Prevalence of age-related macular degeneration in a large European cohort: Results from the population-based Gutenberg Health Study

  • Christina A. KorbEmail author
  • Ulrike B. Kottler
  • Christian Wolfram
  • René Hoehn
  • Andreas Schulz
  • Isabella Zwiener
  • Philipp S. Wild
  • Norbert Pfeiffer
  • Alireza Mirshahi
Retinal Disorders



The aim of this study was to describe the sex- and age-specific prevalence of age-related macular degeneration (AMD) and its correlation with urban or rural residence in a large and relatively young European cohort.


We evaluated fundus photographs from participants in the Gutenberg Health Study (GHS), a population-based, prospective, observational, single-centre study in the Rhineland-Palatine region in midwestern Germany. The participants were 35–74 years of age at enrolment. The fundus images were classified as described in the Rotterdam Study and were graded independently by two experienced ophthalmologists (CK and UBK) based on the presence of hard and soft drusen, retinal pigmentary abnormalities, and signs of atrophic or neovascular age-related macular generation (AMD).


Photographs from 4,340 participants were available for grading. Small, hard drusen (<63 μm, stages 0b and 0c) were present in 37.4 % of participants (95 % confidence interval [CI], stage 0b, 31.6 % [30.3–33.7]; stage 0c, 5.8 % [5.1–6.5]). Early AMD (soft drusen, pigmentary abnormalities, stages 1–3) was present in 3.8 % of individuals in the youngest age group (35–44 years) (95 % CI, stage 1a, 0.4 % [0.3–0.5 %]; stage 1b, 3.2 % [2.9–3.5 %]; stage 2a, 0.1 % [0.1–0.2 %]; stage 2b, 0 % [0–0.0 %]; stage 3, 0.1 % [0.1–0.2 %]), whereas late AMD (stages 4a and 4b) did not appear in the youngest age group. In all age groups, signs of early AMD were detected in 11.9 % of individuals (stage 1a, 2.1 % [1.7–2.6]; stage 1b, 8.0 % [7.2–8.8]; stage 2a, 1.0 % [0.7–1.3]; stage 2b, 0.5 % [0.3–0.7]; stage 3, 0.3 % [0.2–0.6]). Late AMD (geographic atrophy or neovascular AMD) was found in 0.2 % of individuals (stage 4a, 0.1 % [0.0–0.2]; stage 4b, 0.1 % [0.0–0.2]). AMD increased significantly with age (odds ratio [OR], 1.09; 95 % CI, 1.08–1.10). Sex, iris colour, and residence (rural vs. urban) were not associated with different rates of AMD.


In this study, the prevalence of AMD increased dramatically with age; however, although AMD is usually thought to occur after age 50, signs of early AMD were found in 3.8 % of individuals in the youngest age group (younger than 45 years). This population-based sample is the first to provide substantial epidemiologic data from a large German cohort, including data on macular degeneration in younger age groups and incidence data after recall.


Age-related macular degeneration Age-related maculopathy Epidemiology Prevalence Population-based study 



Philipp S. Wild is funded by the Federal Ministry of Education and Research (BMBF 01EO1003).

Financial disclosure

The Gutenberg Health Study is funded through the government of Rhineland-Palatine (“Stiftung Rheinland Pfalz für Innovation”, contract number AZ 961-386261/733); the research programs “Wissen schafft Zukunft” and “Schwerpunkt Vaskulaere Praevention” of the University Medical Center Mainz, Germany, and its contract with Boehringer Ingelheim, Germany; and PHILIPS Medical Systems, including an unrestricted grant for the Gutenberg Health Study. The Department of Ophthalmology received a grant from Novartis.

The sponsors and funding organisations did not play any role in the design or conduct of the presented study. All authors have full control of all primary data and they agree to allow Graefe’s Archive for Clinical and Experimental Ophthalmology to review their data if requested.


  1. 1.
    Bourla DH, Young TA (2006) Age-related macular degeneration: a practical approach to a challenging disease. J Am Geriatr Soc 54:1130–1135PubMedCrossRefGoogle Scholar
  2. 2.
    Lim LS, Mitchell P, Seddon JM, Holz FG, Wong TY (2012) Age-related macular degeneration. Lancet 379:1728–1738PubMedCrossRefGoogle Scholar
  3. 3.
    Heijl A, Algvere PV, Alm A, Andersen N, Bauer B, Carlsson JO, Ehinger B, Eide N, Fledelius H, Foerster M, Hjortdal J, Holmstrom G, Hovding G, Kivela T, la Cour M, Lindblom B, Moller-Pedersen T, Nikoskelainen E, Prause JU, Riise R, Rosenberg T, Seregard S, Stefansson E, Tarkkanen A, Tervo T, Tornqvist K, Zetterstrom C (2005) Nordic research in ophthalmology. Acta Ophthalmol Scand 83:278–288PubMedCrossRefGoogle Scholar
  4. 4.
    Klein R, Klein BE, Linton KL (1992) Prevalence of age-related maculopathy. The Beaver Dam Eye Study. Ophthalmology 99:933–943PubMedCrossRefGoogle Scholar
  5. 5.
    Finger RP, Fimmers R, Holz FG, Scholl HP (2011) Prevalence and causes of registered blindness in the largest federal state of Germany. Br J Ophthalmol 95:1061–1067PubMedCrossRefGoogle Scholar
  6. 6.
    Krumpaszky HG, Klauss V (1996) Epidemiology of blindness and eye disease. Ophthalmologica 210:1–84PubMedCrossRefGoogle Scholar
  7. 7.
    Hoehn R, Mirshahi A, Hoffmann EM, Kottler UB, Wild PS, Laubert-Reh D, Pfeiffer N (2013) Distribution of Intraocular Pressure and Its Association with Ocular Features and Cardiovascular Risk Factors: The Gutenberg Health Study. Ophthalmology 120(5):961–968PubMedCrossRefGoogle Scholar
  8. 8.
    Mirshahi A, Ponto KA, Hohn R, Wild PS, Pfeiffer N (2013) Ophthalmological aspects of the Gutenberg Health Study (GHS): An interdisciplinary prospective population-based cohort study. Ophthalmologe 110:210–217PubMedCrossRefGoogle Scholar
  9. 9.
    Wild PS, Zeller T, Beutel M, Blettner M, Dugi KA, Lackner KJ, Pfeiffer N, Munzel T, Blankenberg S (2012) The Gutenberg Health Study. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 55:824–829CrossRefGoogle Scholar
  10. 10.
    Stang A, Ahrens W, Jockel KH (1999) Control response proportions in population-based case–control studies in Germany. Epidemiology 10:181–183PubMedCrossRefGoogle Scholar
  11. 11.
    Bird AC, Bressler NM, Bressler SB, Chisholm IH, Coscas G, Davis MD, de Jong PT, Klaver CC, Klein BE, Klein R et al (1995) An international classification and grading system for age-related maculopathy and age-related macular degeneration. The International ARM Epidemiological Study Group. Surv Ophthalmol 39:367–374PubMedCrossRefGoogle Scholar
  12. 12.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174PubMedCrossRefGoogle Scholar
  13. 13.
    Ferris FL 3rd, Wilkinson CP, Bird A, Chakravarthy U, Chew E, Csaky K, Sadda SR (2013) Clinical classification of age-related macular degeneration. Ophthalmology 120:844–851PubMedCrossRefGoogle Scholar
  14. 14.
    Erke MG, Bertelsen G, Peto T, Sjolie AK, Lindekleiv H, Njolstad I (2012) Prevalence of age-related macular degeneration in elderly Caucasians: the Tromso Eye Study. Ophthalmology 119:1737–1743PubMedCrossRefGoogle Scholar
  15. 15.
    Vingerling JR, Dielemans I, Hofman A, Grobbee DE, Hijmering M, Kramer CF, de Jong PT (1995) The prevalence of age-related maculopathy in the Rotterdam Study. Ophthalmology 102:205–210PubMedCrossRefGoogle Scholar
  16. 16.
    Mitchell P, Smith W, Attebo K, Wang JJ (1995) Prevalence of age-related maculopathy in Australia. The Blue Mountains Eye Study. Ophthalmology 102:1450–1460PubMedCrossRefGoogle Scholar
  17. 17.
    Augood CA, Vingerling JR, de Jong PT, Chakravarthy U, Seland J, Soubrane G, Tomazzoli L, Topouzis F, Bentham G, Rahu M, Vioque J, Young IS, Fletcher AE (2006) Prevalence of age-related maculopathy in older Europeans: the European Eye Study (EUREYE). Arch Ophthalmol 124:529–535PubMedCrossRefGoogle Scholar
  18. 18.
    Klein R, Klein BE, Tomany SC, Moss SE (2002) Ten-year incidence of age-related maculopathy and smoking and drinking: the Beaver Dam Eye Study. Am J Epidemiol 156:589–598PubMedCrossRefGoogle Scholar
  19. 19.
    Klaver CC, Wolfs RC, Vingerling JR, Hofman A, de Jong PT (1998) Age-specific prevalence and causes of blindness and visual impairment in an older population: the Rotterdam Study. Arch Ophthalmol 116:653–658PubMedCrossRefGoogle Scholar
  20. 20.
    Klein R, Cruickshanks KJ, Nash SD, Krantz EM, Nieto FJ, Huang GH, Pankow JS, Klein BE (2010) The prevalence of age-related macular degeneration and associated risk factors. Arch Ophthalmol 128:750–758PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Kawasaki R, Wang JJ, Ji GJ, Taylor B, Oizumi T, Daimon M, Kato T, Kawata S, Kayama T, Tano Y, Mitchell P, Yamashita H, Wong TY (2008) Prevalence and risk factors for age-related macular degeneration in an adult Japanese population: the Funagata study. Ophthalmology 115:1376–1381, 1381 e1371-1372PubMedCrossRefGoogle Scholar
  22. 22.
    Kawasaki R, Yasuda M, Song SJ, Chen SJ, Jonas JB, Wang JJ, Mitchell P, Wong TY (2010) The prevalence of age-related macular degeneration in Asians: a systematic review and meta-analysis. Ophthalmology 117:921–927PubMedCrossRefGoogle Scholar
  23. 23.
    Cheung CM, Tai ES, Kawasaki R, Tay WT, Lee JL, Hamzah H, Wong TY (2012) Prevalence of and risk factors for age-related macular degeneration in a multiethnic Asian cohort. Arch Ophthalmol 130:480–486PubMedCrossRefGoogle Scholar
  24. 24.
    Piermarocchi S, Segato T, Scopa P, Masetto M, Ceca S, Cavarzeran F, Peto T (2011) The prevalence of age-related macular degeneration in Italy (PAMDI) study: report 1. Ophthalmic Epidemiol 18:129–136PubMedCrossRefGoogle Scholar
  25. 25.
    Cruickshanks KJ, Klein R, Klein BE, Nondahl DM (2001) Sunlight and the 5-year incidence of early age-related maculopathy: the beaver dam eye study. Arch Ophthalmol 119:246–250PubMedGoogle Scholar
  26. 26.
    Fletcher AE, Bentham GC, Agnew M, Young IS, Augood C, Chakravarthy U, de Jong PT, Rahu M, Seland J, Soubrane G, Tomazzoli L, Topouzis F, Vingerling JR, Vioque J (2008) Sunlight exposure, antioxidants, and age-related macular degeneration. Arch Ophthalmol 126:1396–1403PubMedCrossRefGoogle Scholar
  27. 27.
    Tomany SC, Wang JJ, Van Leeuwen R, Klein R, Mitchell P, Vingerling JR, Klein BE, Smith W, De Jong PT (2004) Risk factors for incident age-related macular degeneration: pooled findings from 3 continents. Ophthalmology 111:1280–1287PubMedCrossRefGoogle Scholar
  28. 28.
    Buch H, Nielsen NV, Vinding T, Jensen GB, Prause JU, la Cour M (2005) 14-year incidence, progression, and visual morbidity of age-related maculopathy: the Copenhagen City Eye Study. Ophthalmology 112:787–798PubMedCrossRefGoogle Scholar
  29. 29.
    Tomany SC, Klein R, Klein BE (2003) The relationship between iris color, hair color, and skin sun sensitivity and the 10-year incidence of age-related maculopathy: the Beaver Dam Eye Study. Ophthalmology 110:1526–1533PubMedCrossRefGoogle Scholar
  30. 30.
    Blumenkranz MS, Russell SR, Robey MG, Kott-Blumenkranz R, Penneys N (1986) Risk factors in age-related maculopathy complicated by choroidal neovascularization. Ophthalmology 93:552–558PubMedCrossRefGoogle Scholar
  31. 31.
    Hyman LG, Lilienfeld AM, Ferris FL 3rd, Fine SL (1983) Senile macular degeneration: a case–control study. Am J Epidemiol 118:213–227PubMedGoogle Scholar
  32. 32.
    Smith W, Assink J, Klein R, Mitchell P, Klaver CC, Klein BE, Hofman A, Jensen S, Wang JJ, de Jong PT (2001) Risk factors for age-related macular degeneration: Pooled findings from three continents. Ophthalmology 108:697–704PubMedCrossRefGoogle Scholar
  33. 33.
    Chakravarthy U, Wong TY, Fletcher A, Piault E, Evans C, Zlateva G, Buggage R, Pleil A, Mitchell P (2010) Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis. BMC Ophthalmol 10:31. doi: 10.1186/1471-2415-10-31 PubMedCentralPubMedCrossRefGoogle Scholar
  34. 34.
    Mitchell P, Smith W, Wang JJ (1998) Iris color, skin sun sensitivity, and age-related maculopathy. The Blue Mountains Eye Study. Ophthalmology 105:1359–1363PubMedCrossRefGoogle Scholar
  35. 35.
    Vinding T (1990) Pigmentation of the eye and hair in relation to age-related macular degeneration. An epidemiological study of 1000 aged individuals. Acta Ophthalmol (Copenh) 68:53–58CrossRefGoogle Scholar
  36. 36.
    Klein R, Klein BE, Jensen SC, Cruickshanks KJ (1998) The relationship of ocular factors to the incidence and progression of age-related maculopathy. Arch Ophthalmol 116:506–513PubMedCrossRefGoogle Scholar
  37. 37.
    Munch IC, Ek J, Kessel L, Sander B, Almind GJ, Brondum-Nielsen K, Linneberg A, Larsen M (2010) Small, hard macular drusen and peripheral drusen: associations with AMD genotypes in the Inter99 Eye Study. Invest Ophthalmol Vis Sci 51:2317–2321PubMedCrossRefGoogle Scholar
  38. 38.
    Klein R, Clegg L, Cooper LS, Hubbard LD, Klein BE, King WN, Folsom AR (1999) Prevalence of age-related maculopathy in the Atherosclerosis Risk in Communities Study. Arch Ophthalmol 117:1203–1210PubMedCrossRefGoogle Scholar
  39. 39.
    Kawasaki R, Wang JJ, Aung T, Tan DT, Mitchell P, Sandar M, Saw SM, Wong TY (2008) Prevalence of age-related macular degeneration in a Malay population: the Singapore Malay Eye Study. Ophthalmology 115:1735–1741PubMedCrossRefGoogle Scholar
  40. 40.
    Klein R, Davis MD, Magli YL, Segal P, Klein BE, Hubbard L (1991) The Wisconsin age-related maculopathy grading system. Ophthalmology 98:1128–1134PubMedCrossRefGoogle Scholar
  41. 41.
    Rudnicka AR, Jarrar Z, Wormald R, Cook DG, Fletcher A, Owen CG (2012) Age and gender variations in age-related macular degeneration prevalence in populations of European ancestry: a meta-analysis. Ophthalmology 119:571–580PubMedCrossRefGoogle Scholar
  42. 42.
    Zweifel SA, Imamura Y, Spaide TC, Fujiwara T, Spaide RF (2010) Prevalence and significance of subretinal drusenoid deposits (reticular pseudodrusen) in age-related macular degeneration. Ophthalmology 117:1775–1781PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Christina A. Korb
    • 1
    Email author
  • Ulrike B. Kottler
    • 1
  • Christian Wolfram
    • 1
  • René Hoehn
    • 1
  • Andreas Schulz
    • 3
  • Isabella Zwiener
    • 2
  • Philipp S. Wild
    • 3
    • 4
    • 5
  • Norbert Pfeiffer
    • 1
  • Alireza Mirshahi
    • 1
  1. 1.Department of OphthalmologyUniversity Medical Center, Johannes Gutenberg-University MainzMainzGermany
  2. 2.Institute for Medical Biostatistics, Epidemiology and InformaticsUniversity Medical Center, Johannes Gutenberg-University MainzMainzGermany
  3. 3.Department of Medicine IIUniversity Medical Center, Johannes Gutenberg-University MainzMainzGermany
  4. 4.Center for Thrombosis and HemostasisUniversity Medical Center, Johannes Gutenberg-University MainzMainzGermany
  5. 5.German Center for Cardiovascular Research (DZHK)University Medical Center, Johannes Gutenberg-University MainzMainzGermany

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