, hemorrhage, disciform scar), exudative features developed in only 1 person in 4 years. Less than 1% of persons with early macular changes at baseline had disappearance of related features. Conclusions After 4 years, the development of severe macular disease was rare in this black population, and the incidence of early macular changes also was lower than in other populations. Results are consistent with the low risk of macular degeneration in persons of African descent.